Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1

Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1

BuildaBridge Year 1 Report Philadelphia Refugee Mental Health Collaborative Mission – To connect newly arrived refugees to culturally and linguistically appropriate mental health care, including support groups, therapy, and community-building arts and education projects.

Vision – All refugees have access to quality mental health supports, including a network of trained professionals committed to serving refugee populations, appropriate translation services and treatment centers who access these services and recognition of alternative treatment modules and funding for them.

Lead Art Therapist making individual mandalas with Bhutanese children, April 2012

Narrative Summary BuildaBridge’s role during Year 1 of the Philadelphia Refugee Mental Health Collaborative (PRMHC) was instrumental in accomplishing the mission, vision and outcomes set forth by the collaborative. The key elements of the BuildaBridge ClassroomSM - structure, rituals and boundaries, proved to be the driving forces behind how and why the refugees accomplished the goal of identifying adjustment strategies that build on the strengths of their communities in promoting success, strength, recovery and resiliency in a new culture. The model is trauma-informed, hope-infused and childcentered in an effort to instill hope, healing and resiliency in participants. Art is used as a metaphor for learning life lessons in addition to four major outcome areas which include academic, social, spiritual and artistic skills that are measurable both qualitatively and quantitatively. The model has been used in twenty-five countries in the past ten years with vulnerable and marginalized populations reaching more than 10,000 artists and children. The collaborative’s research has shown that new refugee communities naturally use art-making like dance, drumming and visual art to ground themselves in their native culture while acclimating in a new environment. The combination of this latter research and the BuildaBridge ClassroomSM was used to fulfill the function of providing refugees with monthly community and culturally specific alternative support groups.

BuildaBridge Therapy Groups Personnel Five art therapists and teaching artists Five volunteer assistants Three refugee case aides Outputs 1. Establishment of a Bhutanese art therapy group for children on a consistent schedule.

2. Children’s art projects - Demonstrated the children’s increasing abilities to establish a new identity in the United States, build resiliency and develop their internal locus of control.

3. Group cohesion and a sense of community among 15 consistent Bhutanese children.

4. Establishment of a support system using art-making for Iraqi women and children which will serve as a foundation for the development of Iraqi family art-making sessions for Year 2. Four art therapy groups were held with a total three adult women and two children.

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Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1 BuildaBridge Related Outcomes Individual Outcome #4 – More than 100% of the originally stated number of refugee persons (40) attended and made use of the BuildaBridge community-specific alternative therapeutic support groups.

TOTAL BUILDABRIDGE ATTENDANCE 29 Bhutanese children

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5 Iraqi refugees (3 adults and 2 children)

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Males made up 75% of the Bhutanese and Burmese children attending Year 1 groups.

63% of the Bhutanese and Burmese children were between the ages of 6-9, with the remaining majority between the ages of 10-12.

100% of the Iraqi participants were female

42 Burmese (9 adults and 33 children)

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Majority of Burmese children under the age of 10

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76 Total Refugees Served during Year 1

Program Outcome #1 – 100% of the community leaders from the Iraqi, Burmese and Bhutanese Nepali communities were hired, trained, and actively involved with both the BuildaBridge art therapy groups and other collaborative activities.  Bashar of the Iraqi community recruited mothers and children for the Iraqi art therapy groups, transported all clients to the groups and translated for both the group and individual art therapy sessions.  Bishnu of the Bhutanese Nepali community recruited children for the Bhutanese art therapy groups, traveled with the children to the site, provided translation and behavior management assistance during all sessions.  Khin Khin of the Burmese community actively recruited families for BuildaBridge art groups in June and other collaborative activities, providing translation and behavior management during the sessions.

Program Outcome #3 – Monthly culturally specific alternative support groups will be utilized by at least 30 persons. This outcome was met with the following criteria:  45% (34 persons) of all participating refugees from the Iraqi, Burmese and Bhutanese communities attended the monthly culturally specific alternative support groups at least twice or more during the ten-month period.  Nine children or 31% of the 29 Bhutanese children remained consistent in their attendance from August 2011 to June 2012 attending nine or more times out a total fourteen sessions.  Thirteen out of nineteen Bhutanese children participating in the Spring sessions only (ten total) attended the groups at least five times or more.

Organizational Outcome #5 – Culturally specific activity modules and curriculum were developed and piloted for the alternative support groups in addition to specific social and individual outcomes for each of the groups, Bhutanese and Iraqi communities. Tracking on these modules and outcomes was completed through the therapists’ use of an online assessment system, all of which also supported the goals developed by therapists for the entire year and the mission of the PRMHC. 2

Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1 Bhutanese Goals 1) Help each child to access their thoughts, ideas, and emotions through the creative process 2) Help each child to express their thoughts, ideas, and emotions verbally through language or nonverbally through movement and/or visual arts.

3) Create a sense of group cohesion and community.

4) Identify significant emotional and/or mental health concerns that require recommendation to additional mental health services.

These goals were created in response to the major problems identified by therapists: 1) Limited expression of original thoughts & ideas.

2) Limited expression of and/or under developed modulation of affect resulting in a limited expression of emotion or sharp under-controlled spikes in emotion.

3) Under developed modulation of efforts resulting in lack of impulse control.

4) Under developed sense of body awareness, particularly in regards to sense of self in space and in relation to others.

Curriculum Modules and Activities  The BuildaBridge ClassroomSM model was and is the module used for all of the Bhutanese art therapy groups. The model is comprised of: 1) Safe and structured learning environment, 2) Greetings across the classroom threshold, 3) Opening and Closing rituals which include the BuildaBridge Motto and Rules, 4) Outcomes in academic, social, spiritual and artistic skills, 5) Boundaries of behavior enforced by the rules, 6) Using art as metaphor for learning life lessons and 7) Speaking a blessing or statement of affirmation to each individual child as well as the group. The consistency in following this structured model with in a safe learning environment each time contributed to children’s personal mental development, building of resiliency and finding hope and healing amidst their transition.  Welcome Song – Each child is greeted by name from the group through music. "Hello, hello, so happy to see you, hello hello how do you do? Hello, hello his/her name is [insert child’s name] Hello, hello, so happy to see you!). The Welcome Song is part of the BuildaBridge Classroom SM model’s opening ritual. This song accomplishes Goal #3 in assisting students in creating group cohesion and community.  Safety Dance - In this activity, each member offers a movement of their own choosing. The individual movements are chained together to create a cohesive, repeatable dance promoting Goals #1, 2 and 3. The completed dance requires special awareness, impulse control, and flexibility. The Safety Dance is also part of the Opening rituals. Participation of children in the Safety Dance reached 100% by the sixth session.  Space Bubbles - In this activity, the group explores space and spacial proximity within their environment without touching one another. Many members of the group appear challenged by this activity as evidenced by the seemingly overwhelming need to “pop” another person’s bubble or to impede another person’s exploration of space. This improved after engaging the children in the activity several times. Space Bubbles promotes accomplishment of Goals # 1, 2 and 3.

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Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1  Individual and Group Mandalas – Children were asked to draw patterns, shapes or other forms inside a preformed circle on a sheet of paper demonstrating their individual feelings. Individual mandalas were then taped to a larger wall mandala and children were asked to make connections with drawn lines to other mandalas. The concept encourages individual expressions which are then joined together to create community. This activity was completed during the third and then eighth sessions with increased connections during the latter, indicating an increase in group cohesion accomplishing Goals #1, 2 and 4.

Individual mandalas making up a larger collaborative mandala, Bhutanese group, April 2012

 Goodbye Dance – Three children are chosen at the close of each group to create a different movement. The movements are combined together, similar to the Safety Dance, and performed by the entire group. This represents part of the closing ritual, a key element in closing a session of the BuildaBridge ClassroomSM model. This activity supports Goals #1, 2 and 3.  Character Adventure - The lead art therapist encouraged the children to use their imagination to create a character or hero who they would take on an adventure to a new land. They were to complete 4 drawings to create the adventure: 1) The character’s homeland, 2) The character’s journey, 3) The character’s arrival in the new land, and 4) The character’s future. The art-making explanation was interactive, as the lead art therapist asked for volunteers to write the prompt for each of the 4 drawings on a giant post-it displayed for all to see throughout the art-making on the wall. The Character Adventure activity promotes accomplishment of Goals #2 and 4. The following themes were extracted from the art therapist’s analysis of the children’s drawings:    

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Traveling to the USA. Coming from the Himalayan Mountains. Potentially the child’s lived and/or perceived experience of migration.

Religion (temples, praying). This might indicate the importance of religion to these children and/or their families, or culture.

Reason behind traveling: search for money or employment. A possible glimpse into these refugee children’s lives and/or perceived reasons behind their move to the USA. The choice to travel; all characters wanted to travel for one reason or another. None were forced to travel against their will. This might indicate the potentiality of art-making as a healthy strength building technique, as a method to control uncontrollable past and/or current events, and as a self-esteem enhancing exercise for these children. Art-making is something anyone can utilize in sessions, in their homelife, and in the distant future.

Selective use of color (only coloring certain parts of the drawing, or one object, rather than assigning color to each object). This might indicate concentration on certain details of an experience, rather than the experience in full, possibly because the experience overall is too traumatic to recall.

Hopeful 4th drawings [character’s future]. This might indicate a positive outlook of the future.

Combination of humans and non-human objects (example: a person with a head shaped like a house, a helicopter with what appears to be human arms with fingers extending from it, a house with eyes and a mouth). This might indicate an unclear separation of self and “other-self”; possibility of boundary issues and or lack of sense-of-self .

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Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1 Iraqi Goals 1) Increase participation and attendance 2) Create a safe space where participants can feel comfortable to create art and to share verbally about the art 3) Engage group members in art making processes that are, by nature, relaxing and known to decrease anxiety and to discuss this with the group members to increase awareness of ways to decrease anxiety in daily life 4) Socialization among members 5) Continue to make art with the women, as a means of creating a relationship with them and communicating with them.

These goals were created in response to the major problems identified by therapists: 1) Low attendance 2) Limited safe areas or environments for Iraqi women and children to express their thoughts 3) Limited number of outlets in the Iraqi community to decrease stress, anxiety and address mental health issues related to their refugee status Curriculum Modules and Activities  The BuildaBridge ClassroomSM model was the module used for all of the Iraqi art therapy groups.

The model is comprised of: 1) Safe and structured learning environment, 2) Greetings across the classroom threshold, 3) Opening and Closing rituals which include the BuildaBridge Motto and Rules, 4) Outcomes in Academic, social, spiritual and artistic skills, 5) Boundaries of behavior enforced by the rules, 6) Using art as metaphor for learning life lessons and finally 7) Speaking a blessing or statement of affirmation to each individual child as well as the group. The consistency in following this structured model with in a safe learning environment each time contributes to participants’ personal mental development, building of resiliency and finding hope and healing amidst their transition.  Individual Mandalas – This activity aided participants in telling stories about themselves within a circle, a universal symbol with structure used towards healing and decreasing anxiety. Once completed, participants and therapists shared them with the group. This was the main activity of the Iraqi group, accomplishing Goals #3, 4 and 5.

Stories – Evidence of BuildaBridge accomplishing the PRMHC mission and identified goals “The children’s ability to accurately identify and interpret adult nonverbal communication seems to be improving. Reasons for the increase in visual tracking and improved interpretation may be related to the familiar, safe, and trusting relationship between the children and adults…A familiar, safe and trusting relationship between the adults and children seems evident by the children’s willingness to spontaneously engage in social behavior with each adult….Impulse control improved during today’s session.

Improvement could be related to familiarity with expectations, increased internal locus of control, and the children’s individual motivation to seek positive attention from the adults.” – Art Therapist assessment of Bhutanese group’s fourth session.

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Lead Art Therapist doing movement activities with Bhutanese children, July 2011

Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1

“An improvement is displayed during art-making as children are sharing and passing art supplies and required minimal direction/redirection from clinicians. Children are also more focused, confident and independent in their art-making and movements. Drawings and movements are more unique to each child; there is less “piggy-backing” or mimicking of peers. This might indicate an increase in self-esteem, and an increase in expression of original thoughts and ideas. This might be the result of clinician’s consistent unconditional positive regard, encouragement, and the creation of a safe place for artistic exploration.” –Art Therapist assessment of Bhutanese twelfth session “All of the group members seemed happy to be in group and all indicated verbally and nonverbally that they liked art. F. seemed more relaxed with other people in the group with her. The silence while working and concentration on art making was impressive and very positive, as was the women thanking us. They seemed so in need of an outlet. L’s piece was particularly moving, especially when she said that she had never made a personal painting like that before. She appeared to find the group truly cathartic. Clearly she appeared to be experiencing the group as a safe place. E's wanting to take her project home with her also shows an interest in the group and a pride in her art-making”. –Art Therapist during Iraqi group’s third session “The children seem to do well when structure is added to any activity. For example, when examples are given of ways to paint the box, the children appear to develop art-making "strategies", whereas if no examples are given, the children oftentimes appear hesitant to begin art-making, or are "sloppy" impulsive, or undecided in art-making. When the group is directed to do the Safety Dance "as quietly as we can" for one round, they appear more attentive to the group's movements, and are more in sync. This appears to be a group, overall, that needs structure, encouragement and redirection frequently in order to "try their best" as the BuildaBridge motto states, and to accomplish group's goals listed above.” – Lead Art Therapist assessment of Bhutanese ninth session “We talked about how circles are a universal symbol and that we, in our little group, are also a circle. F. had many questions about what to do with the project and I explained to her that she could make any design she wanted to, and that the act of making art repetitively with ones hands, particularly in a circular shape, can decrease anxiety and make you feel good. F. agreed "yes anything to take our minds off of our troubles". – Art Therapist assessment during Iraqi second session Challenges  The lack of a consistent location for the Bhutanese art therapy group contributed to their inability to accomplish more fully the goals set by the art therapists. The establishment of a consistent, safe and secure location is a key element of the BuildaBridge ClassroomSM. There were three locations for this group during the ten months of the project.  The Burmese community did not participate in the mostly Bhutanese therapy groups for most of the year leading the collaborative to offer three art therapy groups for children at the end of Year 1 in June.  The Iraqi women and children’s group was not well attended. Attendance was sporadic with two groups having just one attendee. Arabic culture focuses heavily on the family unit and with their already busy lives, attending a bi-weekly group just for mothers and children was not the best use of their time.

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Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 1 Recommendations for Year 2  Secure a location for the Bhutanese and Burmese art therapy groups in South Philadelphia that will remain consistent for the whole of year 2.  In seeking to provide the Iraqi community a culturally specific art-focused outlet, hold once monthly family art-making sessions that involve the entire family. This way, the family unit will be able to spend time together while addressing mental health issues through art-making.  Enthusiasm and high attendance at the June 2012 Burmese family art therapy groups is evidence that the collaborative will utilize in offering Burmese specific groups during year 2.  Continue utilization of community-specific Case Aides to provide translation, leadership and classroom behavior management for the groups. It is recommended that case aides hold the responsibility of asking parents to complete the registration forms and is a requirement for the children to attend the groups. The presence of case aides has been instrumental during Year 1 in assisting the therapists, children and parents in addition to their role as community leaders.

Photo Album links: Bhutanese Art Therapy Group, Spring 2012 https://picasaweb.google.com/117182181509527732452/PRMHC?authuser=0&authkey=Gv1sRgCOKj7 MOV3dfsWA&feat=directlink Bhutanese and Burmese Community Kick-Off Picnic, July 2011 https://picasaweb.google.com/117182181509527732452/RefugeeProject2011July?authuser=0&authke y=Gv1sRgCMrRwqGXn8a7NQ&feat=directlink

Teaching artist assists Bhutanese children and a parent in creating drawings for a group mural

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Bhutanese group mural of a tree with individually drawn objects