Working with Refugees

Tips and trouble-shooting for when you're working with refugees

I've never worked with a refugee - help!
Understanding the individual needs of your refugee client will be greatly influenced by their background and where they come from. It’s helpful to be aware of:

• The political/social history of the country/region your client is from
• The reasons for conflict in the area
• The ethnic make up of the area
• The level of persecution that exists there
• Cross-cultural issues

How can I explain occupational things to a refugee?
Explaining ‘occupational things’ in general is quite a challenge! Let alone to an individual who may have English as a second language or has never heard of the concept ‘occupational therapy’. Ensuring that your own understanding of ‘occupation’ and ‘occupational therapy’ is comprehensive will largely influence how you communicate your role to your refugee clients.
Here are a few tips and examples to remember:

• occupation is a term to describe any meaningful, purposeful, and goal-directed activity  (not just work-which is a common misconception)
• occupation can be described as ‘the things you do’
  ·        Self-care/activities of daily living (hygiene practices, diet and nutrition, health maintenance, community mobility)
  ·        Work/productive activities (home management, caring for others, education, vocational activities)
  ·        Leisure (exploration and performance)
  ·        Rest (patterns, how much, quality)
• give an analogy and visual cues to aid your communication (  A Diagram to Aid Your Communication.pdf)
• sometimes people are prevented from carrying out the things they want/need to do; this can cause stress, dysfunction and negative health consequences (occupational deprivation/injustice)…to find out more on this topic go to the 'OT Role' and 'FAQ' pages

What is 'culturally competent communication'?
In order to communicate effectively with your refugee client you need to understand what cultural differences may exist.

• Having a basic understanding and knowledge of an individual’s cultural background demonstrates you are genuinely interested in their personal circumstance and can help establish trust
• Avoid making generalisations about cultural groups; within each cultural group there are differences influenced by geographical location, education, socioeconomic status, age, gender, family and personality
• Discuss and establish what expectations your client may have
• Be aware of your own belief systems and values, and acknowledge that these may be different to your client’s way of thinking
• Avoid jargon and slang terms
• Clarify questions and statements, and check that you understand each other
• Use open questions

Why should I use an interpreter?
Offering a professional interpreter to a refugee client who has little or no English language is important because:

• Using untrained interpreters/family will compromise confidentiality and may influence what the client says; this has implications for accurate assessment
• Using family and friends to interpret may result in them being exposed to information of a traumatic nature
• Communicating with newly arrived refugees who have not yet acculturated and have little comprehension of English language may lead to significant misunderstandings

I've never used an interpreter - help!

Tips for Using Interpreters

• Ask if the client has preferences for a particular interpreter eg. religion, gender, ethnicity
• Allow for a longer consultation period, as using an interpreter may require additional time.  You may also need to discuss the case beforehand to explain any special client needs
• Choose seating arrangments that allow direct communication with the client
• Maintain eye contact with the client and speak to them in first person
• Explain the role of yourself and the interpreter to the client
• Speak clearly and slowly using short sentences
• Check that the client has understood what you have said
• Avoid private conversations with the interpreter in front of the client
• Request the same interpreter for follow-up meetings if they were appropriate

Arranging an Interpreter

• Contact Translating and Interpreting Service (TIS) for telephone and on-site interpreter services

How do I minimise re-traumatisation?
Being aware that your refugee client may have experienced trauma and torture can help you reduce the chances of re-traumatisation.
Your surroundings

• Create a space that is welcoming, friendly and ‘warm’
• If you have uniformed security on your premises, try and avoid making your client wait for long periods, as this can be very stressful
• Avoid rooms that are closed-in and have barred windows as these can trigger flashbacks
• Allow a trusted person to be in the room if this makes your client feel comfortable
• Make your role clear
• Explain clearly that you’re there to help; some of your clients may be fearful of government workers and therefore mistrust you
• Explain confidentiality

Interviewing

• Avoid interviewing styles that may be perceived as interrogatory
• Let your client control the interview process
• Avoid asking your client to repeat traumatic experiences; utilise case notes from other services/workers as much as possible (with the client’s consent)

Looking after yourself - how do I prevent burn-out?
Hearing stories of trauma, loss and grief can have a strong impact on health professionals. It is important to remember that these are normal reactions, and being aware of your responses can aid your work and understanding with this group of people.
Common responses include:

• Compassion fatigue
• Physical and psychological reactions eg. difficulty sleeping, nightmares
• Intense emotional distress
• Feeling inadequate in addressing issues
• Disbelief and denial
• Over-identification/familiarity with the client
• Embarassment
• Avoidance of issues

Tips for coping:

• Regular supervision with a trusted clinician to discuss any stress you're experiencing, transference/counter-transference issues, boundary issues, problem-solving
• Balanced lifestyle that includes non-work related activities
• Plenty of sleep and rest
• Avoiding alcohol and drugs as a support mechanism
• Making a conscious effort to separate work from your home life
• Be aware of your own needs and find appropriate ways of coping with feelings and reactions