Occupational Deprivation, Occupational Justice, Empowerment

lisakaese

Hi out there!

My name is Lisa, I'm a 24 year old OT student from Germany.

Since lots of people flee from Syria and other countries to Germany because of war and persecution, a lot of topics came up in our society. Since September 2015 there is a house in my hometown for refugee families. My mother, sister and I volunteer to help them getting back on their feet, do the authority ways and find an apartement.

From my viewpoint as an OT I'm thinking different about the way of giving guidance than other volunteers. In my opinion it makes it more difficult to take away to many tasks. Even if it is hard for the people to answer flat adverts and arrange appointments to view possible flats i think it is wrong to do it for them completly.

Finging ones way seems for me to be the overaching goal. It also prevents occupational deprivation in my opinion. For me the issue of empowerment is the right way to provide assisstance to the people coming to our country.

I would be very glad if you want to discuss about my opinion and tell me yours. I'm also very happy to hear about your experiences and activities to the topics i mentioned above.

Thank you in advance for your time!
Lisa

Deaconess

Hi, Lisa! I appreciate your views on the role of an OT in helping refugees to settle. I believe there is great potential for OT's to play a role in the present global climate with all of the immigration taking place in the world. Community re-entry should be a wide open arena for us to tackle. I've been an OT for twenty years and have had the opportunity to work in at least 3 countries. (by the way, I lived in Germany for several years before I became an OT. Really loved the food and scenery) Each country seems to have its flavor of OT. I hope to see more develop in Community Health OT, and I think the current immigration and refugee situation spreading across the globe, may be our opportunity. Functioning in a new unknown environment has great challenges, and OT's could be instrumental in preventing mental health, social and medical decline through equipping individuals to cope and thrive in their new life circumstance. I, currently, am in Australia and working in aged care. However, I do want to encourage young OT's to not be afraid of developing further an area of practice in Community Health and using our skills and expertise to address the many social barriers that people must overcome.

lisakaese

Hi Deaconess,

Thank you for your fast reply!
I really like the idea of working in a more group centred way where I, as an OT can support specific groups (like refugees) in their participation in society. And like you I think that OT has the perfect mindset to meet the needs of both, society and those groups.

Though it is needed, there are only a few projects in Germany where OT`s engage in integration of refugees. Most of the offers led by OT's are voluntary projects without remuneration. Also they don't differ from other projects led by volunteers without OT knowledge.
As a refugee in Germany you only receive medical treatment for acute needs, pain or pregnancy. The only way to establish a group based, billable program, is to create a preventive concept funded by health insurance.
Yet, no such concept has been realised in Germany, since I could find out.

Have you heard of similar projects in other countries and how they are funded? I also can imagine to guide young families in finding apartment and get along in the new context as an OT intervention. Maybe to accompany them to cultural and local events and introduce them to the local community.This could help to reduce fears and reservations on both sides.

I`m looking foreward to hear from you!

Lisa

Clarissa Adriel

Hi Lisa,

Thanks for sharing about your role at the refugee house in your town.

Your family is a gift to the newcomers, and also to the wider community - the sooner people are "back on their feet" everyone benefits.

I'd love to hear more about the setting and where you see opportunities. It's probably quite different to here in Australia, so I just have many questions! Bear with my ignorance:

Is it a temporary / transition home? Are people settling in the local area surrounding the house or in transit to other parts of the country?

Who owns the house, how is it funded? How are people's entry / stay / exist from the house managed? How do people sustain themselves whilst at the house? How do they get funds to access a tenancy? Is health insurance a priority if they are attempting to secure housing?

Is there any coordination of the volunteers who provide settlement support? Is there any coordination between occupational therapists engaged in this type of voluntary work? Are there any local OT schools?

Are there any self-help initiatives such as Facebook groups in language? Are there community members with language and cultural skills that have already settled in the town? What's the access to interpreters like? What's access to community radio/ smart phones/ internet like if settlement support resources/tools were developed?

What are the numbers like? What is the impact been on local mainstream service providers such as schools, hospitals, libraries etc? Who are the other stakeholders interested / involved in what happens? Are there pressure points showing in the mainstream system? What's the community / body politic anxious about?

Working with the new families might lead to coordinating others or developing resources or tools to get better outcomes/ reduce the cost/waste/risk of poor outcomes.

Bear in mind, there may be a broader "market" for what you discover or develop along the way because these are widespread challenges. Just one other practitioner doing similar survey/ pilot/ data gathering in another town would be very interesting!

Explore if there's a position to provide solutions to stakeholders who might be facing additional challenges of responding to new comers. This is an indirect way of advancing the occupational needs and rights of the new families.

I don't know if that's helpful at all?
I do hope we get to hear more about your experiences and thinking!

Sincerely,

Clarissa

lisakaese

Hi Clarissa,
Thank you for your interest and the encouraging words!
I love to tell you more about it and I’m glad for the exchange.
The house is property of an individual and rented from the government/community. The people come to us from the reception center mostly by taxi at any time of day. After they crossed the border to Germany they are picked up by the police and brought to those reception centers where they do their asylum application. The people from Syria and Eritrea with good prospects of residence are distributet to the communities. It can take weeks to months until they get the approval. The Federal Office for Migration and Refugees (BAMF) offers integrationcourses but it can take a few weeks until there are places available. Every refugee receives a pocket money while living in a reception center (about 140 € as a single).
The last link in the chain are the volunteers. We so far got information by the community when a new arrival is planned but without a date or information about the person. Since September 2015 about 20 person (adults and children) came to our village. The house is supervised by a caretaker and a responsible from the government. But these people are not seen very often and don’t take care of the peoples personal needs. So we take care of their first needs and take them to the next supermarket, show them how to use the bus and organize bicycles (Our village with ca. 600 inhabitants has no supermarket and a really poor bus connection). The next supermarket is at distance of 5 km so they really need help to make larger purchases. Two times a day they can go by bus to the next big city (Augsburg).
There is a lack of interpreters. My sister established contact to a Syrian woman for translation in difficult situations. The Eritrean couple speaks good English. The kids learn our language at breackneck speed. After a few weeks it was possible to communicate with the parents through their kids. The kids visit kindergarten and school as fast as possible.
The communication between the involved parties (volunteers, offices, …) is really bad. Nobody knows what is to do and how. German beurocracy at its finest. As a volunteer you need to beg for information because nobody feels responsible.
We have some very dedicated people that offer free language courses two times a week until integrationcourse starts for the adults. Another volunteer took care to provide internet for the residents (refugees-online.de). Most of them brought smartphones and if possible we organized used computers or laptops.
My mum mostly cared about sorting and providing contributet clothing. Another women cared about school equipment. My sister and I organized some acitivities such as a trips to the “Plärrer”, a local folk festival and visiting the open house day in the next mosque. We also watched some childrens films in a room of the local church and did three “coffee partys” where we invited some of the locals. Unfortunately our locals are a little reservedly opposite strangers. So the interest was relatively small. They are friendly towards them but most of them don’t want to get involved.
When they finally got their decision they could look for a flat. There are very strict conditions to the size and price. They refer to the limitations a receiver of social security has. When they left the reception center the refugees have an entitlement of benefits that are slightly below social security. There is a housing shortage in our area and due to the lack of a drivers licence the families need access to public transport. We make telephone calls and do flat viewings but mostly the lessors don’t want kids or refugees or both. This makes it really hard. But we persevered and now there is only one family left without a flat.
As a refugee in Germany you only have access to health care in cases of emergency or pain. After lots of communication and official business they got a chip card so the doctors would treat them or even make an appointment.
Next OT school is at distance of 30 km (my former school). It’s a bit too far away to cooperate. I never thought about Facebook groups so unfortunately I can’t tell you. But the idea is really good. I know that the young man from Eritrea often visits countrymen in Augsburg. There is also some communication to the refugees in the next towns. Some of them have family members in other parts of Germany. If they want to visit them they need to get an allowance.
We find some new stakeholders in local employer that are willing to hire refugees or let them do an internship. Also the staff of the local nursery is very helpful. They collect clothing for the kids and involve the families in parties and activities.
Now that I think about it, the problem is mostly based on the lack of access for those people. They are very dependent on the help of us volunteers. Not only the language barrier but also the difficult bureaucracy and the difficult access to other resources is a problem. They need more contact persons and more resources of information. Also everything is going really fast for them. They need to recover from their flight. It takes some time to focus on the new goals and to get along in the new environment. It would be easier for them if there were more possibilities for assistance and mobility. The few volunteers are overstrained and also have limits in time and information.
The idea of coordinating and developing resources makes sense. The volunteers already have connection to other groups and organizations. I was asked to take part in an interview study for developing a volunteers guideline in dealing with refugees from Syria. I don’t know when the results will be published.
Now that I read all above I must say we are doing pretty well already:D.
Thank you for the inspiring questions and the good ideas! I hope I could answer most of your questions and found the right translation (I hope I got the right expressions 😃 ). I would be very glad if you want to give me some more thought-provoking impulses!
Sincerely,
Lisa

Clarissa Adriel

Hi Lisa,

Happy New Year! Thanks for taking the time to share all those initiatives and help us understand more about your context. It’s very interesting to learn, thank you.

Your community sounds like a reservoir of resources. Do you see community pride emerge as people work together to respond to the new arrivals? Human displacement is a global story, but communities reconfigure resources and respond at a local level.

If the community will be engaging refugees for the foreseeable future, perhaps it’s worth a survey to discover and map relevant formal and informal community resources? Asset Based Community Development might give you some ideas: http://www.abcdinstitute.org/toolkit/index.html

If there’s no caseworkers, meeting as a group of community members/ services/ stakeholders /volunteers could increase collaborative and strategic work. Even quarterly is a start. Does the house have a communication book to hand over key information?

If most people have applied for asylum and are waiting, do they move on to a larger city when they are granted protection? Or do they stay in the village? The skills needed and gained is another thing we consider when working with someone wants to move to another state of Australia, or has arrived from another state to Tasmania (secondary migration).

Just for interest, this page has some information about the Australian Cultural Orientation Program: https://www.dss.gov.au/our-responsibilities/settlement-and-multicultural-affairs/programs-policy/a-multicultural-australia/the-australian-cultural-orientation-ausco-programme

Do you know what’s covered in the German integration course, and how it’s delivered? That would be interesting to review with your occupational therapy eyes!

Has there been any evaluation asking people after one year later what was most helpful, what wasn’t and what information / skills are needed now?

Maybe there is a need and opportunity to offer an elective session of tailored for a cohort of the population that have specific needs such as people living with chronic health conditions or disability?

Or an elective session about a specific life role or skill, such as a program that will increase the confidence of a landlord renting a flat out to the family?

If you can make a package of information that’s relevant beyond your village, record it using a mobile phone and upload it online. As one example, SBS Radio makes a settlement podcast: http://www.sbs.com.au/radio/settlement-guide

Anyone can make a free Soundcloud Channel and upload 3 hours worth of audio recordings made on their mobile: https://soundcloud.com/upload This could help volunteers think about ways of making their job more efficient/ repetitive.

It’s great the kids are in school as soon as possible. Most settlement services in Australia include some type of program where young people can come and study with volunteer tutors in either their language or other school studies. Often the parents have high hopes and expectations for youth but are unable to help with homework.

Investing in youth leads to gains to the community over the lifespan. And the displaced population is very young. (UNHCR statistics indicate that more than half of the worlds displaced people are less than 18 years old: http://www.unhcr.org/en-au/figures-at-a-glance.html)

This Youth Settlement Framework helps highlight the needs of young people which can otherwise be overlooked even whilst playing an important (and complex and sometimes fraught) role acting as language support for parents: http://www.myan.org.au/file/file/MYAN_Youth_Settlement_Framework_April.pdf

Thinking of the Eritrean couple with good English, is translating and interpreting a profession in Germany? (Is there an accreditation body to certify language skills? Is there professional development about the role of an interpreter, ethics in interpreting etc.? Do courts, hospitals, schools, doctors, police etc use interpreters when needed and the right language is available?) It could be a win-win for their career as well as the local services.

If interpreting is not a viable career pathway, could they be commissioned to record the interpretation of a key service and safety messages for others who will arrive in the future? This only needs small, once-only funding for each piece of work from the hospital, school, police, or lawyers etc. This could build a local work history to strengthen future job applications. Or could they offer telephone and Skype interpreting for neighbouring villages?

I’ve found that sometimes established community members people fear interacting with new people who have many needs. So containing engagement with a little structure can make people feel safe enough to get involved. Shared occupations provide a natural structure. I've worked with volunteers who like supervising someone’s driving practice because it's a structured way of volunteering a specific time for a specific task.

As another example, this Welcome Dinner Project helps people get outside their comfort zones by providing that social structure and support. https://www.joiningthedots.org/the-welcome-dinner-project

Another simple tool to help people interact is “More Than One Story” game which can be downloaded free to play on a smart phone with one or more people in a group.

Android: https://play.google.com/store/apps/details?id=enmiljon.HelloAndroid&hl=en
Apple: https://itunes.apple.com/au/app/more-than-one-story/id503826984?mt=8

Hope some of that is helpful to explore. And I hope that you keep talking about your efforts, your learning and reflections throughout 2017 – please keep up the good work and stay in touch!

Sincerely,

Clarissa

emilyf

Dear all,

My name is Emily and I am 23 years old. I am an O.T. from Italy, interested in working with refugees, too.
After looking at the literature I have found very little about this developing yet crucial field; most of the resources regard our practice in refugee camps, though me and some colleagues would like to start our service within community/reception centres.
I have found your posts really helpful and inspiring!
If possible, I would be glad to hear more about this topic, as Occupational Therapy is still a quite unknown profession in Italy, and OTs involved in refugees' resettlement represent a narrow group (we are probably among the first ones).
Thank you for your support.

Best wishes,

Emily

Clarissa Adriel

Dear Emily,

Thanks for sharing your hopes and thoughts, it's great that you've already read some literature and talked with colleagues about your interests! Are you working or studying? What's your practice area?

You very well may just be the first, so that support of colleagues will help keep you going. Better still, start a special interest group or community of practice network with your OT Association to take it from "me" to "we". Are you a member of your local Association?

It's very timely to explore how to contribute to the occupational needs and rights of displaced people. I checked the UNHCR Global Trends Report, and Italy jumped from 83 200 to 123 000 refugee claims in 2016! Also, Italy is second only to Germany with 6 000 refugee applications of unaccompanied minors. So there's bound to be a way that you could contribute to the services (formal and informal) that are trying to cope with a 67% increase in demand for services. Greece has had similar experiences and Theo Bogeas is an OT working in reception areas there with children for safety.

Literature is a vital and can orientate you like stars in the sky. But right now your challenge is to look at what's happening on the ground, right in front of you, right now. You want to know what's a valuable, effective, efficient, ethical contribution that you as an OT can make in a particular place, and time, with the situation right now. Literature can't answer that for you.

So network until you find a way to start serving in some capacity. Don't worry about whether it's paid or not, or whether you're serving in an OT capacity or not, just contribute something of value, and make sure you're in a position to learn. The purpose of your learning is to better understand how to position your occupational therapy skills to contribute to your team, organisation, the occupational needs and rights of displaced people.

You're right that 50% of displaced people are living in urban situations, rather than in camps. So you don't have to go far to start networking! How and where do people currently engage with refugee, migrant and mainstream services? How does it work? What's working well? What isn't?

I was about your age when I googled a multicultural directory, printed it out, and spent a couple weeks phoning my way through services in my lunch break asking questions, making notes, orientating to the sector. That was pre-social media, so you could systematically like/follow the social media accounts of key agencies and people as part of your learning!

Don't make your first steps complicated, just start with something so small that it feels joyful and sustainable. I do hope you stay in touch and share how things unfold.

Sincerely,

Clarissa

UNHCR Global Trends: http://www.unhcr.org/dach/wp-content/uploads/sites/27/2017/06/2016_Global_Trends_WEB-embargoed.pdf

ElinWidmark

Hi!

I've experienced similar situations working as an OT with children i Sweden. Autumn 2015 we got alot of new kids to the habilitation centre, with families in different stages of the immigration process. In our team we have different viewpoints on how to help them, were some want to do as you describe that others do in Germany - do it for them. Although, I find it more effective in a long term perspective to help them learn how to do it, even if it's hard in the beginning.

The difficult part is when to do it for them, and when to help them learn to do it. In Sweden the asylum process can be very stretched out and take up to more than a year. A couple of years ago I listened to a lecture by a woman working with immigration, and she told us that before the family has received the decision if they can stay or not, it's really hard to inform them about anything. It's like a state of chaos were they can't take in too much information. We've exprienced it for example when we tell them about their childs disability, how they ask us the same question over and over again, because they don't remember. And ofcourse, we've met families that learn things really fast, but my experience is that they learn the occupations that links strongly to surviving first, and want help with the rest. Like, they learn how to get money,how to shop, how to get to the hospital, how to get in contact with healt care and other authorities and other things that are crucial for their every day life for the whole family.

I think that's an important perspective when we, with our OT perspective, want to help them to learn instead of doing it for them. Are they in a state of mind were they can use this knowledge right now?

It's interesting to work with families that are new in the country, and talk about their viewpoints on for example children with disabilities and how we sometimes have totally different views on what their kids can achive.

Best regards

Elin Widmark
Occupational Therapist, MSc