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A brighter future for refugees
For decades, occupational therapists have been working with refugees and asylum seekers as they resettle in Australia. This article provides considerations for occupational therapists working with people from refugee-like backgrounds, and highlights the work of occupational therapists in the refugee sector.
What is a refugeelike background?
It is pertinent to clarify the difference between refugees and asylum seekers. A refugee is someone who has sought protection, been granted refugee status and has a permanent humanitarian visa allowing them to stay in Australia. A person seeking asylum is someone who is seeking protection but has not yet been granted refugee status and is here on a temporary visa. However, regardless of visa status, refugees and asylum seekers have experiences of fleeing their countries due to fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion1 . This, however, may also be the reality for many immigrants, especially those who have come from countries with political instability, conflict, or where human rights abuses are common. Additionally, we acknowledge that such experiences have intergenerational consequences, impacting children born in the country of settlement. With this in mind, we begin to understand that as occupational therapists working in Australia, a country which is home to many displaced people (Aboriginal and Torres Strait Islander people, immigrants, refugees and asylum seekers), it is highly likely that we will at some stage have the privilege of working with someone from a refugee-like background.
People who have fled their home countries may have had direct or indirect traumatic experiences of physical/sexual abuse, torture, armed conflict, kidnappings, loss of loved ones, or financial and food insecurity. Their journey is often perilous with a focus on survival. While in transit and waiting for refugee status, many experience continued persecution, discrimination and lack of access to essential services and occupations, often living in temporary accommodation or camps with no control of their future. From a bio-psychosocial perspective, we understand that these experiences affect the individual, their family and community. Many people find the transition to Australia challenging with the combination of language and cultural differences and the ongoing impact of trauma2. For example, a student may not be learning well at school due to being triggered by the sound of the bell but may also not understand classroom expectations.
Where do occupational therapists come in?
A recent Occupational Therapy Australia Refugee Settlement Interest Group meeting showcased occupational therapists and students working within settlement services, refugee torture and trauma services, refugee health services and multicultural services.
Whether a specific occupational therapy role or a generic role, occupational therapists working in the refugee sector use an occupational lens to identify occupational issues, enable occupational engagement and address barriers to participation often caused by occupational injustices. Occupational therapists may do this by:
• Assisting with the process of cultural and occupational transition and the development of life skills; • Enabling access and reducing barriers to participation through advocacy for health, disability or other services; • Supporting bicultural workers as a means to provide flexible and culturally responsive services; • Building capacity in mainstream services (e.g. community sector, education, mental health) through consultation and training to support people with refugee-like backgrounds; • Providing individual and group interventions to counter the effects of trauma and occupational deprivation; • Building capacity of refugee communities through community development strategies and relationships with strategic partners and community leaders.
How might a refugeelike background affect occupational therapy?
The significance of a refugee-like background should be considered at all stages of the occupational therapy process. Many people with refugee-like backgrounds have experienced situations where it has been difficult to trust others and their safety has been at risk. Unfortunately, coming to Australia does not mean a person automatically feels safe, particularly those on temporary visas. Therefore, fostering a safe and positive therapeutic relationship is essential. It takes time to build trust and develop the capacity of the client and their family to engage in power sharing. Using
a qualified interpreter and other language support strategies is vital to this process.
During assessment there is the potential to incorrectly label behaviours that may be reactions to trauma. For example, some children may lack eye contact/demonstrate hyperactivity or difficulty paying attention, which could be incorrectly labelled as attention deficit disorder, autism or global developmental delay. Mistrust of many systems or stigma may also mean that people with refugee-like backgrounds may under-report their children’s issues due to concern their children will be taken away. Additionally, symptoms related to mentalhealth presentations need to be considered in relation to cultural understandings and idioms of distress. For example, talk of body-focussed issues may actually be a sign of mental-health distress. This highlights the importance of using interpreters to understand the cultural meanings of words used to describe experiences.
In identifying and analysing occupational issues, there may be systemic barriers to occupational engagement that result in changes to people’s roles. For example, the inability to work in a preferred job may be linked to non-recognition of overseas qualifications, limited understanding of job-seeking processes in Australia, or discrimination on behalf of potential employers rather than an absence of skills. The abilities and resilience of people from refugee-like backgrounds in light of such adversity should be championed.
During occupational therapy intervention, clients may be compliant with suggestions regardless of whether they meet their needs. Reluctance to disagree with the therapist may be reflective of cultural norms or fear
of appearing ungrateful for services, which clients might predict will negatively impact their visa status. Possible trauma responses need to be considered when suggesting the separation of a child from their parent for the purposes of assessment or promotion of occupational engagement. There may be difficulties with money and access to resources, social support and other services. Additionally, ending the therapeutic relationship may be challenging. There may be different views on the role of the health professional, and people may not have had experiences of positive relationships with people in authority or of positive goodbyes.
Some steps occupational therapists can take when working with people from refugee-like backgrounds:
• Become trauma-informed and aware of the biopsychosocial impact of trauma on the person, their family and community; • Develop cultural humility–start by acknowledging your own culture and worldview, and become curious about different cultures; • Consider the people who access your services and learn more about their home country, community and cultural and religious backgrounds; • Advocate for access to services, particularly for people seeking asylum or on temporary protection visas; • Understand the process of cultural transition and its impact on occupational transition; • Always use interpreters, seek training in their use and advocate their use by others; • Consider having translations of resources in other languages and audio recordings to accommodate different levels of literacy; • Be transparent with the information you are gathering and how it will be used; • Dedicate time to building trust and a positive therapeutic relationship. About the authors: Laura Irvine-Brown, Rachelle Coe, Rosemary Signorelli are convenors of the Occupational Therapy Australia Refugee Settlement Interest Group and have a range of experience working with refugees and asylum seekers.
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