Audio transcript (edited)

MR DOLMAN: Well good afternoon everyone and welcome to today's webinar, cultural considerations to support children from migrant and refugee backgrounds' mental health and wellbeing co-produced by Child Family Community Australia and Emerging Minds.

Hi there, my name's Chris Dolman and I'm the senior workforce development officer here at Emerging Minds, the national workforce centre for child mental health. And in today's presentation we'll be exploring how practitioners can engage in respectful and collaborative and curious conversations with families from migrant refugee backgrounds to improve children's mental health and wellbeing.

Let's begin by having a look at the learning objectives to see what's ahead during this hour. So during this webinar we'll be describing some of the challenges that children and families who've settled in Australia experience both pre and post settlement. We'll be considering the extent to which practitioners need to develop expert cultural understandings to work effectively with families from cultures other than their own as well as exploring the extent to which practitioners, in order to work effectively, need to have an awareness of how their own beliefs and values and assumptions are shaped by culture.

And we'll also be spending some time just describing how engaging in respectful and collaborative and curious conversations with children and families can help them reconnect with their own skills and wisdom so that - to their own cultures and communities and can be helpful for them in terms of responding to the problems that they're facing.

As we continue both Emerging Minds and Child Family Community Australia and all of those involved in today's webinar would like to recognise and pay our respects to Aboriginal and Torres Strait Islander peoples, their ancestors and the elders past, present and future from the different First Nations country right across this land. We acknowledge the importance of connection to land and culture, spirituality, ancestry, family and community for the wellbeing of all Aboriginal and Torres Strait Islander children.

This webinar is the fifth in a series of six that Emerging Minds and CFCA are offering in relation to a focus on infant and child mental health. We’ve got another one coming up around responding to Aboriginal children and families in context of family violence.. And you can see there some of the other previous webinars that we've offered as well in relation to supporting children after natural and human induced disasters, working effectively with parents who are living with the effects of alcohol and other drug use and considering the needs of their children in those circumstances, parent/child play is a mental health promotion strategy and also a webinar in relation to child focussed supervision within adult focussed services and how does that work. So they're some of the themes that we've looked at so far and you're welcome to access those on either the Emerging Minds website or the CFCA site as well.

Okay, so I'd like to continue now by introducing our presenters today, Liz Gordon from QPASTT and Julio Alejo from CAASSA. So welcome to both of you. We've already circulated your brief bios so instead of reading that out I'd like to sort of perhaps just begin by asking you each a question really around you know what it is that's captured your interest about this particular area of practice. So Liz, to you, welcome, and yeah, for you, what it is that really draws you to this area of work?

MS GORDON: Yeah, hi Chris and hello to everyone listening. I think this area of work is extremely rewarding, it's rewarding to support people in their recovery journeys and as a supervisor it's really a rich experience to help practitioners grow and every day we're learning something about culture, about the therapeutic process and about each other as well.

MR DOLMAN: Terrific, thank you, Liz, we look forward to your contribution throughout today. And Julio, yeah, what about you? What is it that continues to draw you to this area of work?

MR ALEJO: Yes, hi Chris again and firstly I just would like to thank you for inviting us, giving us the opportunity to present today and also I'd like to welcome our listeners for today. I think for me it's pretty simple, it's really my passion, my passion to help others most specially in the drug and alcohol field. And then in - and then with this, working with ethnic communities in Australia has given it a whole new meaning, a whole new perspective and even has given me a whole new purpose actually in this field.

MR DOLMAN: Terrific, thank you, Julio, yeah, again looking forward to hearing your contributions and stories of practices as we go through the presentation today.

So I thought we'd begin this presentation with this quote which, Liz, this comes from your work context, this quote, would you like to sort of introduce us to this quote please.

MS GORDON: Yeah, sure. And I think it's really important that we start with the words of survivors as well so I'll read it out. It says, 'Before the war my life was like a vase that was then broken when the war came, never to be repaired. But instead of trying to mend the vase so that it looked like it did in the past, it can be made into a mosaic which is still beautiful.'

And I think that's really powerful, it does - it holds two things together which I think you know everyone listening can hold in mind as we talk today, and those two things are firstly, that there's an undeniable impact of trauma for people who've come to Australia as refugees and that that leads to irrevocable change. But the other thing that is held in that quote is that there is also great capacity to heal and to find meaning and experience as well.

So I hope people can hold those two things in mind as we talk today.

MR DOLMAN: When you say that you hope people can do that, have you found you and your team and Julio, as well, that it's not always easy to hold those two in practice?

MS GORDON: Yeah, I suppose there is a challenge when we hear very difficult stories to also recognise strengths and capacity, that can be difficult and vice versa, sometimes it can be really hard to understand experiences that are so difficult but also perhaps really different to our own as well.

MR DOLMAN: Yes. No, thank you for the reminder of both of those aspects of people's experience for us to be attending to when we meet with children and families. You've spoken about the undeniable impact of trauma on the lives of children and families from refugee backgrounds, in the slide you've drawn some distinctions between some of these terms that are used to describe people's experience. Yeah, would you continue to be able to speak to something about those, Liz?

MS GORDON: Yeah, sure. So this is really to acknowledge that there's different journeys of migration for people coming to Australia and there can be overlap. These categories aren't always neat but there's also important distinctions and one way to think about it is to consider how much choice, control and preparation has someone had in coming to Australia. So typically for migrants they are making a choice to come to improve their life. For refugees and asylum seekers it's not so much of a choice. It's more an act of survival. There's been a threat to their basic safety and that's typically due to war, conflict and persecution and there's a need then for protection. With refugees that protection's been recognised so the focus then becomes about settling in the new country and part of that is also managing any impacts from refugee-related trauma.

But there's a real hopefulness about shifting from surviving to thriving in the new context. For asylum seekers there's another distinction so that need for protection is there but it hasn't yet been recognised. So really many asylum seekers are still focussed on survival and there can be a lot of fear about being returned to their country and a lot of uncertainty in the present as well. And another part of that experience can be that, depending on how and when they came to Australia, they may not have access to employment rights, to welfare payments and to education and the process of seeking asylum can be quite traumatising in itself and what we see is high rates of anxiety, depression, post-traumatic stress disorder and the research shows us that as well.

So when we're working with refugees and asylum seekers we're really looking for ways - and I encourage the listeners too to think about this - looking for ways to think about how we can optimise their control, their choice and their safety in any given situation because that's what they have lost.

MR DOLMAN: Yeah, I really like how you sort of highlighted those three concepts I guess like it feels I could hang my hat on a bit in a way, you know, control, choice and preparation, really be listening out for those, how people have experienced each of those in terms of their journey to Australia. And also I guess how they've experienced those in the country as well once they've arrived here. So I'd like to, yeah, move on to talk a little bit more to you both about the refugee experience in terms of you know what it is potentially people have experienced in their country of origin.

MR ALEJO: As Liz has already explained to us well I think, as practitioners, it's good to be reminded that most of our clients who come here have or has experienced you know political repression, deprivation of human rights, harassment, while in their journey from where they were to the camp, to here, threats to life and safety. It's always good to have those kind of things - torture is there, it's also a huge thing.

Actually I do have a sort of a nice - an illustration that I can share. I do have a client in the past that is alone here in Australia and he did share his story with me. The story goes like this: you know his - during the - in his native country there was a civil war and unfortunately his mum and his dad was butchered in the war. Luckily him and his sister were actually taken to a refugee camp in the neighbouring country. When they were there they thought that it was really a safe place but actually like two years, while they were there, actually the sister unfortunately was raped.

My client was resilient enough to face and accept the horrifying ordeal that happened to his life. Actually that didn't stop him from moving forward in his life. And if we go to the next slide, Chris, this will highlight that in them, in these people, in the people that we work with, there is a wealth of strength to persevere. There is this wealth of strength to move on, resilience, there's this huge resilience in them to start fresh and even to contribute to the society that they're in.

I'm actually, as we talk about this, I'm reminded of a book that I've read and the author quoted a quote from Kahlil Gibran and I’d like to read this, I'd like to share this to our listeners out there. A quote it said called 'Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.'

Look this might be true for you and me, Chris, and even for Liz, even for our listeners out there but most importantly this is true to those people who have come to this land of the free, who suffered greatly. And as Liz said or even in the quote that she gave about the vase, you know, it can never be the same again. But they're still healing. The pieces can still be put together and the story can be made beautiful with their life.

So my encouragement is that as we practitioners go out there and - go out to our clients, just to keep this in mind that they do have the ability to succeed.

MR DOLMAN: Thank you, Julio. Yes, and so again both of these aspects of people's experience, both some of the - in what you've both spoken about in terms of that political repression and oppression as well as those other accounts of what it is that sustained people and got them through these times holding both of those intention together, yeah, it can be - okay, as we turn to sort of take a closer look at some of the challenges that these families from refugee backgrounds are facing currently, there are a couple of these aspects that really are prominent in your work at QPASTT.

MS GORDON: Yeah, yeah, sure. I suppose the first thing to say, picking up on what Julio was saying too, is that many families really thrive in this new context but given some of those part experiences there are going to be challenges and needs for support as well and families are in cultural transition and that's often at the same time as they're worrying about family overseas, conflicts can be ongoing or family could be experiencing deprivation in camps as well; refugee camps. And people may have their own physical and mental health difficulties after arriving in Australia and I think with children it's also important to point out that those difficult experiences prior to arriving in Australia have happened at developmental sensitive times and that can have real big impacts on making developmental gains and can impact on you know how they feel about themselves, about being able to regulate behaviour and emotions but it can also impact on people's ability to trust others.

So something that can be a big part of the work that we do is around countering mistrust and suspicion and also people can feel that the world out there is no longer safe or predictable because that's what their experience has been.

We also commonly hear from families about inter-generational issues. So those circumstances where children and young people are learning the language in Australia, the process is faster than their parents. And that can really lead to a sense of empowerment and opportunity which can be a real positive thing for young people. But it can also cause some conflict within families as dynamics change and for parents sometimes there can be a real sense of loss of control in their roles as parents. They may even feel that they're losing that role as parents as children take - and young people take on more responsibilities in the family. And they can also be really worried about their children, feel it's very important for their development and for their success in life.

So that's something that we hear a lot about you know in our families, there's some of these challenges which are also to do with families integrating into a new culture and once again trying to bring different things together you know their own culture but they're transitioning into the Australia community as well.

MR ALEJO: And also just to build with Liz's point, in our organisation we've seen with men, especially the men that we work with, they really struggle with this change in power dynamics in the home. Like in their own culture, where they came from, the men are it, you know they make decisions, they're breadwinners and you know they run almost the household you know to be that force to run. But we've noticed that you know the power, the change here, they do struggle a lot and suddenly you know the wife suddenly has the voice here in Australia, equal voice and then the children, like what Liz is saying, you know the children becomes more vocal and answers back to them. Hence the men, I can see the men you know struggle with this. Often you know self-worth goes down, even self-esteem goes down and hence leads to all kinds of mental health, AOD and all of that you know things comes to play.

MR DOLMAN: And so all family members are impacted by these challenges of course, aren't they?

MR ALEJO: Yes, they are.

MR DOLMAN: Yeah, yeah. Actually, your comments remind me of a recent - I think it's a quite recent report released by ANROWS in relation to family violence in migrant refugee communities.

MR ALEJO: Yes.

MR DOLMAN: We'll provide a link for that on our - on the page after the webinar but, yes, some really important considerations in relation to changing relationships in families. And Liz, you started to speak a bit about some other challenges for families from refugee backgrounds as well in terms of those links to culture and other traditional supports and practices as well. Again this is something that becomes apparent to you in your work, the work of QPASST?

MS GORDON: Yeah, yeah. And another cohort that we often have referred to our service and provide support to is those families where they're single mothers raising children and that can be because the fathers have disappeared or been killed in war and conflict or the women may have experienced gender-based violence in that situation as well. And some of those mums really tell us about the loneliness and the isolation they can experience on arriving in Australia and traditionally, in their own culture and their own communities, the raising of children would be shared across extended family members and community and that's something that's been lost in coming to Australia.

And then that can be really compounded by a lack of knowledge about the supports that exist here or even fearfulness about services or some negative experiences as well when cultural or language needs haven't been met. And so you know we really try to support families in accessing those services and accessing that information but also building connections as well so that loneliness and that isolation is overcome and natural supports build so that people don't feel like they're raising children and surviving alone without that support.

MR DOLMAN: And so that lens to us really understanding that perhaps people don't have access - the same parents don't have access to those same traditional and cultural supports, that's an important lens to which to be viewing people's struggles with their parenting in some way.

MS GORDON: Yeah, I think it's something always to inquire about, it's hard for anyone to be raising children alone so really inquiring into what kind of supports someone has and what kind of gaps there may be and what some of those losses may have been and what typically may have happened as well and why isn't that happening here. And you know in refugee communities it can be at outcome of the loss of family members and the separation from family and from community.

MR ALEJO: Yes, and just again building to the point of Liz and even with our slide there, we've noticed as well that some people coming to Australia you know some of them have prior qualifications you know back in their country, they may be civil servants, they may be lawyers or doctors or - you know had a really good career and suddenly these qualifications are not recognised. And then of course then they'll be labelled as refugees as well really doesn't help self-esteem and all of that. And hence, like Liz was saying, you know, like for us at CAASSA we are very - we take this into account and we're trying to close the gap really that's out there in the community. And hence that's why we do sort of like you know support groups, we do have social groups, we do have referral pathways, information, education and the like. And I'm sure QPASST are doing the same things as well. Just to close that gap, that is really prevalent with this group.

MR DOLMAN: So part of the message to people tuning in would be also about really making sure they kind of research what is available. If their organisation isn't in the position to provide those services - - -

MR ALEJO: Yes.

MR DOLMAN: - - - to also discover what might be possible to refer people to or link - supports they can be linked in. Right. Sure, sure, okay. So let's have a further look at you know when responding to children and families from migrant refugee communities, these twin considerations I guess of you know to what extent do practitioners need to be developing expert cultural understandings alongside of having an awareness of their own beliefs and values and assumptions shaped by culture as well. This emphasis on the importance of ethical practice and these aspects of ethical practice, Liz, again is something that shapes the work of QPASST as well?

MS GORDON: Yeah, yeah, and I think this thinking around what our values are and what constitutes ethical practice is really important to think about. I kind of like to shift away from thinking of cross-cultural practice is something we just add on to our work or just is an extra chapter in a book but really think about the cross-cultural practice is really possible and can be operationalised in a way in the context of a really strong value base and cultural diversity is just one aspect of diversity.

So this is important for all of our work and every day we may be working with clients who are different to us in some way and diverse in ways. And those different points of difference may intersect as well. And so the values provide a compass for us in our practice, give purpose, direction, but can also be really useful when we're challenged in the work or we're really struggling as well.

You know if I look at client-centred practice and collaboration, if we have a real commitment to that as a value, then we will always work as hard as we can and wherever possible to optimise choice and control, to give information so someone can make an informed decision to participate. We're really focussing on working together to arrive at the best outcomes possible with the clients that we work with. And that kind of also intersects with other values so flexible service delivery is needed to - for this to really happen.

There has to be a really big focus on building relationships, I would say that's one of the key aspects of our work and really is a really important aspect of creating change as well. And it also just really point out that thinking about our work, as justice doing, if we think about things like accessing employment or stable housing or education, that that's an activity of justice because they're the very things that many of our clients from refugee backgrounds have missed out on or have been denied. So really encourage people to think about what their value base is and return to it if they're struggling in the work as well.

MR DOLMAN: And supports you from a - I guess in a clinical supervision perspective as well in those conversations with practitioners or - - -

MS GORDON: Yeah.

MR DOLMAN: - - - in teams as well to be referencing work as well against these concepts, these values.

MS GORDON: Yeah, yeah, absolutely and I really love that quote from Vicky Reynolds and it sort of says that if we're not sitting within what we consider our values and our ethical practice that can actually - that can be quite painful, that's the point where we can experience burnout and vicarious trauma but that also gives us a message that maybe something we're doing needs to be looked at as well. So I think it's really really powerful.

MR ALEJO: Yeah, no, I appreciate what Liz is saying like for us - for me, what really stands out in what Liz was saying was the flexible service delivery. I mean they're like - even in our practice at CAASSA we innovate, we turn, we make it client centred and it's all about building relationships just like Liz said. As mentioned earlier you know these people have a hard time trusting services, governments and the like.

MR DOLMAN: And so along with this goes a particular kind of take on this understanding of culture and cultural knowledge as well.

MS GORDON: Yes, so at QPASST we have clients that come from over 70 different countries so we can't all be experts on every different culture or community that we work with. It can be really useful to have some information and to do a little bit of research or talking with a colleague about some of the specificities of a cultural background but what we really also focus on is a conceptual understanding of culture as well. You know that culture changes over time, that there's a lot of diversity within a cultural community and different practices and different beliefs. Another part of our kind of understanding is using this iceberg model where often we're just seeing the tip of the iceberg in someone's cultural practice but underneath that is a whole lot of values and way of understanding the world and that that shapes relationships and behaviours but it's often sort of hidden from us and hidden from others as well.

You know an example of that for me is talking with a colleague and we're talking about our families and he was talking about his eight children and I said to him, you know, I have two children, I don't know how you cope having such a large family with eight children and he said to me, smiling, 'I don't know how you cope only having two children.' And I think that kind of really revealed my own assumptions about what's manageable as a family, what's valued as a family. And that's one of the delights of the work as well is learning more about ourselves and our own cultures and having those challenged as well. That's really important work - - -

MR ALEJO: And when - yeah, go ahead, Liz, sorry.

MS GORDON: I was just going to say one last point and it's just that that second one and that's a real valuing of culture as something that's really protective as well, rather than seeing culture as a problem to be solved, it's something that can hold wisdom and for many people the loss of culture has been extremely difficult and where - in the field of trauma where we're learning things about how rhythmic repetitive movement can help soothe the traumatised brain, that if I speak with my clients often they will tell us about the importance of song and dance and music with those rhythmic and repetitive movements that actually that something that they've already been using and have found effective and it's also important for their identity as well. So, I say there's lots of wisdom if we take the time to understand someone's cultural background and what it means for them.

MR DOLMAN: If we're guided by this idea of culture as protective not just as problematic, what would be some things that we could - we would more likely ask people early on in our conversations with them perhaps that was shaped by that? Do you have some reflections on that, Liz?

MS GORDON: Yeah, yeah. One of the conversations that we will have with families is you know what are some of their practices, their values that they've brought to Australia that they really want to hold onto? What are some of the things that they really did value or that they miss as well. And also what are some things maybe they want to change or even in the Australian context, are there things that they see here that they really want to take - to make use of or to learn more about. And so it’s really opening up those conversations which acknowledge that there can be great wisdom and value but there can also be things that are really difficult as well and that that's the process of family transition, it's not giving up everything and taking you know everything from Australian culture, it's about a bringing together and what's useful. And also can encourage recovery, hearing and belonging in this new context as well.

MR ALEJO: You know, I totally agree with Liz, how we can foster you know cultural knowledge and even in a working environment and to our listeners out there, we should not learn just the big things but also the small things you know in their everyday norm and I have this story that I can tell you about. So I do a lot of home visits as you would know and one day went for a home visit and when I went to the house, before I went in, they wanted me to remove my shoes. And lo and behold that day I used my favourite socks, black socks with a hole - with a hole in the middle toe and so you know I was really brave enough to just walk into the room and find the coffee table and stuck my feet down there.

So what I'm saying is that you know like what Liz was saying as well, the cultural knowledge is very important. There are some cultures that you know they would prefer a woman - women to work with women you know and all that kind of stuff. So you know those itsy bitty - the small things should be taken into account as well, right, and also the big, sure.

MS GORDON: And I think, just following on from Julio, your story is how important it is to just have a go, that you know there's going to be moments where we may feel uncomfortable or embarrassed or we not do things perfectly but I've found that the people that I work with have been really generous and will appreciate an attempt you know to recognise what their cultural practices are and so I'd really say, yeah, be ready to sometimes feel, yeah, a bit uncomfortable and maybe even embarrassed but to give it a go anyway.

MR DOLMAN: And it has me wondering whether this is what you both describe in there is also part of this concept of cultural humility as well. Yeah, and again this is a concept that's part of the practice that you both engage in. Is there something else you could speak to in terms of the importance of supervision in relation to cultural humility is or something more, yeah, more broadly even than that.

MS GORDON: Yeah, yeah. Look at QPASST supervision's really essential in terms of reflective practice and also really working on our understanding of ourselves as well. And I thought I’d provide an example of a situation, a really recent situation, where I was working with the mother a child that I'm seeing and the mum is an Iranian asylum seeker and she was discussing how overwhelmed and how worried she is about the education of her son at the moment in terms of online learning and the COVID environment and she was really really distressed about this.

And with me sitting alongside this mum, you know there's points where we have commonality, we're both mums, we're a similar age, we both have sons as well. And so there are things that are in common but it's also really important to recognise the differences and also my own position in that relationship and really I have a lot of power and a lot of privilege, you know I have freedom, I have permanency in Australia, I have the language, I have a job and financial security, sort of get the education system but I also have I suppose a cultural value around you know 'the kids will be okay, they'll catch up, they'll be fine', that kind of really sort of Anglo-Australian attitude of you know, 'It'll be all right'.

But for her, her experience is that life has taught her that things won't be okay and you know for her culturally, her son's education is a way out of poverty, it's a marker of her own success as a parent and also potentially his success into adulthood. And so if I was to not think about my own position in that relationship and emphasise with her own experience, I may dismiss her reaction as unreasonable or minimise it and in doing that what I would really be doing is replicating her early experiences of persecution where she hasn't been heard, where she - her distress hasn't been recognised or been validated or acknowledged.

But if I can - if I can really acknowledge that, and it may also involve some advocacy with you know with the school but if I can really let her know that I'm trying to understand her situation while putting aside some of my own cultural values, then that's going to be most effective and most supportive of her. I also - - -

MR DOLMAN: Sorry Liz. I was just going to say like in that example like what would tell her that you're trying to really understand or really I guess putting aside those other things and seeking to get her experience. Like how would she pick up on that or what would you be doing that others could do?

MR GORDON: I think it's a real sitting with, it's not trying to problem solve straight away, it's giving her space and time to share her experience. It may be making some tentative emphatic responses, you know it may be - because I'm wondering if this is, you know whatever that may be, giving her the opportunity to correct that if that's the case. And so it's a real kind of joining with and it's not imposing, you know it's not me going, 'Look, it's going to be okay, he'll catch up.' That's my understanding, that's my value so it's not kind of trying to reassure her because that could be a minimisation of actually what her distress is about which is about her son's education but it's also about something a lot bigger for her as well.

MR ALEJO: Yeah, to our listeners out there, actually I cannot stress enough the importance of reflective practice as Liz said, if you do have access also to clinical supervision you know supervision with your manager like I do, we do have, that's a standard practice for our organisation and I'm also privileged to work with - I do have support workers working with me so every session I take time to debrief how the session went you know just to learn also like Liz was saying, you know what do I need to improve, was I inappropriate when I asked these questions and all of that stuff so yes, so please please do that, reflective practice and you know not knowing really, not knowing is okay as well. Not knowing is okay and you know so, yes, that's my encouragement for listeners out there.

MR DOLMAN: Yeah, and I guess these are not even doubly but more than that important particularly when working with children as well in terms of asking those very questions that are on the slide there around privilege and blind spots. Let's have a look a bit further about practices for engaging in collaborative and respectful and curious conversations with children and families, extend on what we've been talking about so far. And there's this concept of cultural safety. I'll perhaps read this quote, 'An environment that is safe for people, where there is no assault, challenge or denial of their identity, of who they are and what they need, it's about shared respect, shared meaning, shared knowledge and experience of learning, living and working together with dignity and truly listening.' And we can think about cultural safety through different frames or aspects of that. And firstly, to you Liz, in terms of this notion of cultural safety shaping assessment and practice as well, could you speak about a bit some of your learnings in relation to that?

MS GORDON: Yeah, yeah. So at QPASST cultural formulation is a really important part of our assessment and really it recognises that you know as practitioners we need to take the time and make the effort and show curiosity and interest in someone's cultural background and so weaving that through our assessment conversations. And it would be really using questions to unpack someone's cultural identity so really simply asking them how they describe their cultural background or their cultural identity. And that - we can even drill down further into that you know in terms of a particular ethnicity or tribal group or you know religious practice, whether - or religious belief, whether they live in the country or in a city in their country of origin. So really trying to understand that.

But then if they're also coming to our service with a particular issue or difficulty or problem we may ask questions around you know in their language does that issue or difficulty have a particular name? How do people cope with it or manage it? What do other people say about this issue you know what do they - might they think about it? And some of that's to really also unpack whether there's stigma associated with whatever the difficulty is which is quite common when it's a mental health difficulty. And that can also impact on the therapeutic relationship and accessing other supports.

Those questions can also help reveal where there's particular strategies or skills that a client or a family may be able to put to good use here in Australia or that there may be barriers to that and we may need to think how to address those barriers. But all of that takes time and you know a real curiosity and an intentionally asking of those questions. And as I said before I've found that people are really willing to share that a lot of the time because their experience has been that people don't ask that or they make assumptions instead so it's an opportunity to share something of themselves and also some of the things that they may be missing as well from their country and community of origin.

MR DOLMAN: Asking what they're missing?

MR ALEJO: Yeah.

MR DOLMAN: Yeah.

MR ALEJO: And I totally agree with Liz, I can think of. within our practice, we do have men from a certain community that we have this social group ongoing. We did ask that question. What is your interest? And so then we learned that they came from a fishing, animal tendering background. So then we designed our social group in that manner so we went fishing near Gawler, then next session we went up to the hills and Rialta Park and had a walk into the wilderness and you know that gave them a sense of you know relief or connection.

MR DOLMAN: Yeah, right. Yeah, connection to those practices, those skills that they're quite familiar with.

MR ALEJO: That there were before, yeah.

MR DOLMAN: Yes.

MR ALEJO: And we're still - and I'm still busy looking actually for a farm which we can go to see animals and goats and what have you and all of that stuff but yep.

MR DOLMAN: It's interesting, isn’t it, to think about the type of skills that people will employ in those contexts that you've just described and how a reconnection with those could also stand them in good stead to respond to the - you know the predicaments they're facing, of the reasons why they might be consulting with you as well. And, yeah, Liz, I've heard you also speak earlier at other times about even very ordinary everyday ways of inquiries about cultural identity through the use of maps on phones or globes or something like that.

MS GORDON: Yeah, yeah. And I really encourage people to be creative so yeah, that's right, you know there's been times when I've sat with a client and we've looked at an atlas together and you know gone through that and even plotted out the journey, the refugee journey. Something that came to mind that I thought just then that may be useful in terms to share with working with children something I sometimes have done with kids is, and I use a quite play based therapy approach, and so I would sort of act this situation out where I might say to a child, you know, 'Some of the kids have told me that being in Australia it feels like one foot is over here ' - and I would be acting this out - 'this foot's in Australia and that might be at school and with friends at school and this other foot is still in the country' that they've come from you know whether that's Somalia or South Sudan and for some kids they feel really strong on these two feet together but sometimes other kids tell me that those feet feel really far apart and they can feel like they're falling over or they can't stand up straight anymore.

Now what's it like for you? Where are your feet? Can you show me? Or I might say, you know, 'Can we go over to this side and stand here and you tell me more about what it's like', you know what was Somalia like or what's it like being with your family when you meet with your community members from Somalia? So just kind of being a bit creative as well and opening up those conversations and being playful especially with kids about that as well.

MR DOLMAN: Yes, thank you, that's a lovely kind of - it reminds me too of the importance of you know sharing children's knowledge with other children as well when we have the opportunity.

MS GORDON: That's right, yeah, yeah.

MR DOLMAN: And there's different aspects to that, isn't there, even in terms of how children understand family and who is their family and - 'cause I guess their definitions or the boundaries they might draw around family might be quite different to what we might routinely consider family as well. This is another important consideration.

MS GORDON: Yeah, and at QPASST we take a really broad view of family and that people can define themselves who's in their family. And it's an important consideration to think about that family, for people from refugee backgrounds, will often involve people who are deceased and disappeared, who are physically distant but you know in camps or overseas in the country of origin still and that even though they're physically distant, psychologically they're really present because they're thinking about them a lot, they're speaking to them on the phone, they might be sending money over trying to support them, they may be trying to get them to come to Australia which can be a really prolonged experience. So you know if we're - sometimes when we're working with kids and we say, you know, 'Can you draw a picture of your family?' It will be populated with all kinds of people who may not be here in Australia and for some kids they're primary attachment figures may not be here as well and so there can be work about you know building some other alternative strong connections here in Australia so those attachment needs are met as well.

MR DOLMAN: Okay. Thank you. Let's sort of zoom in a bit more in terms relation to safety in conversations with children and families as well and there's a few important points there that you've both listed. Perhaps we could speak to a couple of each of those. Is there some that come to mind for you, Julio, as particularly pertinent in your work?

MR ALEJO: Yeah. Yes, I think - I think one thing that stands out to me is really listening and acknowledging their feelings and their journey with empathy, with genuine empathy and sympathy is empowering. I think it makes a huge difference when that is present every time you meet. The other thing that I could share with our listeners as well is the interpreting side of things. I would greatly suggest that you will have an interpreter that carries the context of your message not just word for word, it sometimes can - the word for word can sometimes be misunderstood and the genuineness is there but in our organisation I'm very very you know appreciative, and grateful that I can work with you know with support workers that can interpret for me with the context of what I was saying. So that is something that I'd like to talk about, remind everybody.

MR DOLMAN: Yes, it certainly reminds me how working with the interpreters is actually a practice skill, isn't it, and so - - -

MR ALEJO: It is.

MR DOLMAN: - - - I think we could probably spend another whole webinar or two on that very topic actually as well.

MR ALEJO: Yes.

MR DOLMAN: So it would be something that we can perhaps look at for later on.

MR ALEJO: Yeah, also I just would like to throw in as well is to maintain clear boundaries and educating them about boundaries because sometimes in their own culture boundaries looks really different from where we're coming from. And to know their boundaries. Also to let them know your boundaries is really a healthy way of working together you know so yep.

MR DOLMAN: Yes. Thank you, Julio. Are there a couple aspects of structuring safety, Liz, that are particularly pertinent that you'd like to speak to?

MS GORDON: I think probably just to really second what Julio has said and just on the interpreter issue, I think you know it’s really important to know what your organisational processes are around accessing interpreters and appropriate interpreters so children in a family are not an appropriate interpreter, that puts kids in a really difficult position and can also reinforce those differences in power dynamics that are challenging for families. So just to put that in there.

And sort of touching on what Julio said too in terms of being clear what our boundaries are and I think part of that is also taking the time to explain our own role and what our own purpose in connecting with someone will be and what the processes will be and for some of our clients counselling is a really unfamiliar practice and so we spend some time setting the frame of our work and also really talking through confidentiality and privacy and that really connects with - you know one of the impacts is a mistrust as well so really spending some time talking through that.

And just lastly, you know as we've talked about before, expecting to make some mistakes but what becomes important in that is making that effort to repair. When we feel someone has said something and we notice they withdraw a little bit or something changes in them, just checking if something happened in the relationship and if there's a way that we can get back on track again as well.

MR DOLMAN: Great. Yes, I think we're almost out of time, there's been so many additional threads and themes that we could expand on further so we'll leave the presentation there for now. So I'd like to firstly thank everyone for tuning in to this webinar and thank you to Julio and thank you also to Liz for sharing your skills, your experience, your knowhow with us. Thanks also to our friends at CFCA, all the work that they do behind the scenes as well. And so, yeah, I'd just like again to remind people that there will be a link that appears on your screen to the website to continue this conversation, the different threads that have been generated and we certainly look forward to joining you again next time. So thank you.

MR ALEJO: Thank you.

MS GORDON: Thank you.

WEBINAR CONCLUDED

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Slide outline

1. Cultural considerations to support children from migrant and refugee backgrounds

Liz Gordon and Julio Alejo 
CFCA Emerging Minds Webinar 13 May 2020

2. Cultural considerations to support children from migrant and refugee backgrounds 
Liz Gordon and Julio Alejo

3. Learning outcomes

This webinar will assist practitioners whose work includes responding to families from migrant and refugee backgrounds through:

• Describing some of the challenges that children and families who have settled in Australia experience, both pre- and post-settlement
• Considering the extent to which practitioners need to develop ‘expert’ cultural understandings to work effectively with families from cultures other than their own
• Exploring the extent to which practitioners need to have an awareness of how their own beliefs, values and assumptions are shaped by culture in order to work effectively
• Describing how engaging in respectful, collaborative and curious conversations with children and families can help them reconnect with skills and wisdoms linked to their community and cultural traditions.

4. Acknowledgements

Emerging Minds and CFCA wish to acknowledge the Traditional Custodians of the lands across Australia upon which our webinar presenters and participants are located.

We wish to pay respect to the Elders past, present and future for the memories, the traditions, the culture and hopes of Indigenous Australia.

5. Webinar series

2019/20 Emerging Minds series: Focus on infant and child mental health.

Upcoming webinar:

• Responding to Aboriginal children and families in contexts of family violence

Previous webinars in this series:

• Supporting children after natural and human-induced disasters
• Working with parents affected by alcohol and other drug use: Considering the needs of children in practice
• Parent–child play: A mental health promotion strategy for all children
• What is child-focused supervision in adult-focused services and how does it work?

6. Housekeeping

• Send through your questions via the chat box at any time during the webinar.
• Let us know if you don’t want your question published on the online forum following the presentation.
• All our webinars are recorded.
• The slides are available in the handout section of GoToWebinar.
• The audio and transcript will be posted on our website and YouTube channel in the coming week.

7. Presenters

• Liz Gordon, Clinical Supervisor & Children’s Counsellor, QPASST
• Julio Alejo, Case Worker, CAASSA
• Chris Dolman (Facilitator), Senior Workforce Development Officer, Emerging Minds

8. Cultural considerations to support children from migrant and refugee backgrounds

9. Torture and trauma counselling client quote

‘Before the war my life was like a vase that was then broken when the war came, never to be repaired.

But instead of trying to mend the vase, so that it looked like it did in the past, it can be made into a mosaic, which is still beautiful’

Torture and trauma counselling client from refugee background

10. Journeys of migration

Migrant

• Choice, seeking improvement
• Preparation and planning, including documentation, belongings
• Farewell 
• Permanent/or temporary with possibility of return

Refugee

Refugee: ‘Owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country.’ (UNHCR, 1951)

• Lack of choice, preparation, farewell
• Fleeing due to fear and persecution
• Recognition of need for protection
• Permanent with limited opportunities for return

Asylum Seeker

Asylum seekers ‘… are individuals who have sought international protection and whose claims for refugee status have not yet been determined.’

• Lack choice, preparation, farewell
• Fleeing due to fear and persecution
• Recognition of need for protection uncertain
• Fear of return

11. Challenges experienced by children and families pre- and post-settlement

12. The refugee experience (Country of origin)

• Persistent and long-term political repression, oppression and intimidation
• Deprivation of human rights and harassment/intimidation
• Threats to life and safety of self and others, assaults, witnessing harm and killing of others
• Torture - intentional and sanctioned infliction of harm for gain
• Separation from and loss of family members, home and culture
• Forced displacement and extreme deprivation
• Deprivation of education, social interaction and psychological development for children

13. Strengths in families from refugee backgrounds

• Resilience and resourcefulness
• Adaptability
• Strong commitment to the family and values of the community
• Strong desire to achieve educationally and economically
• Desire to contribute to new country
• Broad international experience, multilingual and awareness of many cultures

14. Some challenges for families from refugee backgrounds

• Changes in power dynamics, roles and responsibilities in families:
  • intergenerational conflict
  • family violence
• The impact of intergenerational trauma and persecution on parenting, children and parent"-"child relationships
• Grief, guilt and fear related to family remaining overseas, re-traumatising events in country of origin
• Impacts of mental and physical health difficulties

15. Some challenges for families from refugee backgrounds part 2

• Limited access to traditional supports and cultural practices
• Loss of belonging in new communities
• Prior professional qualifications and skills not recognised
• Unfamiliarity with social expectations, institutions and potential supports
• Experiences of racism and discrimination
• Impaired trust in services

16. To what extent do practitioners need to:

... develop ‘expert’ cultural understandings?

… have an awareness of how their own beliefs, values and assumptions are shaped by culture?

17. The importance of ethical practice

Commitment to:

• Self-awareness & self-scrutiny
• Valuing difference & diversity
• Justice seeking and addressing power imbalances
• Client-centred practice and collaboration
• Dignified and meaningful relationships
• Flexible service delivery

‘I believe that if we are able to enact our ethics, we can be sustained in the work. When we are not able to enact our ethics, we experience spiritual or ethical pain.’ 
V. Reynolds

18. Cultural knowledge for working with families from refugee backgrounds

• Conceptual understanding of culture (rather than expertise in specific cultural practices)
• Culture is protective for trauma survivors; however, refugee experience often involves destruction of culture
• Some country knowledge is useful (e.g. key language/s, key religion/s, access to education, health care, conflict?)
  • Held lightly and checked with child/family

Text description: Iceberg Model of Culture

Above the surface - Food, music, language, visual arts, festivals, performing arts, literature, holiday customs, flags, games, dress

Below the surface - Nature of friendship, values, notions of beauty, religious beliefs, body language, norms, etiquette, rules, learning styles, leadership styles, expectations, gender roles, attitudes towards social status, notions of 'Self', perceptions, attitudes towards age, notions of modesty, thought processes, views on raising children, concept of fairness, importance of space, approaches of problem solving, notions of cleanliness, importance of time, assumptions.

J Penstone Creative Commons Attribution-NonCommercial-ShareAlike 2.0 UK: England & Wales License.

19. Cultural humility

‘Respecting and engaging with the Other’s life-world through a process of empathy and awareness of power.’ 
(Cleary and Schweitzer)

‘Culture hides much more than it reveals, and strangely enough, what it hides, it hides most effectively from its participants.’ 
(Hall)

20. Cultural Humility part 2

Self-knowledge

• Interrogating and understanding of own cultural identity, values and beliefs
• … and how this intersects with other aspects of identity 
  (gender, sexuality, class, ability, profession) 

Where are my points of privilege and blind spots?

How do they impact on safety for the client and my relationship with them?

How may I be perceived by client?

Importance of supervision

• Learning to manage
• Uncertainty
• Discomfort
• Not knowing

21. Engaging in respectful, collaborative and curious conversations with children and families

22. Cultural safety with families from refugee backgrounds

‘An environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. 

It is about shared respect, shared meaning, shared knowledge and experience of learning, living and working together with dignity and truly listening.’ 
(Williams in Cleary and Schweitzer)

23. Cultural Safety with Families from Refugee Backgrounds part 2

Cultural formulation in assessment

Curiosity about:

• Cultural identity
• Cultural understandings of the issue/challenge
• Cultural attempts at coping
• Stigma?
• Impact of culture on therapeutic relationship.

Cultural lens to family functioning

• How are family routines, patterns and roles shaped by cultural values?
• How do family practices adhere to (or differ from) cultural norms?

24. Cultural Safety with Families from Refugee Backgrounds part 3

Explore the family’s cultural transition

• Changes in cultural family practices may be a source of conflict, confusion, grief or opportunity for different family members.

Broad definition of family

• People decide who and what constitutes their ‘family’.
• Consider biological family members, guardians/carers, extended family members, important community members and/or family members who are deceased, disappeared and/or physically distant.

25. Cultural knowledge for working with families from refugee backgrounds

• Structuring safety into sessions
• Appropriate interpreters
• Clarifying and explaining role and process e.g. counselling, confidentiality
• Therapeutic presence

Open, Grounded, Focused & Interested

How can you address any power imbalances?

• Choice and consent
• Maintain clear boundaries

Consistency, Predictability & Reliability

• Repair relational ruptures

Acknowledge, Check in & Address

• Make tentative offerings of earnt expertise e.g. normalising reactions, psychoeducation, knowledge of Australian systems and available support

Don’t underestimate the value of an authentic, empathic & empowering interaction!

26. Applying a cultural lens to family practice

• Gentle, gradual pace
• Holistic interventions beyond an individual focus
  • e.g. group work, community development, systemic advocacy and capacity building
• Organisational processes for client involvement and feedback regarding service delivery and program development

27. Q & A Discussion

28. Continue the conversation

Do you have any further questions?

Please submit questions or comments on the online forum following today’s webinar: aifs.gov.au/cfca/events/cultural-considerations-support-children-migrant-refugee-backgrounds