Aakifah completed a 7 week prac as a final year undergraduate OT student with the University of Queensland, Australia in 2009. She was brave enough to be the first full time OT student at the Multicultural Development Association (MDA) under the supervision of Linda Rylands who is an OT working in a case managment role with refugee families experiencing complex settlement issues. Following the success of the placement she went on to complete an action learning project with 3 other student OT's (Stephanie, Suzie and Jennifer) exploring the role of OT in teaching the life skill of public transport for newly arrived refugee families. Even before graduating she was quickly offered a position as "Settlement Life Skills Worker", and after graduating is now working full time at MDA. What a fantastic outcome for a new graduate OT to grow in such an OT-specific role in the refugee settlement setting. The life skills coordinator role is now contributing to a new and emerging framework relating to "life skills competency" for refugee families.
Links to Public transport resources:
Here are her accounts and reflections so far . . .
So, how did you first hear about OOFRAS?
OOFRAS captured me in my second year of my degree, when we were given a quick introduction to the MDA organisation, the refugee experience and what the OT role can be. After that lecture, I had so many more questions and not sure where to get my answers. I sat on my computer that night and quite literally filtered my way through the entire OOFRAS website - which answered some of my questions but then I felt the need to get more involved. What I wouldn't give to get some real life experience!
How did you come to obtain fieldwork at the Multicultural Development Association working with Refugee families?
While I was on a placement based as the University, we were invited to attend a breakfast as part of OT week. Linda and Sally were giving a speech on behalf of OOFRAS so I approached them to see if there were any opportunities for experience. Linda seemed pretty keen to have a student at MDA, and after talking to her I was pretty keen to have a supervisor at MDA!
What was your role in this organisation as a student?
I was working in a team that supports clients who experience complex barriers to settlement. My role had a strong case management focus, but there was also lots of opportunity to provide the support the client needed in an occupational capacity.
So what were the 'steep learning' curve moments you remember when you first started working at MDA?
My big learning curve happened over time. MDA’s work environment is like no other I have been in before. Lunch times are filled with amazing foods, lessons in Arabic, French, Somali and so many more! However the role of an occupational therapist is not well known. I remember standing in front of the entire MDA staff very early on in my placement, planning to give a quick workshop on workplace ergonomics but having to first explain the role of an OT. How confused would they have been – an OT student in a refugee settlement service presenting on ergonomics – will she be looking at our office set up for 11 weeks? After I gave my definition of the profession, I’m hoping they were a bit clearer about why I was up there! We’re all so used to being in workplaces where the role is known or easily understood so this posed as a positive challenge. But it wasn’t over. Throughout my placement, the project and my employment I have given countless explanations of what an occupational therapist can do in this setting…and slowly but surely people are beginning to see just how handy we can be.
What did you learn about the best way to give a ‘definition of the profession to staff who had never heard of OTs working with refugees?
It’s important to go back to basics. Thinking simply about the idea of an ‘occupation’ and what this could mean to a settlement worker – not just helping them find employment – as many may think. Explaining the way we think in terms of meaningful occupations, transforming life roles and creating opportunities to explore these new life roles (and new occupations) also brings clarity to our role. I’ve also learnt that when you’re explaining the OT role it is possible to tailor the explanation according to the role of the staff member and the occupational issues they are already observing with their clients. Then they see just how relevant an OT perspective is for newly arrived families. It may just mean giving them food for thought, or it may mean giving them a thorough explanation where they can go away having a clear idea of when and where to consult or refer for further support.
What kinds of topics did you need to research to complement your practice in this area?
I had to do a huge literature search; not only OT related, but social work, education and community development. I found myself reading up on teaching methods, counselling, cognitive theory, and the refugee experience. Anything and everything to help me understand the client!
What did you learn about yourself as a person, especially in terms of your personal 'cultural bias' that you brought to your practice?
I learnt that cultural bias is not always a bad thing. I worked with clients where, in certain situations, I understood why they did what they did. Cultural and/or religious knowledge can help greatly in understanding what is meaningful for the client. This is because everyone has the right to keep their culture and practice their religion freely in Australia. Sometimes people like to hang on to every aspect of their culture/religion, sometimes they adapt them slightly depending on where they are. Understanding, for example, whether to shake hands or hug someone…or not touch at all…will help in building a working relationship with a client. They will appreciate you having that knowledge and they will respect you for it.
With that sort of knowledge you can advocate for and empathise with a client in a way that is very meaningful to them.
Can you describe a moment in your practice that you had to be creative with your life skills assessment or intervention because of an assumption that you made of the clients knowledge or skills?
I was visiting a client with Linda and had planned to do some money handling assessments. I had only seen her handling money once and it seemed like she was okay with notes, so I started thinking about ways to work with that. When the time came to sit down and do some activities with her, I found out very quickly she wasn’t all that familiar with notes! So I had to do some quick improvising and started talking about the colour, the size and the value of the notes we use in Australia. From that we established she knew the green and the yellow notes quite well – and told us she wanted them!! She didn’t really want the coins as much (hehe) but they did prove to be another hurdle…most are round so how to tell between them if you can’t read numbers or fully understand the value of them? Together we made links with the size of the coin, the feel of the coin, and the colour of the coin. Before we reached this point though, I noticed that she was struggling to identify the coins I asked her about…so with her 3 year old daughter sitting patiently by her mother’s side, I placed coins underneath pieces of paper and coloured over each coin to create a ‘traced’ version of them. From there we matched up the coins by placing the right ones on top of the traced pictures. There are so many ways to approach these sort of assessments, but being familiar with someone’s literacy level gives a good indication that using the Domestic and Community Living Skills Assessment (DACSA) in isolation is not enough. Having an understanding of the clients knowledge and capacity in this area was key to understanding her difficulties in functioning in other more complex day to day tasks including shopping and budgeting.
This particular client had a great sense of humour so making it into a simple game and making jokes really helped the process!
What strategies would you recommend to other students for reflection on cultural assumptions who aim to build 'cultural competence' ?
The main strategy would be to reflect on your own cultural experiences, think about how that impacts on your OT practice and ways to channel those experiences into a positive and productive outcome for your work!
What did you learn about the importance of occupation-centred practice?
There is a whole world of occupational change happening for someone who arrives in Australia after spending years in a refugee camp. From when they get on the plane to come here to when they gain employment in Australia as a permanent resident, their roles are constantly changing. Refugees keep some of their previous occupations and life roles, and lose others, and develop brand new ones in a strange and new country. Occupation-centred practice is therefore central to newly arrived families’ settlement.
How did the Action Learning project build on the skills that you had already learnt in your placement?
The public transport project that Jennie Sampson, Steph Maynard, Susan Cloete and I completed at MDA helped us to understand what goes on behind the scenes at MDA. Being familiar with work only in the team I had completed my placement in, it was interesting to investigate what and how things are done as soon as a family arrives in Australia. This was the part of the MDA experience that we had the opportunity to critically analyse service delivery and implement change! The skills I had picked up along the way proved very useful during the life of the project, and aided in our ability to quickly get things underway.
The project looked into what was being done in terms of teaching newly arrived families to use public transport independently. Using the bus or the train is central to a family’s ability to access the community and I saw this demonstrated even before the project took off. During my placement I saw that not knowing how to do certain tasks involved, like buying a ticket and knowing where to get off, can really cause a client to get distressed and experience a sense of disempowered and isolation. I took my experiences on placement, shared them with the girls and soon enough we were all pumped to do the best project we could!
What tips do you have for other organisations facilitating Action Learning Projects in the Refugee Settlement area?
In terms of the placement plan and logistics, I feel that the following things should be considered:
· It is likely that a whole array of issues will be identified by service providers relevant to the OT role. It’s important the student receives assistance to identify which of these issues are operational, systemic and individual.
· When identifying appropriate individuals/client group for needs assessment and intervention, previous exposure to life skills necessary for life in Australia should be considered. Coordinator/supervisor can assist to decide on goals for assessment and treatment that are realistic in terms of the client/group’s previous experiences. E.g. Iraqi clients (mostly well-developed skills, e.g. have used ATM in Jordan, and literate in own language) compared to Rohingya clients (little schooling, highly traumatic refugee experience, very little or no exposure to concepts and skills needed to live in Australia)
· Some clients are more participatory than others, so it is also useful to know which groups these are and which ones may need more work to engage
· Needs assessments and interventions may be organised in isolation to other programs being run, but attendance may be greater – therefore assessments and interventions more meaningful – if they are completed within a group that is already established. E.g. information sessions, women’s groups, men’s groups, etc. If clients are expected to attend a session there are often barrier to consider such as difficulty making appointments on time, cost and abilities of using public transport, clash with English classes or other appointments, perceived importance of the session for clients receiving help.
Needs assessment:
· Easy way to access staff is through staff meetings. Small team meetings are useful for focus group/discussions. Bigger meetings are good for relaying important information, making the OT role clear, gets the staff thinking!
· Client interviews: they are very busy people! It’s important to keep in mind that they will have many other things on their mind such as bringing their families to Australia, getting out of debt, etc. Make your purpose clear.
· Getting clients to attend: (specific to groups)
o Have your list of attendees ready
o Use a telephone interpreter or ask someone who speaks the language to invite clients
o Make sure if you are getting someone else to invite clients, clearly explain why you are asking them to come – in simple language!
o Tell them it starts 30 minutes before it actually does! That way you will only have a few stragglers coming in late
o Simplify your language
· Organise things at least one week in advance.
· Explain your purpose to Case workers and include them in the process
Intervention and evaluation:
· From the list of intervention options, make sure the client chooses. Choice and independence is extremely important, but even more so in the settlement area. Clients know what they need. Consider what stage of settlement they are in – it may be they just need time.
· Completing intervention may take longer than proposed. It is always unpredictable when you organise a meeting/session/visit. There may be something more important to the client that is happening, and your intervention will be secondary to them. Accommodate for unexpected events.
· Try and do as much as you can with the client/s once you have them with you.
Coming into this organisation as an OT called for a whole lot of advocacy for the profession, explanations and justifications. I found myself explaining to many staff/other stakeholders what I do at a refugee settlement service, and how my skills are being used instead of ‘working in a hospital’. Initially achieving something meant merely following in the footsteps of the other staff, understanding how they work and how an OT fits in. Achieving something then meant being able to justify what I do in terms of occupational justice for the client and stopping the vicious cycle of occupational deprivation. It now means empowering people with the knowledge and skills that they feel confident to live an independent life in Brisbane.
To reach a goal it was important to be proactive and sometimes make the most of the opportunities that arise. Logistics were frustrating, and I found myself doing a lot of admin work and not a lot of OT. Or so I thought.
Tell us more about your current role as a "Settlement Life Skills Worker" in a settlement service for refugees in Brisbane?
My role not only reaches clients, but involves working with the bilingual support workers and the case coordinators at MDA. My role with case coordinators and support workers is to increase their capacity to assist their clients in achieving core life skills they need in the settlement process. Bilingual workers are the backbone of the settlement process at MDA, and provide all of the practical support the clients need. At the moment there is no standard procedure for teaching clients skills, so how great will it be if we train the trainer with a special ‘occupational-task-analysis’ focus!
I will also be providing intensive life skills support for clients that are experiencing significant trouble with basic skills needed for independent living. This is the part where I can be as creative as I want! Because there are no established assessment or intervention methods, I can develop tailored support for each client and really take on the strengths-based practice we love!
What advice would you give to a supervisor when first beginning with a new student?
A good introduction to the area will do wonders. I found that it helped when I was given readings and resources to look at before getting straight into things. Being able to understand the refugee experience and the socio-political environments that our clients come from will also help to provide the most meaningful support. Reading through past OT projects also helped a great deal do get my head around the reasoning, frameworks and boundaries of practice.
What advice would you give a student when starting this journey?
Be a sponge. Take in all the information you can get. Observe as much as you can and ask questions!
Aakifah is now leading on publishing her group’s research in the area of addressing independence in public transport for newly arrived refugee clients. We look forward to seeing her name published soon!
Thank-you Aakifah for your wonderful contributions to assisting clients to build strong foundations in life skills which is so important for a successful settlement.
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