Trauma Informed Casework for Refugees

1. Trauma Informed Casework for Refugees International Counseling and Community Services, a program of

2. Stages of Refugee Migration Encampment or Exile Fleeing Resettlement

3. Results Poor sleep Fatigue Hyperarousal/Irritability Poor memory/Difficulty focusing Lack of Trust/Suspicion Poor Physical Health Difficulty making decisions Lack of ‘agency’ Flooding Disappointment

4. Trauma and Migration Impact on Casework • Feeling overwhelmed/difficulty setting goals • Poor memory • Difficulty focusing • Unrealistic goals • Unrealistic timeframes • Lack of agency • Complex external barriers • Competing resettlement commitments • Frustration/Anger • Hopelessness/Feelings of Defeat

5. Trauma Informed Casework Understands the client’s current context Recognizes that certain casework activities can be triggering Knows the many different ways stress and being overwhelmed can present itself

6. Trauma Informed Casework Adheres to strict privacy rules Conveys confidentiality to the client Is strengths-based Empowers the client Helps mitigate anxiety by be consistent and transparent Is open-minded about client concerns and has a process for evaluating them

7. Trauma Informed Casework Has private room to meet with client Uses professional interpreters Keeps all client information locked and secure Uses Releases of Information for all entities Is able to ask for help from colleagues and supervisors

8. What is Casework? Case work is a collaborative processwith a individual to reach a goal.Both people – the case worker and the client – work to make the goal happen. The case worker generally offers their expertise, resources, and guidance while the client offers their energy and initiative.

9. Basic Casework Step 1: ASSESSMENTWhat is the client hoping will happen? Does it differ from what you think should happen? Is it realistic?

10. Basic Casework Step 2: PLAN Set measurable goals. If goals are too big break them into smaller pieces. Example: Non-measurable – Client will improve English. Measurable – Client will move from Level 1 to Level 2 within 3 to 6 months.

11. Basic Casework Step 3: IDENTIFY BARRIERS Language Phone Minutes Transportation Responsibilities at home

12. Basic Casework Step 4: IMPLEMENTATION What does it take to get it accomplished? Is everyone clear on the next steps? Do you have a timeline?

13. Basic Casework Step 5: MONITORSet regular check-ins Assess “why” if goals are not met

14. Basic Casework Step 6: Reconfigure goals or move towards terminationCreate new or modified goals if necessary If case is completed let client know

15. Intake ‘Flow; or Process The way you structure the intakeso that you can help determine goals, set an action plan, and collect needed information for billing and reporting

16. Intake Flow • Introduction • Discuss confidentiality (with specifics) • Collect demographics • Identify goals (client voice and choice) • Assess other areas of need • Set goals • Allocate tasks • Establish timeframes • Ask if anything is missing • Establish next check-in time

17. Case Example - Dorcas Dorcas is a 37-year old woman from the DRC. She is married and has two elementary school age children. She has been in the U.S. for five months. Her husband found work at Sky Chef but recently lost his job. She is coming to you for housing assistance because they family is having great difficulty paying rent. Initial thoughts about goals and barriers?

18. Case Example - Dorcas In talking to Dorcas you discover that her 10-year old daughter has been in and out of Children’s Hospital with what may be a serious cardiac problem. Second thoughts about goals and barriers?

19. Case Example - Dorcas You also find out that her husband lost work because he has been taking the child and mother to Children’s Hospital and had to miss work several times because of conflicting appointments. Final thoughts about goals and barriers?

20. Assessment What are the client’s need(s)? • 1. Housing Assistance • 2. Transportation • 3. Exploration of SSI • 4. Medical Case Management • 5. Employment Services for spouse • 6. • 7.

21. Assessment What barriers does the client have to self-sufficiency? • 1. Lack of English Skills • 2. Medically Needy Child • 3. Insecure Housing • 4. • 5.

22. Assessment What local resources are available to address the client’s needs and/or barriers? • 1. Refugee Health Promotion Project • 2. HopeLink • 3. Rental Assistance • 4. Employment Programs • 5. • 6.

23. Assessment What PRIME Program service(s) will the agency provide to address the client’s needs and/or remove barriers to Self-Sufficiency? • 1. Refer to RHPP • 2. Ask Children’s Hospital about HopeLink • 3. Apply for rent assistance • 4. Connect spouse to employment • 5.

24. Things You Might Need • Private Room • Way to Keep Confidential Information • Releases (in addition to DSHS) • Establish times for checking progress • Ways to track outcomes

25. Progress Notes A Progress Note is a written detail of what the caseworker and the client did together to achieve the goal. It provides: • A way to review progress made • A way to review what has been tried and re-establish goals and interventions as needed • Accountability to all involved • A guide for future caseworkers

26. Progress Notes Should always be: • Clear • Concise • Relevant • Useful

27. Progress Notes Should always have: • Goals worked on • Interventions • Outcomes • Any referrals and next steps • Name and contact information for anyone contacted

28. Progress Notes Should never have: • Private sensitive information • Non-relevant information • Judgement and Conclusions

29. Examples INCORRECT: Spoke with client who said she is really worried about her daughter and that she is throwing up all the time. She also said husband has started drinking. Spoke with lady at Children’s Hospital who said child is really sick but she doesn’t know if she will die. Told them that client needs HopeLink.

30. Examples CORRECT: Spoke with Mary Lewis at Children’s Hospital (206-555-1212) regarding establishing HopeLink transportation for client’s child. Mary said she felt child would be eligible and would have the clinic fill out the forms by the end of the week. Agreed to contact Mary next Monday, 11-14-15, to check in on status. Called client to convey status of transportation forms.

31. Examples CORRECT: Spoke with Mary Lewis at Children’s Hospital (206-555-1212) to check status of HopeLink application. She confirmed she sent it to HopeLink. Called client and updated her on transportation issue and made appointment for her to come into office tomorrow (11-15-15) with list of child’s appointments so I could teach her how to use HopeLink.

32. Helpful Hints • Affirm – “This IS a difficult process” • Normalize – “Almost everyone has a difficult time and it is common to feel overwhelmed, sad, or even angry” • Connect to client’s larger life goals – “Learning ESL is really going to help you parent your children as they go to school and adjust to the United States.” • Praise/Encourage – “I admire that. That tells me a lot about you as a mother.”

33. QUESTIONS?

34. Further questions… Beth Farmer, LICSW Lutheran Community Services Northwest International Counseling and Community Services 206-816-3252 bfarmer@lcsnw.org