ILLAWARRA COMMUNITY CONSULTATION REPORT

9^TH OCTOBER 2001

INTRODUCTION

The following is a brief overview of the history of STARTTS involvement in the Illawarra. The present level of service provision is also outlined. In October 1995 a Service Agreement was established with the Illawarra Area Health Service for STARTTS to provide an outreach sessional service.

The STARTTS Outreach Program has been developed to assist Area Health Services throughout NSW to address the mental health needs of refugees settling in their target areas who have experienced torture and trauma. At the same time it is not meant to be the sole answer to their mental health needs. The establishment of the Illawarra service is part of STARTTS contribution to assist the Illawarra Area Health Service to address this local need, particularly with clients that present with often very difficult and challenging problems.

HISTORY OF SERVICES OFFERED

Clinical Practice

As outlined in the service agreement, STARTTS provided a limited service involving the placement of a STARTTS officer every Thursday, operating out of the Wollongong Community Health Centre at Piccadilly in Wollongong. The STARTTS officer carried a limited case-load offering assessment, appropriate counselling interventions, and referral where necessary.

Marc Chausssivert was assigned to the outreach position and remained for four years. Svetlana Milojkovic replaced Marc for an eight month period. Peter Davis commenced in the position in October 2000 and remains until the present. He was joined by Elizabeth Rowe in July of 2001, who also works one day a week on a sessional outreach basis.

Consultancy and Liaison Role

Networking with local health service providers was initiated, with a focus on those  working specifically with refugee survivors of torture and trauma. The purpose was to assist them in their work with this client group.

Workshops and Training

Several trainings and workshops for community workers and service providers were conducted, in order to help them gain a better understanding of the problems affecting torture and trauma survivors and how to adapt their skills in working with this client group. It should be noted that individuals from the Illawarra region regularly attend workshops and trainings conducted from STARTTS in Sydney.

FICT

The Families in Cultural Transition is a resource kit that contains group activities, games, methods, and ideas which equip a group facilitator with a comprehensive package of resources to assist groups of immigrants or refugees deal better with the process of adjusting to living in Australia. A Train the Trainer program of three days was held. As a result a number of Department of Education Staff and others in the Illawarra have conducted the program since.

Support and Supervision 

In order to complement training provided by STARTTS and the development and maintenance of networks, ongoing support and supervision have been provided where possible.

Early Intervention and Health Assessment

Initiated in 1998, the Early Intervention Program (EIP) is designed to assess the physical, psychological and settlement needs of refugees soon after arrival in Australia. Appropriate intervention is then provided. A small number of eligible clients were accessing the service in the Illawarra in the initial two years.

Youth Camps 

Up until now STARTTS has not held a youth program in the Illawarra for youth survivors of torture and trauma. However, a number of young people have participated in Youth Camps organised by STARTTS, having connected with direct services in Sydney.

CLIENT OVERVIEW

Referrals

Referrals were initially made through the Illawarra Community Health Service. These were made to the Intake Officer at STARTTS in Sydney or directly to the STARTTS officer in Wollongong. There were times when there was a waiting period, however, this has fluctuated.

Backgrounds

The backgrounds of the client base in the initial years included Iranian, Chilean, Colombian, Bosnian, Vietnamese and Serbian. This has changed over the years with a majority of clients presently from Serbia, Bosnia and Croatia. This has also been a reflection of the Federal Government’s Humanitarian Program.

Age

The majority of clients are between the ages of 30 – 60 years. However, child and adolescent clients make up a significant number of client assessments in the Early Intervention Program. Several of these have continued with ongoing counselling.

Trends

Over the last year the demand for STARTTS services in the Illawarra has been increasing. The number of clients referred to the Early Intervention Program (EIP) rose sharply in the first half of 2001. This was partly a reflection of increased focus on networking and developing the referral processes. Referrals to STARTTS General Services have also steadily increased.

STARTTS PRESENT INVOLVEMENT

Two STARTTS counsellors are working one day a week offering counselling and therapeutic interventions. Sessions are conducted with use of interpreters from the Illawarra Health Care Interpreter Service. The service operates from both the Wollongong Community Health Centre at Piccadilly and “The Cottage” in central Wollongong. Home visits are made in exceptional circumstances.

At the time of the consultation STARTTS counsellors were currently seeing more than 20 clients. This included both EIP and General clients. The majority of these clients were receiving ongoing counselling. A number of clients in the Illawarra have accessed STARTTS services in Sydney.

Clients are now referred from a variety of sources including Multicultural Health Service, Cross Cultural Ministries, AMEP, MRC, and various community workers. Referrals are made directly to the STARTTS counsellors working in the Illawarra. Alternatively, referrals can be made to the Intake Officer at STARTTS in Sydney.

Community networking with government and non-government service providers continues to be developed. Opportunities have been taken to promote STARTTS services particularly amongst minority communities.

Ongoing training and workshops have been held to continue to equip those working with refugee survivors of torture and trauma. Consultation has been provided for individual health service providers where necessary.

STARTTS is also working in cooperation with a Physiotherapist who is providing a service on a Tuesday morning for a number or our clients.

THE CONSULTATION

The consultation was organised by STARTTS and supported by the members of the Illawarra Refugee Issues Forum (IRIF). It was held on the 09^th of October 2001 at the St Michael’s Church Hall in Wollongong. Approximately 30 service providers and some STARTTS clients attended.

The aims of the consultation were to:

• Receive feedback on STARTTS services in Illawarra.
• Discuss suggestions for enhancement of our services in the area.
• Provide information about STARTTS.
• Give an opportunity for service providers working with torture and trauma survivors to discuss their work, joint projects and increase networking.
• Discuss the needs of refugees in Illawarra particularly focusing on the needs of small and emerging communities.

The program included update on STARTTS, information about the Early Intervention Program (EIP) and information about STARTTS services in Illawarra.

Questions raised during the presentations mainly focused on the training, waiting list, and contact with referral source related issues. There were also questions about the Families in Cultural Transition (FICT) Program and work with refugee young people.

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 in Illawarra
3. Needs and issues for refugee communities in Illawarra
   

MAJOR ISSUES RAISED

• “ Invisibility” and lack of access to many services by small and emerging communities in Illawarra (eg. Lao, Afghan)
• Need for further training and structured supervision for agencies working with torture and trauma survivors in Illawarra
• Issues of identity and participation for refugee young me
• Interaction of trauma and ageing process for refugees
• Lack of media and community awareness of refugee issues in Illawarra
• Need for support for English language teachers working with torture and trauma survivors
• Need for an increased community and service providers education about STARTTS
• Lack of bi-cultural mental health staff in Illawarra
• Lack of services targeting refugee young people in Illawarra and their specific needs
• Difficulties with service access for refugee communities in rural areas
• Dental health difficulties and problems with accessing dental health services for refugees in Illawarra
• Insufficient support for proposers of refugees and humanitarian entrants in Illawarra
  

RECOMMENDATIONS FOR STARTTS

·        Training and supervision

¨      Community development

¨      Referral and other service provision issues

¨      Children and young people

¨      Rural issues

¨      Refugee aged

RECOMMENDATIONS FOR OTHER SERVICE PROVIDERS

IMPLEMENTATION PROCESSES

It was suggested that the following approach is taken:

• The recommendations will be discussed, followed-up and monitored jointly by STARTTS and IRIF.
• Other relevant networks and interagencies will be involved at the appropriate times.
• Wollongong City Council will consider including some of the issues raised at the consultation in its Social Plan
  

TRANSCRIPT OF THE CONSULTATION RESULTS

Group2

• Small communities often miss out on services – lack of access
• Not all communities represented in STARTTS statistics eg long term Laos, Vietnam
• No TPV Holders in Illawarra
• Need for flexible and creative awareness raising strategies including pamphlets and media releases.
• Currently IHSS is not implemented in Illawarra
• EIP related comments
• Lack of understanding of the service by community workers
• EIP information needs to be sent out to workers
• EIP Information sessions needed for staff and clients
• Need to look at the possible use of bi-lingual counselling staff where appropriate
• General Services and EIP
• Insufficient feedback to referral sources

WHAT SERVICES ACCESSED?                      

GROUP 1

• Issue of “aged”/”aging” communities eg schizophrenia in one concentration camp group
• Issues of “loss of identity” in older people /younger males
• Maybe a chess group for elderly
• Community market garden – Macedonia – Dapto – Bellambi CC
• Issue of assisting communities which require professional input, and are isolated
• Continue running workshops in Illawarra in order to respond to changing face of torture and trauma situation
• Issue – how to provide input to community leaders who may resist issue eg ministers
• School response – refugee students
• Educational kits
• Leadership camps – competitions eg art
• Media education
• Use of alternative therapies – eg art therapy

SERVICE ACCESSED and  COMMENTS

• Co-facilitated group of torture and trauma clients – only negative thing was pertaining to “eating food” in culturally and sensitivity inappropriate way
• Issue of grief and bereavement
• Question of whether all families needing support are actually accessing STARTTS services – especially proposers
• How to provide appropriate support for proposers?
• How to promote STARTTS eg of aged care worker who only found out about services in 2000 affirmation services response eg dementia of depression
• Post WWII issues - STARTTS training helpful in addressing these (interaction b/w past trauma and degenerative disease)
• Issue of professionals needing input re: nature of T/T. “Transitions” can be helpful but does a professional gain a realistic appreciation of torture?
• Arrange a clinical training session
• Better use of website, library and other resources
• Issues of vicarious trauma
• Trained in “Family in Cultural Transition Programme” and ran a joint program with the Arabic community. Very helpful and in Arabic aged day-care (use of groups)
• Australian professionals lack appreciation of torture and trauma issues.
• How to incorporate into intake questionnaires. (R-CAT)

BARRIERS TO ACCESS

• Interpreters – language barriers, difficulties with counselling through interpreters
• Counselling - stigma attached
• Fears about confidentiality related issues
• Some people don’t understand the concept of counselling
• Feeling comfortable with interpreters and counsellors
• Referrals - Clarify basis for referral
• Need more feedback to the referring agent – more formal report

Group 4

SUPERVISION AND DEBRIEFING

• As a response to crisis
• Need for ongoing – establish
• Identify needs

Bi-lingual counsellors

Training: working with interpreters

Using TIS

Incorporate this in training program

NEW PROJECTS

• Youth
• Elderly
• Children

RECOMMENDATIONS

• Children’s programs run with other agencies
• Culturally sensitive
• Explore the use of bicultural workers in Illawarra
• Use family therapy
• More FICT groups- train the trainer
• Additional support to set up group
• FICT Co-ordinator  to set up regular  meetings
• All refugees could participate in FICT as a part of orientation or the AMEP curriculum
• More information about STARTTS– agencies – EIP/General Services/Government and Non Government
• Clients – languages
• Information  - incorporate form other services
• Youth camps in Illawarra
• Update “eye of the needle”
• More feedback – referrals
• Support for small and emerging communities and workers
• Need for children’s counselling services in Illawarra

Group 3

• Increase STARTTS services in area
• STARTTS be conscious to debrief interpreter (particularly contract worker) after session
• Training for teachers (AMEP/TAFE): Classroom management, debriefing for teachers, self care strategies, how to manage difficult cultural opinions racism, grief and conflict
• Resource pack for Outreach workers, tutors, teachers – in particular remote workers
• STARTTS to address issue of refugees in remote are eg 1800 free call, virtual counsellor and promotion of this service
• Assistance with transport to Sydney for specific counsellors (eg language specific)
• Exploring existing mental health services in the area for clients
• Addressing issues of accessing young men
• Tailor training to suit the needs of service providers
• Dental health issues
• Clients often request the same interpreter - worry about workload of interpreter (eg Serbian interpreter)
• Can counsellor come to client it difficult to set to Sydney?
• Can be difficult rapport with different cultural counsellor
• No recent Bosnian arrivals so have not made referrals recently
• Important for STARTTS to try to have bi-lingual counsellor
• Clients travelled to Sydney for bi-lingual counsellor
• AMEP – only 20 % of their students seem to access EIP
• Have regular meetings with Liz and Peter
• All teachers have done basic training

COMMENTS

Networking is positive

High level of co-operation between counsellors and  Liz and Peter

Training could focus on specific issues for teachers/in classroom

Teachers loving opportunity to debrief

Classroom management

Accessing Sydney, difficult Carramar

TAFE

• Ensure that training is specific enough for teachers
• Need for bi-lingual counsellors. Training for our own counsellors in cultural issues/difficulties
• New consultant that has been appointed to look at Mental Health Issues at TAFE – possibilities of collaboration.
• Covering a big region. eg Moss Vale, Queanbeyan, rural areas and Cooma
• Resource information for teachers/tutors so they have an increased awareness of org’s available to access (good for outreach)
• STARTTS attend a session at TAFE for staff to inform of service
• Health issues: Dental, mental illness (good relationship with local health service) sexual assault
• Peter has been very visible in the community