BOSNIAN-HERZEGOVINIAN COMMUNITY CONSULTATIONS WITH THE NSW SERVICE FOR THE TREATMENT AND REHABILITATION OF TORTURE AND TRAUMA SURVIVORS (STARTTS)

30/11/01

THE CONSULTATIONS

The consultation was jointly organised by a number of organisations including Bosnian Interagency, Bosnian Welfare and Information Centre (BIWC), and Cabramatta Community Health Centre. It was supported by the Auburn Council, Auburn Migrant Resource Centre (MRC) and Parramatta, Holroyd and Baulkam Hills MRC. The consultation was held on the 30^th of November 2001 at the Lidcombe Community Hall. Approximately 40 community members attended, and the vast majority of them were STARTTS clients.

The aims of the consultation were to:

• Hear the views of the Bosnian-Herzegovinian community members and workers about the needs/ issues and concerns of the community as relevant to STARTTS work.
• Receive feedback on STARTTS services from community members and workers
• Discuss the concept of counselling
• Provide updated information about STARTTS
• Feedback on Auburn Migrant Resource Centre was also sought

The program included update on STARTTS, information about the Early Intervention Program (EIP) and STARTTS services to the Bosnian-Herzegovinian community (included clinical and community development services).

Following the presentations, there were small-group discussions focusing on a variety of topics including:

1. Feedback on STARTTS Services
2. Suggestions for STARTTS to enhance its work with Bosnian-Herzegovinian Community
3. Participants’ understanding of the concept of counselling
4. Feedback on Auburn MRC services

STARTTS SERVICE FOR THE BOSNIAN-HERZEGOVINIAN COMMUNITY

STARTTS (Early Intervention Program and General Services) has had 837 clients from Bosnia-Herzegovina since 1993 when the first referrals from this community were received. 51% were female and 49% male across a range of ages. There are currently 10 Bosnian-Herzegovinian clients waiting for counselling services. 644 clients of 837 clients have been discharged to date.

Table 1: Gender of Bosnian-Herzegovinian Clients at STARTTS from 1993-2001

In comparison with many other communities accessing STARTTS, referrals rates of Bosnian-Herzegovinian clients are high and have been steadily increasing with the employment of bi-lingual staff and introduction of the Early Intervention Program (EIP). It appears that clients of this background have a reasonable understanding of the concept of counselling and post-traumatic reactions. However, the high rates of referrals might also reflect the directions of the Australian Humanitarian and Refugee Program in the 1990s, as well as an extensive community education and community development work with this community. 

Table 2: Referral Patterns of Bosnian-Herzegovinian Clients to STARTTS from 1992-2001

The majority of referrals to STARTTS are referrals from Community Welfare (usually ethno-specific) organisations and self-referrals. Again, this indicates a high level of community liaison and networking as well as a reasonable understanding of STARTTS services in the community.

In addition to counselling and psychotherapy, Bosnian-Herzegovinian clients have accessed the following STARTTS services:

¨      Specialist Migrant Placement Officer – Employment and Education program. The community has been accessing this program since its introduction in 1993.

¨      Families in Cultural Transition (FICT) Program – there are a number of bi-lingual facilitators and numerous FICT groups were run for this community, both in Sydney metropolitan region as well as the Hunter Outreach.

¨     Youth Program – Bosnian-Herzegovinian young people have been attending STARTTS Multicultural camps since 1994, and are usually one of the groups with highest numbers of participants (some camps had 50-60 % of participants from this background).

¨     Physiotherapy and massage therapy –high numbers of clients attended this service since 1994

¨     Group sessions – Bosnian Women’s counselling group, Bosnian Women’s stress management group (1995), significant number of information sessions.

Furthermore, following are some of the community development projects where STARTTS provided significant support for the community:

¨      Bosnian Ethnic School

¨      Bosnian Interagency

¨      Training and support for Bosnian community and welfare workers

¨      Zena 21 – Family Magazine

¨      A variety of health projects such as production of the self-help booklet “Becoming ourselves again”, assistance with production of the Bosnian language version of the “Health System in Australia” booklet, participation in women’s health projects.

¨      Extensive community education efforts through ethnic media and information sessions

¨      Participation in a number of committees of Bosnian community organisations

¨      Assistance with Bosnian Youth Projects including 3 Youth Camps

Work with Bosnian-Herzegovinian community was structured according to the STARTTS systemic model. Consequently, interventions are provided at a number of levels of the social system including individual, family, social support group, community and mainstream services and institutions. This work was presented at the 6^th International Conference on Health and Human Rights in Cavtat, Croatia, in June 2001.

ISSUES RAISED DURING THE SMALL GROUP DISCUSSIONS

Five distinct themes were identified through the small group discussion. The themes included feedback on STARTTS services received up-to-date, community information related needs, group-work related needs, additional services required or an extension of already existing services and suggestions for the youth-work area. Each theme will be presented and supported by the participants' comments.

Feedback on STARTTS services received up-to-date

The feedback was overwhelmingly positive. Some participants commented on the specific aspects of STARTTS services which they found helpful while others commented on the usefulness of counselling in general. Overall, counselling was considered useful because it provided an outlet for the expression of emotions, and appeared to result in physical and psychological health benefits for some of the participants.

                        …you can open up and that is often impossible with

family and friends…

When I was first referred to STARTTS I was feeling

physically and psychologically unwell. STARTTS

assisted me in both areas and should continue with

good work.

When I first met Indira it felt like all the little cups

in my mind were messed up, and Indira helped put

them all in order.

The other aspects of service which received positive feedback included Families in Cultural Transition (FICT) groups, Zena 21 (useful information), massage therapy (assists with physical health), transition between Early Intervention Program (EIP) and General Services, comprehensiveness of EIP services, ease of access and short waiting times. Additionally, participants commented on usefulness of both individual and group counselling. Finally, it appeared that all the participants had a good understanding of the concept and processes involved in counselling.

Community information related needs

Community information related comments focused on the segments of community that should be targeted and types of information required. Firstly, it appears that since the introduction of EIP most new arrivals were made aware of STARTTS. However, the level of awareness of STARTTS services appears lower among Bosnians who arrived prior to introduction of EIP. Consequently, the group that should be targeted with the information are Bosnians who arrived 3-5 years ago.

Secondly, following are the information types that were identified as necessary for the Bosnian-Herzegovinian community:

¨      Additional information about the FICT Program

¨      Information about the difference between EIP and General Services

¨      Information about STARTTS relationships with other Government service providers and related advocacy

¨      Clarification of referral processes for both EIP and General Services

¨      Information about the types of therapeutic interventions undertaken at STARTTS for example group and individual interventions.

¨      Information about the STARTTS Specialist Migrant Placement Officer (SMPO) program

It was suggested by the participants that the avenues for information provision could include Bosnian ethnic media, Bosnian centres, Bosnian interpreters and information sessions on specific topics.

Group-work related needs

There were numerous comments on the value of group-work and the need for STARTTS to increase this service with the Bosnian-Herzegovinian community. The aims of the groups would be as much therapy-related as they would be social isolation related. It appears that social isolation is a significant issue for many single women and widows in the community.

We need social support groups to break

the cycle of isolation. Loneliness is like a

type of "illness", particularly for single

women and widows.

There was also a significant emphasis on provision of group-work for men. One participant of the men's group suggested that the consultation process was highly therapeutic for him as he had an opportunity to talk to other men, sing and share a meal with other consultation participants. Consequently the types of groups suggested included:

¨      Social support group for single women/widows

¨      Group for mothers with young children

¨      Men's social support group (can also be mixed)

¨      Men's therapy group

Social support groups would include outings/excursions as well as art and craft activities.

Additional and extension of existing services

A number of participants expressed a need for additional psychiatrist time particularly in the light of one of the STARTTS psychiatrists taking a year off and another leaving Australia. Most of the comments about access to psychiatrists came from the men's group.

Women's group focussed on the access to physiotherapy and massage therapy in terms of the waiting times and the criteria for using this service. It was suggested that there was a need for more massage therapists at STARTTS.

Furthermore, one group suggested for STARTTS to consider extending its Outreach (both EIP and General Services) to the central Sydney area particularly Redfern/Central/Sydneham.

There were also suggestions that after-hours appointments and home visits should be made available depending on individual client needs. Moreover, one group suggested that STARTTS should maintain a directory of doctors and other health professionals who speak languages relevant to the Bosnian-Herzegovinian community. Finally, it was also suggested that STARTTS should continue to provide training and support for Bosnian welfare and community workers.

Youth-work related needs

According to the consultation participants, some of the difficulties Bosnian young people experience include social isolation and lack of constructive activities. The usefulness of youth camps was acknowledged, but there was a concern that many goals achieved at the camps (eg. breaking social isolation) are not maintained during the period between the camps.

                                    Camps happen once or twice a year

                                    and when they come home they do not seem

                                    to keep in touch with each other.

                                    Bosnian children can contribute a lot to

                                    Australian society if they receive appropriate

support.

Many young people are isolated and they do

not make friendships easily.

A need was identified for an ongoing, group-focused intervention to achieve the following goals:

¨      Break social isolation cycle

¨      Provide Bosnian young people with educational activities

¨      Provide Bosnian young people with safe environment where they can discuss settlement/culture change/refugee experience and other relevant issues.

ISSUES RELATED TO AUBURN MIGRANT RESOURCE CENTRE

The first issue raised was lack of information in Bosnian language at the MRC. The second issue focused on the lack of information about availability and roles of Bosnian speaking workers providing services from the MRC premises and/or employed by the MRC. A suggestion was also made that these workers should increase their community information roles and organize relevant information sessions. Finally, it was suggested that MRC could facilitate and support Bosnian social-support groups in the Auburn area particularly looking at organizing a men’s group.

RECOMMENDATIONS

Recommendations for STARTTS

Recommendations for other service providers

TRANSCRIPT OF THE SMALL GROUP DISCUSSIONS

Group 1

¨      Referred by brother in law. Overall very helpful service. Massage assisted with major health problems. No difficulties with access eg. waiting list.

¨      When first referred to STARTTS was feeling physically and psychologically unwell. STARTTS assisted in both areas and should continue with good work.

¨      For elderly clients - counselling very important particularly access to the same cultural background counsellors

¨      Zena 21 - very good as provides lots of useful information.

¨      Need more information sessions on specific topics.

¨      Importance of provision of STARTTS information immediately after the arrival - early intervention.

¨      Assistance with obtaining employment

¨      Experiencing difficulties getting into TAFE courses.

¨      Need for more information about STARTTS services

¨      STARTTS very good. Referral mechanisms efficient and would recommend for it to keep going.

¨      Attended counselling for 2 years and left when feeling better. Recommenced because of the effects of the Sep. 11^th attack.

¨      Not enough activities for young people - need group activities, friendship, dealing with social isolation, need for follow-up after the camps.

¨      Young people and children have a lot to contribute if assisted.

¨      Referred to STARTTS by a Bosnian welfare worker - no difficulties with access

¨      Need for specific-need groups eg. women with children

¨      Need to know that we can all work together with the community

¨      Have been in Australia for 5 years and was never referred to STARTTS. Only needing assistance with accommodation and income support

¨      Was given wrong information about what STARTTS does (information provided by an interpreter)

¨      Need for STARTTS to make better use of Bosnian radio programs

¨      Auburn is a good location but Carramar is not very accessible. Need for services around Central/Redfern/Sydneham

¨      STARTTS was very good and helped our family. All information was provided in one spot. Should continue to provide early intervention.

¨      Bosnian centre should be one of the main points of contact

¨      Need for a women's social support group - to include monthly outings/excursions.

Group 2 (men's group)

¨      Positive experience with the Waiting List Team

¨      Individual counselling very useful

¨      Good that STARTTS only uses professional interpreters.

¨      Need for "Bosnjak" interpreters (ethnicity rather than language)

¨      Poor access to psychiatrists at STARTTS - not enough

¨      Examples of long waiting periods and short waiting periods.

¨      Positive experiences and opinions about individual counselling

¨      Need for after-hours appointments for people who are employed

¨      Need for group work - Men's Social Support Group

¨      People who have arrived prior to EIP have less information about STARTTS than the new arrivals. Need to focus community education on that group.

¨      Utilise Bosnian ethnic media

¨      Would like STARTTS to provide information to clients about doctors and specialists who speak their language

¨      Difficulties accessing psychiatric services at STARTTS

¨      Need for more group activities - social support (mixed group) as well as group therapy (men's group)

¨      Need for further STARTTS training for Bosnian welfare and community workers

Auburn MRC feedback

¨      Should have more pamphlets and other relevant materials in Bosnian language

¨      Not informed about the services Auburn MRC provides

¨      Otherwise OK. Services steadily improving over the last 2 years.

¨      More information from Bosnian speaking workers – roles, availability and other relevant information

¨      Group-work – social support groups

¨      Organise a men’s group

Group 3

¨      Feels that service was very good and beneficial

¨      EIP enabled access to General Services

¨      Need for an increase in physiotherapy/body-work services

¨      Satisfied with services but need for continuation of support after counselling completed - social club for new arrivals.

¨      Need for social support groups to break the cycle of isolation. Loneliness defined as a type of "illness". Particularly difficult for single women and widows.

¨      Social support group with monthly outings

¨      People happy with General Services counselling

¨      FICT was beneficial but there is not enough information in the community about this service

¨      Counselling very useful - both group and individual

¨      Need for groups - both therapy and social support (to include art and craft, etc.)

¨      Need to clarify the difference between EIP and General Services further - use Bosnian ethnic media

- what services provided

- what type of support (individual or group)

- referral processes clarification

- more information about the relationship with other service providers such as Department of Housing

¨      Need to address the misconceptions about what STARTTS can do particularly in relation to housing issues - Priority Housing.

¨      Explanation of counselling - beneficial, "makes you feel better", "you can open up and that is often impossible with family and friends", therapy is helpful.

SOME FURTHER INFORMATION AND COMMUNITY BACKGROUND RESOURCES

The Australian Development and Training Group (1999), “Bosnian-Herzegovinians in NSW: 1998 Community Profile”, Bosnia-Herzegovina Project Inc., Sydney (for a copy of the report, please contact Bosnian Information and Welfare Centre on 9749 9177)

BosNet – a computer group/forum run by volunteers on Bosnia-Herzegovina, provides information on current events, history and culture – http://www.bosnet.org

Ethnic Communities Council Gold Coast (1997), “The Need for Gentle Words: A Community Needs Assessment of Survivors of Torture and Trauma from Bosnia Living at Gold Coast”, can be found at http://ariel.ucs.unimelb.edu.au/~atmhn/www/research/bosnia-survivors.aspl

Fogelquist A.F. (1993), “The Break up of Yugoslavia”

Riedlmayer & Andras (1996), “A Brief History of Bosnia-Herzegovina”