1 Introduction to Trauma Informed Care in Legal and Social ServicesCONNECTING OTTAWA With Mego Nerses & Jaime Lefebvre erin
2 CONNECTING OTTAWA Mandate: Increase access to justice for linguistic minorities and people with disabilities; i.e. those who are not proficient in English or French or who face communication challenges as the result of a disability or sensory impairment. Services: We provide case consultations which include “capacity building” and regular “Public Legal Education” workshops/ presentations -Tools: Rack Cards, Volunteer Facilitator Program etc. Erin- We work with service providers (settlement counsellors, social workers, lawyers, housing workers etc.) who support clients who have communication barriers. As such, the end users of our services are clients who are not proficient in either French or English or who have a disability or sensory impairment which results in a communication barrier.
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4 VOLUNTEER FACILITATOR PROGRAM- “trusted intermediaries” who assist our clients by bridging the gap that can exist between the point of referral and the point of legal services delivery for persons who have a significant communication difficulty. - Reaching out and being matched with clients who have been referred to a legal service but who may not be able to access the service without the support of a Volunteer Facilitator. The Facilitator is an accessible and approachable resource to the client. Solve problems that may prevent the person from connecting with the legal service- navigation, transportation, explanation of the services sought… erin
5 TRAUMA INFORMED CARE An Introduction Erin
6 Goals of this Session: This talk aims to provide an INTRODUCTION to Trauma Informed Care -1)what is the basic idea of this approach? -2)what are the basic tenets? -3)why this useful in legal work/ social services work? -4)What are options for to obtain full training in this approach? -5)exposure to one case scenario FORMAT: 1) Basic Idea 2) Basic Tenets 3) Case Scenario 4) Small Group Work 5) Resources in Ottawa 6) Questions 7) Help yourself to Materials Erin;
7 THE ALI FAMILY Grandmother, (not pictured) Mother, KhadraFather, Moustafa Son, Omar 18 yrs. Son, Ahmed 9 yrs. Niece, remains in Karbala *We will be looking at Mother today JAIME: This family of five: Grandmother, Mother, Father, Older son and younger son arrived in Canada at Ottawa seven months ago. Their country of origin is Iraq. They lived in Karbala, a city that is 100 km southwest of Bagdad. The family spent one year time in a UNHCR camp prior to their arrival. The family are “GARS” –government assisted refugees. They speak Arabic. Both parents and the sons learned some English in the UNHCR camp and in Iraq. The sons had some English language instruction in their schools. The father is an engineer in Iraq. The mother is a seamstress. Grandmother was a homemaker. Her husband died 10 years ago along with two of her sons – there deaths were related to the insurrections. The extended family includes other members who chose not to make the journey to Canada. Grandmother’s other daughter (son-in-law) and other grandchildren remain in Iraq. Her daughter (Mother) is one of her three surviving children.
8 Mother – Khadra- Client comes to see you at your clinic/ centre:Khadra is 43 years old and is a talented seamstress and devoted mother a wife who is hopeful for a better life for herself and her family in Canada. Since arriving in Ottawa she had not been engaged in her new community as of yet. She shows reluctance to leave their home and will only leave when there are pressing family obligations such as picking up her young son from school and grocery shopping. In her former neighbourhood, she regularly interacted with her neighbours and had a wide circle of friends. She now has trouble sleeping. She repeatedly says to her mother that she feels like she has less energy than she did in Karbala. She misses her sister and nieces in Iraq. She has attended a language circle twice in three months even though she states that she wants to learn English. Nonetheless, Khadra remains committed to the original goal of becoming a Canadian citizen. What is your approach? What will you keep in mind? JAIME
9 4. RESISTS : pitfalls that lead to re-traumatization.with thanks to: Dr. Azaad Kassam at Queensway Carleton & Dr. Doug Gruner, MD, CCFP Department of Family Medicine TRAUMA- INFORMED APPROACH REALIZES: impact of trauma (the context) and understands that there are many ways to recover RECOGNIZES: the signs and symptoms of trauma RESPONDS : by integrating knowledge about trauma into practices/care and policies 4. RESISTS : pitfalls that lead to re-traumatization. Mego
10 RECOVERY AND RESILIENCEKEY ELEMENTS TO RECOVERY: - survivors need to be respected, informed, connected - be aware of the link between trauma and symptoms of trauma ( depression, anxiety, substance abuse, lifestyle choices) - the need to work with family, friends and community resources KEY PRINCIPLES SAFETY TRUST EMPOWERMENT COLLABORATIVE CULTURAL/HISTORICAL/GENDER ISSUES Mego
11 MENTAL HEALTH As health care providers we need to be on the alert and highly vigilant for the early signs. However the evidence suggests that we should not be screening for PTSD, depression and other mental health concerns in otherwise asymptomatic individuals for a number of reasons. 1. Bringing this up can cause harm especially if the individual is not ready to discuss this. 2. It is crucial to ensure there are adequate resources in place to deal with the issue. Mego
12 WHEN TO REFER a CLIENT :Mental HEALTH COUNSELLINGIf integration and acculturation challenges are interfering with or even causing distress that interfere with a person’s ability to carry out their “ADLs” (activities of daily life) that is when a referral to a medical professional and/ or counsellor OR a trusted intermediary who is able to then refer an access social services and mental health and health resources for the person and their families is recommended. Please be aware/ Gentle reminder: the best practice framework is to be very “family oriented”. It is important to use of strong “family lens” when working in these situations as opposed to a more “individual client lens”. Every person’s path to integrate and acculturate is different. There is no “right” way to integrate and thus no objective test/ one-size fits all test to indicate “when to refer”. Mego/ erin
13 Group Discussion: Case Scenario- KhadraPresenting Issue/ Reason for Referral or Requested Appointment? Client Strengths/ Protective Factors? Risk Factors? Legal Issue(s)? Resources ( Consider cost/ no cost and any other barriers to accessing resources)? What are the possible challenges or barriers to implementing your recommend intervention?
14 MOTHER - Khadra Key Client Strengths/Protective Factors Risk FactorsSafe and together, with immediate family, overall healthy except migraines, good coping skills pre-migration, employable trade, registered ESL, attends settlement counselling, shows hope and perseverance - committed to Canadian citizenship Risk Factors Migraines becoming more frequent, concerned about family in Iraq, infrequent attendance ESL, sleep concerns, social isolation; missing sister, intercultural parenting differences Legal Issue: Will apply for Canadian citizenship when eligible, No current legal issue. Awareness only of process Resources: Counseling in Arabic; OCISO, Lebanese and Arab Social Services Agency, Jewish Family Services, Centretown CHC. Community Kitchens. SW CHC Newcomer Clinic. School Guidance Counsellor Taking up the exercise- ALL of us – Erin will lead – but happy for us all to contribute here Client Presenting Strength/Protective Factors – she is with her immediate family who arrived together and who are safe. She is relatively healthy and she demonstrates good coping skills pre- migration. She had a trade pre migration that could translate well in Ottawa and is not necessarily language dependent- seamstress; she signed up for ESL through going to appointment with the settlement counselling and ; shows hope since she remains firm in her goal of attaining Canadian citizenship Risk Factors - pre-existing migraines that are now more frequent; while immediate family in Ottawa- strong ties and concerns about family in Iraq; she is not going to ESL; language; social isolation- specially sister; sleep concerns; intercultural differences and norms in teenage development and parenting strategies;
15 LEGAL and SOCIAL SERVICESRESOURCES in OTTAWA LEGAL and SOCIAL SERVICES Erin- IF TIME permits- we will have this on the table at the side also- for participants to take with them….
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17 Counseling/Therapy ServicesBest delivered in primary language Range from general counseling to trauma-specific psychotherapy Community-based agencies Ottawa Newcomer Clinic (ONHC)/Catholic Centre for Immigration (CCI) Immigrant Women’s Service Organization (IWSO), Ottawa Community Immigrant Services Organization (OCISO) Jewish Family Services (JFS) Mostly time-limited, supportive Referral pathway – work in progress
18 Connecting Ottawa: Website –Legal & Mental Health ResourcesMENTAL HEALTH RESOURCES LIST – Counselling Resources for those with precarious status: This is available on our website at: http://connectingottawa.com/counselling-resources . This list of counselling resources was compiled to complement the legal resources guide so that people could easily access no- cost social services Also meant to emphasis access to services for those with precarious refugee/ immigration status- ensure access for all -recognition of cascading effect and cluster effect and necessity of ensuring that legal issues addressed and counselling offered to support the person TIC RESOURCES LIST: https://docs.google.com/document/d/1LraXic9uw0YiRe4iYnBE- 6lvLAAlugEchU-Qns0iyaw/edit# erin
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20 Online Resources www.ementalhealth.ca www.kidsnewtocanada.ca Contact Dr. Azaad Kassam at
21 Thank you & please to connect with us…Alexandra Derisier, LLL LLB Erin Fitzpatrick, LLB LLM MSW 290 Rue Dupuis, Ottawa ON K1L 1A2 Mego Nerses, Registered Psychotherapist Centretown Community Health Centre Jaime Lefebvre, Lawyer South Ottawa Community Legal Services @connectottawa Facebook.com/ConnectingOttawa ConnectingOttawa.com erin