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The refugee crisis and Georgia: How does occupational therapy fit in?

Presented by: Karen McWaters, OT/M StudentGeorgia State University Class of 2018

Co-authors: Payton Pritchard, Christine Sherwood, Wei Wang

What Is a Refugee?● Refugee is a technical term used by the United Nations● Defined in the 1951 Geneva Convention as a person who has

“well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or

political opinion

is outside the country of his nationality

and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country.”

International Perspective on Refugee Crisis

● In 2017, global numbers of displaced individuals reached 68 million○ 25.4 million internationally

displaced and recognized as refugees

○ Over half of these are under age 18

● Crisis hotspots - 68% of the world’s refugees come from five countries

Refugees and the US

● In 2018, the US will have admitted 30,000 refugees by FY end in September

● In 2016, the US admitted 85,000

● The process of entering the US takes 18-24 months

● Section 6(a) of Executive Order 13780 from April 2017 increases security screening measures

Refugees and Georgia● Georgia is in top 10 resettlement states in the US - 3.7% of total in 2017 ● Clarkston, GA (DeKalb County) has become home to over 40,000 refugees in the

past 25 years● Clarkston welcomes approx. 1,500 refugees a year● Friends of Refugees a non-profit organization based in Clarkston, GA

○ Mission: “to empower refugees through opportunities that provide for their well-being, education and employment.”

○ Core values: relationship, empowerment, and stewardship ○ In 2015, served over 4,000 people through 7 different programs

Friends of Refugees Programs

● Cafe Clarkston and CareerHub● Jolly Avenue Community Garden● Jolly Avenue Development Center (coming soon!) ● StartMe: Business Accelerator (partner program)● Embrace - Refugee Birth Support● Youth Programs - academic support, social development, work-readiness skills● Family Literacy Program - Mommy and Me

○ Provides English to Speakers of Other Language (ESOL) classes to refugee mothers and their children aged 0-5 years old through a parent-child joint learning approach

○ Currently serving over 200 women who speak over 20 languages through biweekly classes○ Pilot site for Eat, Move, Talk! Initiative for the Georgia Department of Public Health

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Occupational Profile of a Refugee● Occupational deprivation

○ Women in refugee camps report difficulty re-engaging with meaningful occupations and struggling with the “being” and “becoming” dimensions of occupations■ Compared life in camps to life in prisons■ New occupations were chosen to be prepared for the future

○ Overt discrimination based on race, ethnicity, or SES

● Trauma○ Death of loved one ○ High rates of generalized anxiety disorder, post-traumatic stress disorder, and depression

● New surroundings ○ Occupations are adapted in three stages

■ Maintaining familiar occupations in familiar environments ■ Exploring new skills within adjusted ways of doing■ Undertaking challenging roles within the new environment

○ Connection to needed services for refugees with disabilities

How can occupational therapy address these needs?

Solutions must be:● Creative● Evidence-based● Community-based

Physical Activity for Life Skills (PALS): Program development and implementation

Introduction

● Partnered with FoR Mommy and Me program

● Refugee families in Clarkston live primarily in apartments

● Children's physical activity levels are low

Exercise + Childhood =

Play

Needs Assessment Findings

● Two sources of data○ Secondary data from Georgia Department of Public Health:

■ Showed local geographic trends of inactivity and mortality risks related to inactivity

○ Key informant interviews: ■ Little to no external physical activity was known of for the children

aside from time spent at the program. ■ Active time spent at the program (which is attended twice per week) was

reported as well beneath the daily physical activity recommendations of 120-180 active minutes per day

Therefore, structured physical activity time should be added into Mommy and Me curriculum

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Theory: Ecology of Human Performance Model (EHP)

Occupational Performance: tasks available within context that support the person

Person: experiences and abilities (sensorimotor, cognitive and psychosocial)

Context: physical, temporal, social, and cultural environments

EHP Mode applied to PALS Program● Person: children (1 mos- 5 yrs) enrolled in the family literacy program at Friends of

Refugees ● Abilities: estimated by age and what developmental milestones they should be

achieving ● Context: classroom, gym, or outside play area ● Therapeutic interventions

○ Establish/restore: new level of physical activity ○ Create: opportunities for movement

Four program principles

1. Importance of physical activity

2. Importance of play 3. Importance of tummy

time4. Activities should be

related to larger themes of Mommy and Me program

Importance of Physical Activity

● Prevents childhood obesity - 80% of cases will lead to adult obesity

● Reduces the risk of hypertension, hyperlipidemia, and diabetes

● Improves psychosocial well-being: gain self-confidence and improves self-esteem

Importance of Play

● Play is essential occupation for children from birth till their adolescence. ● Benefits of play

○ Gross and fine motor skills○ Emotional regulation○ Language and communication skills○ Social interaction

● Types of play in PALS program○ Themed play ○ Pretending/Role play ○ Sensorimotor○ Social play

Importance of Tummy Time

● Overall development ● Improves:

○ Child’s motor skills ○ Strengthens neck and shoulder

muscles○ Prevents positional plagiocephaly○ Language development

● Sensorimotor play and exploration○ Toys spread out on a blanket○ Encourage development of

functional reach patterns

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Activities should be related to themes

● Mommy and Me program has monthly themes for ESOL classes● Parent-child model means that child and parent learn the same material to

carry over conversations at home● Program themes

○ Zoo○ Community helpers ○ Friends and family ○ Farm

Program Overview ● Recruitment: All children in Mommy and Me program will be included in the

program● Intervention strategies: use the occupation of play and evidence-based

techniques to tackle known client and contextual factors which interfere with occupational performance

● Program goals:○ The children will engage in 16 weeks of structured physical activities which require gross

motor coordination. ○ The teachers will be able to articulate the importance of physical activity and play as an

occupation in relation to childhood development. ○ The children will be able to use English words related to the themes correctly to demonstrate

language acquisition.

Lesson Plan Overview

Two types of lesson plans were developed in this program: 1. Infants - tummy time recommendations including themes covered in literacy classes

during the semester2. Toddlers and Preschoolers - activity suggestions which require ability to walk based

on themes covered in literacy classes during the semester Infants

Tummy Time Recommendation

● The American Academy of Pediatrics recommends that babies spend a cumulative of 40-60 minutes prone each day

● Our tummy time recommendation is at least 15 minutes during their time at Friends of Refugees

● Blankets should be placed under the infants ● Toys related to theme should be spread out within the infant’s reach to encourage

development of functional reach ● Board books related to the theme can also be read to the infant to develop

language

Zoo Theme

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Overview

● During the Zoo theme, lesson plans center around the names of zoo animals which are used with yoga poses.

● Yoga and childhood development ○ Research has found yoga to be a beneficial form of exercise for

children and improves psychological health (Galantino, Galbavy, & Quinn, 2008; Weaver & Darragh, 2015)

○ If a child is unable to do a pose, teachers model it for them because they are learning through watching via mirror neurons (Lago, Cheeran, Koch, Hortobágyi, & Fernández-Del-Olmo, 2014).

Weekly Plans

Flow of Yoga Sessions● Warm Up● Breathing● Poses (Kriya)

Week YogaPoses

Week1 Bear,Cobra,Lizard,&Gorilla

Week2 Crocodile,Dolphin,Zebra,&Elephant

Week3 Lion,Frog,Giraffe,&Eagle

Week4 Turtle,Camel,Flamingo,&Monkey

Community Helpers Theme

Overview● Children will engage in pretend role play activities● They will be assigned roles such as doctors, construction workers, farmers, and

firefighters● Pretend role play

○ Helps children with cognitive development, social and language skills and translates to later academic achievement (Doris et al., 2002)

○ Help children to understand roles in the community

Community Helpers Weekly Activities● Week 1 – Firefighting team

○ Teams work together to put out pretend fires by working through an obstacle course● Week 2 – Construction repair team

○ Teams work together to carry needed items through an obstacle course to repair imaginary damage done to buildings during a hurricane

● Week 3 – EMS team rescue○ Teams of four work through a series of games and obstacle courses to retrieve and rescue an imaginary

patient● Week 4 – Farming teams

○ Children are split into two teams to alternately sow and reap crops by jumping through obstacle courses with bean bags

Friends and Family Theme

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Overview

● During the friends and family theme, classic games center around social play and motor and sensory development

● Games that they might experience in traditional classroom● Social play and childhood development:

○ Large piece of social development in the preschool years ○ Leads to pretend play and pragmatic play ○ Through interacting with peers, students expand their cognitive and social abilities ○ Help develop social competence and emotional expression (Reifei & Frost, 2010) ○ Social class can have an effect on the level of social play

Friends and Family Weekly Activities● Week 1 – Ring around the Rosie● Week 2 – Follow the leader● Week 3 – Red light, green light ● Week 4 – Simon says

Farm Theme

Overview

● Children will engage in activities related to the farm theme

● Social play used to develop social skills (Frost et al., 2010)○ Cognitive and social abilities through

interacting with peers ○ Ability for children to express their

emotions and feelings

Farm Weekly Activities● Week 1 – Chicken dance

● Week 2 – Musical chairs○ Themed music – “Old MacDonald” or “Flight

of the Bumblebee” by Rimsky-Korsakov

● Week 3 – Cat and mouse● Week 4 – Farm animal charades

Program Evaluation● Completed at midpoint and completion of the program● Informal observation and conversations

○ During bi-weekly staff meetings● Teacher reports

○ Survey○ Questions related to

■ Program’s implementation■ Teachers’ perception of the program’s impact■ Estimated unexpected costs

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Ethical Considerations ● Important to consider to avoid community alienation, wasted resources, or

missed beneficial opportunities● AOTA Code of Ethics (2015) Principles

○ Beneficence ○ Nonmaleficence ○ Autonomy ○ Justice ○ Veracity ○ Fidelity

● All are used when creating: utility, feasibility, propriety, accuracy, and evaluation accountability standards

Additional Resources● Program manual included other various resources for ESOL teachers:

○ Yoga poses and instructions○ Needs assessment interview guides○ Program evaluation interview guides and procedures ○ List of early intervention clinics and contact information○ Developmental milestones and ages along with guide regarding when to be concerned about gross/fine

motor development○ Business plan to create in-house EI clinic specifically to serve refugee children and families in

Clarkston■ Job descriptions, budget estimates, business policies and procedures■ Quality improvement standards■ Documentation forms

Get involved

1. Advocate for OT services to be applied to refugees under the Refugee Medical Assistance program

2. Contact organizations like Friends of Refugees and volunteer

3. Create community-based programs like after-school help, community gardens, etc.

4. Reach out to Georgia Division of Family Services Refugee Youth Programs

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