Trauma-Informed Health Education & Screening for Refugees

The project is implemented by The University of Scranton with and for the Bhutanese Cultural Society Association and the Congolese Refugee Community in Scranton, USA. This is an ongoing project and we are now expanding this to Afghan Communities and will continue this as part of our Community-Based Learning Program Projects delivered by faculty in specific courses, supported by The University of Scranton and Office of Community Engagement.

Our project began in 2020 by the development of relationships between university faculty and the local Bhutanese and Congolese Refugee Population. Many months were spent learning about the needs from a diverse representation from each community and what they deemed as valuable goals and outcomes for the health education/screening sessions. We created health education documents and translated them into Nepali and Swahili. We trained a group of faculty and graduate students to interact with best practices for refugee populations prior to interaction with the communities.

In 2021, we started pro bono health education/screening sessions with support of local translators and leaders within the refugee communities on a monthly basis. We served over 400 people and provided health education/screening on over 20 topics from 2021-2023.

The aims of the project are to:

1. Fulfill a gap in health education/screening for refugee populations in the area.
2. Provide a collaborative, cultural and language appropriate sustainable health education/screening model for working with vulnerable populations of refugees.
3. Provide care that is both trauma-informed and culturally supported specific to the needs of each community we work for and with toward better health outcomes.
4. Open dialogue for future collaborations, training for refugee people within the community who want to partner in training (train the trainer), and provide opportunity for resource sharing.

Elements that facilitated the implementation include:

• Grant funded project for one year in 2022-2023 allowed this project to expand.
• Collaborative approach throughout the process with real planning and input from the communities.
• Partnership with the refugee communities, graduate students, faculty, and the university.
• Payment to refugees to help with translations of the documents and for oral translation.
• Mandatory training for and with the refugee community partners for all healthcare provider participants, including faculty, students, and clinicians.

Main activities of the Good Practice

1. Collaboration was essential throughout the planning process, continual formative and summative assessment of the program, and provision for immediate access to local, available mental health resources for trauma responses.
2. Mandatory training that included a history of local and global refugees, trauma-informed training for students and faculty, and key aspects of working with vulnerable populations from a cultural and linguistically sensitive approach.
3. Creating health education materials with a 6th grade reading level is most appropriate for US Health Literacy Standards and having all documents translated into the language of choice - Swahili and Nepali and English were all given as options.
4. Providing tangible give aways to help people monitor their own health at each fair. For example (depending on the topic), we gave away Blood Pressure Cuffs, pulse oximeters, pregnancy support belts and exercise equipment, menstrual products, prenatal/postpartum/children’s/women’s multivitamins, COVID kits and Respiratory Health Monitors, etc).
5. Continual communication with community partners and continual monitoring of the program through focus group feedback, survey feedback, and open dialogue with community partners were critical components to our success.
6. We invited nursing, occupational therapy, and social work/counselling services to collaborate and provide services in a multi-disciplinary approach. This allowed for expanded medical services and resource knowledge to improve access to care in the community.

Partners involved

• Bhutanese Cultural Society Association in collaboration with Chandra Sitaula in Scranton, PA
• Congolese Community with Elm Park Methodist Church in Scranton, PA and with Ushu and Prisca Mukelo
• Office of Community Engagement at The University of Scranton and Julie Schumacher Cohen.
• All One Charities for funding for one year 2022-2023 of the project expansion.

What challenges were encountered in delivering the project and how were they overcome?

Challenges

We needed more translators in some sessions because the amount of people who showed up varied from month to month, depending on weather.

How they were overcome

We requested 2 more translators than the anticipated need at each event.

Results of the Good Practice

People in the Bhutanese and Congolese Community that attended the health fairs have expressed their feeling of being supported from our community, knowing they can call on us with questions and help regarding these issues (so a sense of connectedness), and confidence in navigating health issues, our local health resources, and preventing chronic diseases such as diabetes, stroke/heart conditions, issues related to prenatal/postpartum care, intimate partner violence, respiratory conditions and COVID-19, issues affecting pediatrics through geriatrics, and somatic exercises to help with triggering events related to post-migration trauma.

Our community members learned very helpful benefits and knowledge regarding various health issues that we are not aware of before these health sessions. They learned what benefits and harms them and how to identify disease, prevent disease, and treatments available and where to find them. They respected our community and treated us as equals. We are out of words in terms of showing how much we appreciate them - Chandra Sitaula

In what way does the good practice meet one or more of the four objectives of the Global Compact on Refugees?

Objective 2: Enhance refugee self-reliance

We have improved access to health education/screening/knowledge/resources for the local refugee community through this project.

We have worked with local refugee partners and improved confidence in preventive health measures for chronic disease screening, identity, and prevention.

Often, the refugees we serve have been in refugee camps for up to twenty years and have experienced long term trauma. We are opening up avenues to access resources for help with trauma and rebuilding trust within the local communities at the micro, meso, and macro-level.

Next steps

This is a sustainable project that will keep going. The project leader and PI, Prof/Dr Lori Maria Walton began planning of this project with the intention of utilizing a sustainable, culturally and language appropriate model for community based rehab programs in Fall 2020 when this project began development.

Are there areas in which support would be required to continue and/or scale up your good practice?

To scale up our good practice, funding for translations and other supplies to expand this to other refugee communities would be a great opportunity. However, we are continuing our currently established program with the Bhutanese and Congolese Community and looking for funding to expand topics and to include more local Refugee and Migrant communities.

Dr/Prof Lori Maria Walton, PhD, DPT, MSc., MPH (s), Professor and Project PI, The University of Scranton, Department of Physical Therapy

[email protected]