what's up february 2010

8/9/2019 What's Up February 2010

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Q & A: Traumatic Stress among African Refugees

in New Hampshire

Continued on page 2

Wellesley Centers for Women Research & ActionReport Fall/Winter 2009

Reprinted with permission from the WellesleyCenters for Women

Michelle Porche, Ed.D., a senior research sci-entist at Wellesley Centers for Women (WCW),

studies academic achievement in literacy and sci-ence among young children and adolescents. Sheis especially interested in the influence of genderand socioemotional factors on the academicachievement of children from low-income fami-lies. More recently she has expanded her work tostudy the impact of trauma on learning andachievement. In addition to work at WCW,Porche spent ten years as a researcher on the lon-gitudinal Home-School Study of Language andLiteracy Development at the Harvard University

Graduate School of Education where she receivedher doctorate. She is co-author of Is LiteracyEnough? Pathways to Academic Achievement forAdolescents, which describes findings from theHome-School Study. In 2002 she was a co-recipient of the International Reading Associa-tions Albert J. Harris Award for contributions in

literacy research.

Lisa Fortuna, M.D., M.P.H., a board certi-fied child and adolescent psychiatrist, is an as-sistant professor of psychiatry and the Directorof Child and Adolescent Multicultural HealthResearch at the University of Massachusetts

Medical School. Her research interests includeLatino mental health services, immigrant men-tal health, post-traumatic stress disorder, andsubstance abuse. As the recipient of a five-yearCareer Development Award from the NationalInstitute of Drug Abuse, Fortuna has beenworking with Stanley Rosenberg, director ofthe Trauma Interventions Research Center atthe Dartmouth University Medical School, onpost-traumatic stress disorder in adolescentsand children.

What was the impetus for your work withyoung African refugees, and how was theneeds assessment funded?

Porche: This work is one of several collabora-tive projects Lisa and I have done investigating

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Page 2 FEBRUARY 2010 Whats Up...

the consequences of trauma on mental health, as wellas on school and achievement outcomes.

Fortuna: This project grew out of my work on post-traumatic stress disorder (PTSD) in adolescents andchildren with Stan Rosenberg, whos been doing alot of training on trauma-informed, evidence-basedtherapies for kids in NewHampshire. Endowmentfor Health, a foundationwhich helps fund some ofhis work, felt they coulddo more to reach youth inthe refugee community,who clearly have a hightrauma exposure. So Stan

and I and the Endowmentfor Health program offi-cers brought in Michelle,and we put our heads to-gether to think about howto disseminate evidence-based treatments for kidsin the refugee community.

Porche: The original smallgrant came from the Na-tional Child TraumaticStress Network, through Stan. We also had moneyfrom the Endowment for Health. But the funding wasvery limited and we could not have done the projectwithout matching funds from Wellesley Centers forWomen (WCW) to support my work.

Who are these young Africans and what kinds oftrauma are they fleeing from?

Porche: They come from many countries that haveexperienced political violence especially Somalia,

but also Sudan, Sierra Leone, Liberia, Burundi andthe Congo. But they seldom come directly from theirhome country.

Fortuna: They move first to refugee camps in differ-ent parts of Africa, where they may spend up to tenyears, and some kids were born in the camps.

Porche: But some of the older adolescents had witnessedirect political violence, such as their fathers beinkilled, horrible atrocities, etc.

Fortuna: Many of the parents had experienced atrocitieWe didnt ask about specific trauma, but some parenvolunteered information about violence in their countrie

of origin, including rape and sexual assault against women; itpart of the political violence.

How did they end up in NeHampshire?

Porche: Everyone wants tknowwhy African refugees

New Hampshire, which seems be such a rural place? Placemeis facilitated by the Lutheran Social Services, which partners withe U.S. Department of State resettle refugees all over the country. New Hampshire has abo5,000 African refugees.

Fortuna: The refugees have ncontrol over where they lanonce placed, they receive tim

limited self-sufficiency services from the States Officof Refugee Resettlement. Later on, when theyre realsettled, some refugees may move to another state to bwith other family members or where the refugee commnity may be more vibrant.

Porche: For example, Minnesota is a big state for a lot refugees, especially Somalis. By the way, the U.S. takein fewer refugees than most countries.

This project required much collaboration by stak

holders. How did that come about and how did yocollect data?

Porche: The Endowment for Health was key to the success of the needs assessment. Their program officehelped us make contact with appropriate providers anagencies as well as the African Coalition, a group o

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Whats Up... FEBRUARY 2010 Page 3

leaders of grassroots African refugee organizations. Theprogram officers invited about 60 of these stakeholdersto an introductory meeting: African leaders, the Resettle-ment Office, school people, therapists from mentalhealth clinics, primary care providers. We presented our

design for the needs assessment and let people know thatwe wanted to come talk with them.

The African refugee leaders were eager to collaboratewith us and helped recruit the families and young adultswe wanted to talk to. They also served as translators.Some of the kids spoke to us in English, but all the par-ents spoke in their native languages and the Africanleaders translated.

Fortuna: We held individual interviews with many ofthose people and then dialogues in groups with all levelsof stakeholders to look at data from the interviews toidentify problems and areas where something might bedone better.

What did you find are some of the key resettlementchallenges for these young people?

Porche: Lets make that young people and families.The original grant mechanisms were to find out moreabout the risk for youth, but as soon as we got into it weknew it had to be a family-systems piece.

Fortuna: That made sense. Im a child psychiatrist so Ialways think theres a family-systems element to thework we do; even the refugee leaders said, This isreally about families. Here are parents and older adoles-cents experiencing physical violence that causes them toleave their country of origin, then everyone trying tomanage in the camps, then coming here with continuedissues of displacement and family members no longerbeing together; thats a very powerful loss for everyone.

Porche: Some mothers have come without their children.

Its especially hard for them to feel settled here, to havea sense of the future. Of course, for everyone there arehuge hurdles at startup, everythings new. They dontknow how to turn on a light, how to use the stove andeveryone they see is white. Worse, parents struggle for jobs to provide for the familys needs and each familymust pay the government back for travel expenses to the

U.S. so they start out in debt.

Fortuna: School soon becomes a major area of stress.The refugee camps may not have had schools. Ifthere were schools, the parents may have been fear-

ful about sending kids there so a lot of kids comeover with no literacy skills. There are some whocant read or write in their native languages or at aminimum have no sense of structured school.

Porche: They learn English quickly and becomepretty proficient in about a year. Thats a good thingfor the children, but its a double edged sword be-cause the kids end up serving as interpreters and me-diators for the parents. Thats not good for the par-ent-child relationships because the children thenhave knowledge and some power that really should

be the parents. As children do better in school andlearn English it can create problems in other areas oftheir lives.

Fortuna: Here are moms, whose husbands may havebeen killed, challenged by a big shift in their parent-ing role while dealing with adjustment to the UnitedStates then finding their children empowered insome ways, while they feel disempowered. That canbe very stressful and demoralizing.

Porche: Meanwhile, a key struggle for the children isthat in the U.S. theyre placed in classrooms by age,so a 15-year old whos had no formal education isput into high school with peers whove had ten yearsof formal schooling. (In African education systems,if someone needed to start at a second-grade level,thats where theyd start in a mixed-age classroom.)They do get help and they get English as a Second orOther Language (ESOL), but even though they makea lot of progress quickly, its very hard for them tocatch up. If they dont have a way to do well aca-demically, theyre going to figure out other ways to

feel good about themselves, acting tough, gettinginto fights, all sorts of things.

There are identity issues too. For example, thereare different African groups or tribes that dont getalong because of historical conflicts. That createstension when children have to share the same school.

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Fortuna: The kids of color fight each other a lot. Acouple of African girls said, We really fight with theLatino kids.

Porche: This may be about the scarce resources of

new groups coming in and the tensions of being dif-ferent in the schools.

Fortuna: And about who will be who in this newdynamic.

Say more about the stresses for parents.

Porche: Discipline issues cause a lot of stress. Manyrefugees are used to corporal punishment, which wegenerally dont allow in the U.S. Kids are told, Yourparents cant hit you any more, so they say to their

parents, You cant touch me. If you do, Ill call911. This creates incredible tension. Parents feel dis-empowered.

Fortuna: Other people are controlling the situation.The police come, the parents cant speak English, andits the child whos telling the police whats hap-pened. Its a really scary situation for parents.

Porche: Its a matter of language barriers as well ascultural misunderstandings. There are difficulties

about school. Parents arrive with great respect foreducation. Theyve survived every horrible trauma sothat their children can thrive here and get a good edu-cation. In their home countries, teachers were the ex-perts; parents didnt get involved in formal schoolingthe way parents do here. So teachers here may feel,Those parents dont care; they dont come to schoolor help with homework. While the parents are think-ing, But youre the teacher. I take care of the chil-dren, I raise them, I make sure theyre respectful. Idont sit and do homework with them, thats theteachers job. Employment is another challenge.

Jobs are very difficult to come by. This isnt a greattime to be here, in the middle of a horrible recession.

Fortuna: There are gender issues, too. Some of thewomen can find work like childcare and house clean-ing, but jobs for men are harder to find right now.

Porche: Its especially hard for men who had jobs

Continued from page 3 with particular skills and status and now cant getequivalent work. Men do get limited assistancewith job training and placement and an opportu-nity to take ESOL classes, but a lot of them feelthose classes dont help much. Finding transporta-tion is often very difficult. Also, large familieshave been coming in and the housing stock oftenisnt well suited for large families. The familiesface racism, theyre a visible minority, they have-nt experienced that before.

Fortuna: Thats what triggers PTSD. They alreadyhave a history of trauma because of who they are-and where they were, but not because they wereblack. They come to this country and their skincolor is another marker that makes them vulner-able to discrimination or attack.

Porche: The biggest sense of loss is the parentsrealization that theyve escaped from torture, rape,and danger, struggling to get to this country fortheir children, who are, as they say, their wealth,their treasure, and then in the midst of all theiracculturative distress, they feel theyre losing theirchildren to this culture that allows crime and themisbehavior of young people. That is very painful.

Fortuna: We also often heard the parents wish thattheir children would keep their religion and cul-tural values. Thats a way of saying, Then theyd

still be part of us.

With all of this pain and stress, do any refugeeswish they hadnt come?

Porche: Everyone we talked to said, Were reallygrateful to be here. The challenges are difficultand cause a lot of worry, but as one mother said,In this country, when my children go to school, Iknow that theyre going to get there safely andtheyre going to come home.

What was the follow-up to your needs assess-ment?

Porche: This past May we held a two-day learningcollaborative conference for the people wed in-vited to the first kick-off meeting and others wedsince learned should be involved. We brought inresearch teams from Boston, Vermont, and Min-

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What Up FEBRUARY 2010 Page 5

nesota with expertise in treatment and support forresettled African refugees. The research teams in-cluded researchers, clinicians, and front-line Africanoutreach persons. We had great attendance fromstakeholders from various parts of New Hampshire.

Fortuna: The research teams presented best practicesabout their experience of what has been successful inworking with African refugees in their communities,such as models for parenting that help with disrup-tive behavior and communication in a family understress.

Porche: Afterward we held a debriefing with the Af-rican leaders, who said that the parenting piece wastheir priority. We hope to support the development

of an adaptation of what we learned that will alsoincorporate traditional African parenting values. Oneof the primary outcomes is an initiative led byGeraldine Kirega of the Women for Women Coali-tion, a grassroots organization in New Hampshire,which will be a program that integrates support formothers with afterschool tutoring for their adolescentchildren. I will collaborate with the Women forWomen Coalition to evaluate a pilot of the programto be conducted with women from different Africanethnicities, but who all speak Swahili. Besides sup-porting parenting in general, the goal will be to help

mothers make connections with school personnelthat will support their childrens academic achieve-ment. Thats really the parents goal, they want theirchildren to do well.

Fortuna: Another result of the meeting is that Stanand I want to collaborate with the mental health clin-ics that actually have African clinicians to developan evidence-based intervention for the kids aroundbehavioral and emotional needs. The African clini-cians can speak the language, so they can involve the

parents and may know some culturally useful adapta-tions of the intervention.

Porche: We also hope to work with the African lead-ers and communities in developing other kinds ofinterventions. Its important that these be truly col-laborative, that the African leaders lead the way inthe services provided.

Fortuna: Another thing that came out of the learning

collaborative conference was the idea of building aNew England network of researchers, African leaders,and providers sharing lessons learned and maybe aweb-based interactive learning network. I do sometelemedicine already and Im interested in how tech-nology can be a bridge for communication and infor-mation sharing.

Porche: The value of that two-day meeting will con-tinue for a long time to come. We presented some ofthis work at the American Psychological Associationannual convention in August and one of the next bigsteps is for us to write up our results so we can pub-lish them.

Fortuna: Thats an important piece for which wedont have money for.

Say a bit more about funding. In these economi-cally difficult times, how do you find funding forwhat seems like a very specialized area of need?

Porche: I think theres plenty of interest in immigrantand refugee communities as a growing population.What were learning seems specialized, but it hasbroader implications. Were working on collaborativegrants for those projects with the leaders and theircommunities. The Endowment for Health is interestedin being one of several funding sources for the pro-gram to integrate parental support and afterschool tu-

toring for children, and the African Coalition leadersare looking for other grants.

Fortuna: Meanwhile, Im putting in grant proposalswith Stan for work with those leaders and Africanclinicians, probably focusing on mood and disruptivebehaviors. The National Child Traumatic Stress Net-work and other agencies have a lot of interest in thisarea, and were putting out some other proposals inNew Hampshire. Theres still evidence-based knowl-edge thats needed.

Porche: Its also true that all of us, including the Afri-can leaders, do a lot of work thats not funded. Its amatter of get-a-little-money-and-push-it-as-far-as-you-can and a lot isnt covered. Its really a commit-ment and a labor of love.

Fortuna: It plays to our passion and why we do re-search, to make an impact for communities that arevulnerable, that need to have something work better.

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State of NH Refugee Program Facts

Who are Refugees?

Refugees are people who have been forced to flee their home countries because of a well-founded fearof persecution for reasons of race, religion, nationality, political opinion, or membership in a particular

social group. Persecution could be physical violence, harassment and wrongful arrest, or threats to theirlives. They take with them only what they can carry, only what they have time to pack. Sometimes allthey have left are their dreams, their hopes and the will to survive.

Since the early-1980s more than 6,000 refugees have made New Hampshire their home. Refugees havegreatly contributed to our state and local communities. Through their hard work, they have strengthenedour economy and their presence has enriched the cultural diversity of New Hampshire.

Refugees come to New Hampshire from more than 30 different nations and represent a diverse group ofethnic minorities. For the most part, refugees adjust well to New Hampshire life. They frequently findemployment within the first few months of arrival and they actively participate in the life of the com-

munities where they make their new homes. Many eventually become naturalized U.S. citizens. Manyof New Hampshires refugees live in Hillsborough County, with significant resettlement also in theConcord, Franklin and Laconia areas.

Refugee Resettlement by Municipality

Federal Fiscal Year 2002 - 2009

FY 02 FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 TOTAL

Manchester 182 195 471 165 146 99 246 303 1807

Laconia 33 5 8 15 55 15 59 70 260

Concord 11 38 75 126 54 94 192 188 778

Franklin 13 6 0 2 0 0 0 0 21

Boscawen 0 0 1 0 0 0 9 0 10

Hooksett 3 0 0 0 0 0 0 0 3

Hanover 2 0 0 0 0 0 0 0 2

Milford 4 0 0 0 0 0 0 0 4

Haverhill 5 0 0 0 0 0 0 0 5

Charlestown 0 0 0 0 0 0 3 0 3

Nashua 0 0 0 2 5 51 12 0 70

Warner 0 0 0 2 0 0 0 0 2

Peterborough 0 0 1 0 0 0 0 0 1

253 244 556 312 260 259 521 561 2966


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http://www.nh.gov/oep/programs/refugee/facts.htm

Refugee Arrivals to New Hampshire by Country of Origin:1997 - 2008

1997-1999 2000-2007 2008 Total

Totals 1,442 2,889 520 4,851

Europe 1,068 1,167 2 2,237

Bosnia 868 788 1,656

Croatia 67 101 168

Kosovo 49 0 49

Russia 28 40 2 70

Serbia 0 4 4

Ukraine 56 45 101

Meskhetian Turks 0 187 187

Africa 218 1,516 140 1,874

Algeria 3 6 9

Burundi 0 132 52 184

Cameroon 0 6 6

Congo 0 54 23 77

Egypt 0 6 6

Eritrea 0 4 4

Ethiopia 1 19 20

Liberia 27 216 243

Nigeria 52 7 8 67

Rwanda 21 50 71

Sierra Leone 3 51 2 56

Somalia 19 131 43 193

Somalia (Bantu) 0 373 373

Sudan 92 434 6 532

Togo 0 21 6 27

Zimbabwe 0 5 5

Asia 126 18 277 421

Vietnam 126 18 144

Bhutan 277 277

Middle East 30 186 101 317

Afghanistan 0 99 3 102

Azerbaijan 0 9 9

Iran 3 18 21

Iraq 27 59 98 184

Cuba 0 2 2

Latvia 2 2

Ivory Coast 1 1

Armenia 1 1


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9/12


Having an event?Reaching a milestone?Got something to say?

Send your news, articles, poetry, pictures, or feedback toElizabeth Gruber at [email protected] and be featuredin the next issue ofWhats Up...at the Coalition.

RAINN online trainings ...are self-paced courses designed for rape crisis centerstaff and volunteers and those who work in relevantsfields. There are also lesson plans available for peo-ple who want to conduct the trainings in-person attheir center or organization.

Available Trainings:

Beyond "date rape" drugs: Drug-facilitated Sex-

ual Assault

Train-the-trainer: How to conduct great trainings

Establishing Partnerships with Faith Communi-ties

Introduction to Cultural Competency

Cultural Competency: Self-awareness

Cultural Competency: Skill-building

Helping suicidal or self-harming callers

Self-care

Incest: Helping Victims and Survivors of Incest

For more information visit: rainntrain.org

Saturday, February 6, 2010Common Man Inn, Plymouth

Tickets: $40.00

Cultural Competence Champions

February 15, 2010Time: 8:00am to 12:00 pm

Location: Welcoming Light - The Institute

45 High St. Nashua NH 03060

This presentation will explore the many chal-lenges in honoring cultural diversity withan emphasis on developing skills for promotingcultural competence in order to increase thequality of services.

Registration:

$40 per person if paid prior to 1/14/10$50 at the doorTo Register:

Email: [email protected]

or call Carolyn at 603-882-3616x1132

Questions about the course:Call Karen 603-882-3616x1157

National OrganizationAgainst Male Sexual

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For Complete Information, and to

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ter discount code: AFFILIATE toreceive a 10% savings off your

registration.


10/12


Coalition NewsNARAL Honors NHCADSV at annual Roe v. Wade Anniversary Celebration

On January 26 at the Capitol Center for the Arts in Concord, NARAL Pro-Choice New Hamp-shire CELEBRATED THE POWER OF THE REPRODUCTIVE RIGHTS COALITION whosemembers include the New Hampshire Coalition Against Domestic and Sexual Violence, Con-cord Feminist Health Center, the Feminist Health Center of Portsmouth, New Hampshire Civil

Liberties Union, Planned Parenthood of Northern New England.

The Reproductive Rights Coalition is the nexus of providers, patients, activists, and legislatorsworking to protect and expand access to the full range of reproductive health care services forwomen of New Hampshire. Amanda Grady and Jennifer Durant of NHCADSVs Public PolicyDepartment received special recognition for their ongoing work to protect victims and reproduc-

tive freedom in New Hampshire.

Grace Mattern has been selected as one of 20outstanding women you should know in NH

Radio station 95.7 WZID and Hannaford are behind thisaward which is in conjunction with the Womens Expohappening next month in Manchester; thousands ofwomen are expected to attend.

Grace will be recognized at the Expo as well as on air at WZID. This is a great honor and an op-portunity for more people to learn about the amazing work that Grace and all of you are doingacross the state.

Subscribe to the Open Doors to Safety Project Blog! The Open Doorsto Safety project is working to develop the capacity of the member programs ofthe Coalition and local communities to address the effects of trauma and thecomplex need of victims with mental health and substance abuse problems.Through training of crisis center staff and community collaboration it is hopedthat the survivors of trauma will be given more choices for change in theirlives. Given that a number of trauma survivors who access services provided bydomestic violence service programs have used drugs and/or alcohol to self medi-cate the pain of the trauma in their lives and may also be challenged by a men-tal illness or decreased mental health, the Coalition has made it a priority toenhance services to this population. You can learn more about the program by

subscribing to our blog. For more information go to opendoorsnh.blogspot.com


11/12


What's New in the Carol HeathMemorial Library?

Domestic Violence: Intersectionality and Culturally Competent PracticeEdited by Lettie Lockhart and Fran DanisColumbia University Press, 2010Experts working with twelve unique groups of domestic abuse survivors providethe latest research on their populations and use a case study approach to demon-strate culturally sensitive intervention strategies. Chapters address African Ameri-cans, Native Americans, Latinas, Asian and Pacific Island communities, personswith disabilities, immigrants, refugees, women in later life, LGBT survivors, and military couples, as well as do-mestic violence in rural environments and among teens, and the role of religion. ~from the publisher

Childrens Program Kit: Supportive Education for Children of Addicted ParentsBy the Substance Abuse and Mental Health Services Administration, 2005A comprehensive educational curriculum for those working with children affected by substance abuse.

Trauma and Recovery: The Aftermath of Violencefrom Domestic Abuse to Political TerrorBy Judith Herman, MDBasic Books, 1997Herman draws on her own research on domestic violence, as well as on literature on combat veterans and victimsof political terror, to show the parallels between private terrors like rape and public traumas such as terrorism. Atthe heart of the book is a unique approach to recovery that demands that the therapist depart from a stance ofmoral neutrality, working slowly toward integration rather than catharsis. ~from booknews.com

A Woman's Place: The Compassionate Guide for Reclaiming Body Mind and LifeBy Wendy Hilsen-Bernard, M.S, L.P.C.Still River Resources, 2001

Lovingly written for women to help heal from domestic violence and sexual assault. Includes a 70 minute audioCD featuring a yoga class, meditation, visualization and relaxation.

Cultural Competence in Trauma Therapy, Beyond the FlashbackBy Laura S. BrownThe American Psychological Association, 2008The author shows therapists how to become more sensitive to individual identity when working with clients whohave suffered trauma. The author explains how culturally sensitive therapists draw upon multiple strategies fortreating patients and are aware of both dominant group privilege and of their own identity and culture. Of particu-lar interest is a chapter on the role of systems of faith and meaning-making in trauma therapy. The book has apractical focus and contains a variety of case studies illustrating how theoretical constructs can inform assessmentand treatment. Given the ubiquity of trauma in its various forms, all therapists, from trainees to seasoned profes-

sionals will find this volume educative and thought-provoking. ~from the publisher

To borrow resources, contact us at [email protected] or call 224-8893, ext 316.


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