Cultural Competence in Working with Refugees: Grant Application

This grant application, submitted by Shally Patel, proposes a two-hour workshop aimed at improving the mental health and social integration of refugees in Australia. The application addresses the increasing number of refugees and migrants, highlighting the mental health challenges they face due to pre- and post-migration factors, including trauma, acculturation, and access to healthcare. The workshop employs a salutogenic approach, incorporating talk therapy, narrative therapy, and cognitive behavioral therapy to build resilience and promote well-being. The program logic outlines inputs such as research and contextual resources, outputs including various therapeutic strategies, and anticipated outcomes like improved health literacy, reduced depression, and increased social integration. The application also addresses ethical considerations and outlines a framework based on various health behavior theories. The goal is to improve refugees' quality of life by enhancing their access to healthcare, building confidence, and promoting social inclusion, with the long-term aim of sharing best practices across countries.

Name: Shally Patel
Student Id: 19561675
Subject: Health Education Development
Subject Code: PHE2HED
Assessment: Grant Application
Due Date: 30th may 2019
Word Count: 2032
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Table of Contents
TITLE............................................................................................................................................................. 3
BACKGROUND............................................................................................................................................. 3
RESEARCH PROBLEM................................................................................................................................ 3
PURPOSE....................................................................................................................................................... 4
PROGRAM LOGIC....................................................................................................................................... 5
INPUTS......................................................................................................................................................................5
OUTPUTS...............................................................................................................................................................6
ANTICIPATED OUTCOMES......................................................................................................................................6
COMPETENCIES AND ETHICAL ISSUES................................................................................................. 7
FRAMEWORK.............................................................................................................................................. 8
APPENDIX..................................................................................................................................................... 9
BIBLIOGRAPHY......................................................................................................................................... 11
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Title
Cultural competence in working with refugees in Australia
Background
Over the past two decades, there has been a steady increase in the arrival of refugees
and migrants in Australia. They would have encountered poor socio-economic situations,
intolerable adversities and tragic events including war and army-based conflict, racial and
linguistic discrimination and natural calamities before arrival at their host (Hynie, 2018). The
main factors are moving away from the home country and getting acclimatised to the
environment in a new country, life style, language and culture (Silove et al., 2007). In addition,
the refugees are impacted by the tough situations and decision making before departure, during
travel for several days and post-arrival. As such, the refugees might struggle to get accustomed
to the socio-economic context of the countries where they seek refuge (Kramer et al., 2017;
Fazel et al., 2018; Brolin et al., 2018). Even after arrival at the host country, they need to get
adapted to the novel environment, in particular, a new language and diverse culture (Orna and
Shifra, 2011).
Challenges such as legal needs for obtaining visa or permission to stay in the host
country can lead to mental health stress (Langeland and Vinje, 2016). As such, they suffer from
mental health disorders. However gaining access to the healthcare and receiving quality care
has been a constraint for the refugees (Riedel et al., 2011). There is discrepancy in the quality of
healthcare obtained to the refugees compared to native residents (Shawyer et al., 2017) which
may be due to barriers in language and possessing less information about the healthcare
systems in the host country (Landsverk and Kane, 1998; Sen, 2016). To address the
aforementioned issues, the World Health Organization has formulated several strategies for
improving the mental health related issues for refugees however, there is discrepancy in the
guidelines between countries and a clear approach has not been formulated yet (Jan et al.,
2011).
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Research Problem
To support the management of mental health issues and stress encountered by refugees,
various professional agencies and policy maker have acknowledged both physical and stress
related mental health requirement of the refugees (Zipfel et al., 2019). The World Health
Organization has formulated strategies to offer better mental health and the need for healthcare
systems to provide access and engage with the stress and other mental disorder issues
encountered by the refugees when required (Hodes, 2019). Currently, there is less evidence
about the interventions related to health and care for refugees. Despite various case studies by
non-government agencies and government authorities, there still remain questions about
prevalence that are yet to be answered. For example, whether there are variations in the
prevalence of mental disorders among refugees, whether the case studies can assist in
predicting the mental health issues in refugees, how the prevalence enhances after settlement of
the refugees. As a result, several strategies have to be developed to improve the quality of life
for the refugees (Von Werthern et al., 2018). Furthermore, the research should not only focus
on pre-migration factors such as trauma but also the post-migration factors such as status of
residency, quality of life, acculturation and social support. Not only this research gap exists in
adhering to the problems of the refugees, however it has to be extended to their children. Are
the current approaches to improve the life of a refugee sufficient or evidence-based?
Purpose
Based on the aforementioned criteria for refugees, the two hour workshop will focus on
interaction with refugees and policy makers to improve social integration and mental health
disorder. This workshop will aim to throw light on the approaches to gain and obtain quality
healthcare and improve the well-being of the refugees by making them understand about the
healthcare system and the legal entitlements. The major goals are to promote social integration,
gaining access to healthcare and fostering the same quality care received by the regular
residents. The eight areas of priority are improving mental health via integration with the
society, sharing of information about the entitlements for healthcare, setting up new services,
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translation and interpretation for refugees with language and cultural barrier, mental, physical
and social integration, providing excellent training to medical staffs and the work force to work
in accordance with the refugees, investment in follow-ups and planning of service, and sharing
of good practice among countries (Xia, 2013; Hynie, 2018).
The Salutogenic talk therapy will aim at strengthening the coherence as a major
outcome (Borwick et al., 2013). This mode of therapy will be introduced in our workshop in
groups of 3-4 people trying to overcome mental health challenges (Orna and Khaled, 2018). In
addition, narrative approach therapy will be utilised to support the participants to narrate their
story based on the traumatic events so that reports can be generated in a coherent narrative.
Also trauma focused cognitive behavioural therapy such as exercise will be provided to reduce
post-traumatic stress disorder.
Program Logic
Inputs
The inputs include research on the Salutogenic approaches, several therapies as
mentioned above, transportation via arranging private buses and also guiding the participants if
they prefer public mode of transport (Brolin et al., 2018). Contextual resources will be in the
form of interactions and discussion among the participants in the presence of a group leader.
Situational resources include developed awareness about the entitlements for refuges in
Australia and access for healthcare systems (Langeland and Vinje, 2016). Also, resources such
as translation and interpretation services and cultural mediation services will be available. The
overarching goal will be to increase the awareness and confidence level among the participant
refugees. In addition, the focus will be on their internal and external sources and their
capability to increase coherence and well-being, intelligence, emotion management, building
rapport, developing interpersonal skills and improving the sociocultural aspects. In addition, the
external parts will include artefacts and institutions while internal factors include self-belief,
values, cognitive style and consciousness.
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Personal resources involve personal development of courage, confidence, employment,
energy and time (Hodes, 2018). Fazel and Betancourt in 2018 stated that the internal factors
that impact mental health are gender, emotions, hormones, physical strength, immunity and
personality. Therefore, internal factors such as gender, emotions, hormones, physical strength,
immunity and personality and the external factors such as sociocultural relationships, status of
employment, intergenerational conflict, cultural shock and difficulties in working together
should be considered for brining in the participants for the workshop.
Outputs
The strategies include talk therapy, narrative approach therapy and trauma focused
cognitive behavioural therapy. Moreover, the workshop will utilise various theories of the
salutogenic approach such as theory of social support, person centred theory, self-efficacy
theory and narrative theory (Langeland et al., 2006). Furthermore, the workshop will focus on
the health continuum model, person’s story and history, salutary factors, understanding the
tension and adaptation. The group leader or facilitator needs to ensure an environment for
interaction among the participants which can be achieved arranging few ice breakers or fun
activities to start off with. Furthermore, the group leader will be the driving force and need to
empathize and provide positive messages to strengthen the will of the participants (Langeland
and Vinje, 2016). In addition, the output strategies framed in this workshop will emphasize on
empowering the refugee physical and mental health. Furthermore, promotion of mental health
via social, mental and physical integration, sharing of information on entitlements to care and
proper training to workforce will be other outputs (Riedel et al., 2011). The leader should ask
the refugees if they have lived overseas, have relatives abroad, paid bribe, uncertainty about
future, family being threatened and fear of own life as this will make the discussion interactive
and help to retrieve more information for the development of further strategies and plans (Sen,
2016).
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Anticipated Outcomes
The significant outcomes of this two hour workshop on the salutogenic approach for
refugees will be improved literacy on health, absence of depression, reduction in hostility, well-
being and happiness, development in empathy, home and financial security with adequate
source of income positivity in psychology and relationships, building confidence, learning, self-
esteem and resilience. High quality services on translation and interpretation will significantly
support interactions between refugees and the general practitioners in an effective manner
(Langeland and Vinje, 2016). Also cultural mediators such as the workforce can assist the
refugees to gain access to healthcare services (Borwick et al., 2015). The utilisation of
information technology will support engagement with the healthcare facilities (Walker et al.,
2017). In addition, the refugees have the opportunity to get involved in community activities. It
will be beneficial in evaluating the interpersonal relationships available to individual refugee
thereby increases the awareness and access to healthcare system. In addition it will bring
happiness and empathy in the life of refugees (Hynie, 2018). This workshop will ensure
confidence and self-esteem within the participants.
Furthermore the economic status might also improve as their employment status might
change after attending the workshop. This workshop might lead to evidence based research
studies which can support effective planning of service and provision. One of the major long-
term outcomes will be to share the principles of better practices across countries. In addition,
refugees will get the knowledge about the process of screening and ways to be granted
conditional community release, knowledge about processing the application, accommodation
facilities and access to adequate mental health services (Xia, 2013). Also short and long-term
outcomes are improvement in health interventions such as minimising the morbidity and
mortality due to mental health disorders and short term emergency assistance on humanitarian
basis with long term programs on health and vaccination. Women and children will be provided
with better health and well-being.
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Competencies and ethical issues
Competence consists of possessing awareness and knowledge about the culture,
identity, client’s background and attitude and communication skills of the worker. Developing
competency in culture is important to work in accordance with refugees as they may be
different in terms of countries, background, religion, economic status, education and ethnicity
(Sen, 2016). In addition, refuges are mostly considered as minorities in their home country. The
ethical issues relate to hiding the information of the participant and improving confidentiality,
ability to retrieve information about the traumatic events and dealing refuges suffering from
stress related issues (Silove et al., 2007). Other challenges such as religion, tradition and
culture of the refugees might also impact the outcome of the awareness workshop (Bansel et
al., 2016). Informed consent is a major aspect of ethics while conduction research on the
mental health among refugees (Siriwardhana et al., 2013). The discussion between the
facilitators and the participants are important to get information about the issues they have
encountered. In case there is a lack of rapport, it might lead to the breakdown of the salutogenic
approach. Policy makers and clinicians must be aware of the cultural beliefs and linguistics
(Andrulls, 2007). These approaches will definitely support in reducing stigma to prevent mental
health issues.
Framework
The choice of theory should be logical, in tandem with day to day observations, same as
existing programmes and previously researched (Hynie, 2018). The following theories have
been utilised to provide mental health awareness to refugees rational model, health belief
model, extended parallel process model, trans-theoretical model of change, theory of planned
behaviour and activated health education model, social learning theory and social cognitive
theory (Coulson et al., 2016). The strategic planning is based on individually adapted mental
health related programmes that are designed to teach refugees about the management of stress
and mental disorders and improved quality of life (Riedel et al., 2011). Furthermore core
competencies via health education will be provided in order to positively influence the refugees
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via education and assess the health behaviour of individuals (Silove et al., 2007). The two
framework theories such as the extended parallel process model (EPPM) and rational model
will be utilised. The EPPM is based on fear management and combination of emotional
reaction to determine decisions on behaviour. However the extent to which a refugee gets
threatened by mental health issue leads to the determination of the individuals’ motivation. The
main variables in EPPM are threat variables that are based on perceived severity and
susceptibility and efficacy variables that are based on response and self-efficacy (Tannenbaum
et al., 2015). The rational model will encourage refugees to provide positive health belief and
create awareness and knowledge about the utilisation of healthcare (Storey, 2013).
Appendix
What mental health problem(s) may your vulnerable group
be facing?
Post-traumatic stress disorder
General health and health behaviour
Psychological distress
What is a salutogenic approach?
 The term salutogenesis refers to a design or
plan for health where the focus is to address
the experience of the individual in addition to
his history, dreams and ideas.
 This mode of therapy was introduced in
groups trying to overcome mental health
challenges
Problem/Research question/background
 a steady increase in the arrival of refugees and migrants
in Australia.
 The community of refugees include those who leave
their home country due to war or any severe political and
economic consequences.
 They may also be asylum seekers or migrants for
economic purpose.
 the migration process is quite complex and can lead to
stress because of moving away from the home country
and getting acclimatised to the environment in a new
country, life style, language and culture.
 Even after arrival at the host country, they need to get
adapted to the novel environment, in particular, a new
language and diverse culture can lead to mental health
stress.
 There is discrepancy in the quality of healthcare obtained
to the refugees compared to native residents.
 This may be due to barriers in language and possessing
less information about the healthcare systems in the host
country. In addition, there is minimal privilege for
Medicare and other health insurance plans that offer free
medical treatment.
 The educational background of the refugee plays an
important role in interacting with the healthcare
professions to express their mental health issues or
stress.
Research problem
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 there are variations in the prevalence of mental disorders
among refugees
 how the prevalence enhances after settlement of the
refugees
 whether the case studies can assist in predicting the
mental health issues in refugees
Main Aim (purpose) The aim is to provide improved quality of life and providing effective management of
mental stress issues for refugees
Objectives
1. improving mental health
2. Setting up new
healthcare services
3. Mental, physical and
social integration
Inputs
 The inputs include research
on the salutogenic
approaches, transportation
via arranging private buses
 Contextual resources will
be in the form of
interactions and discussion
among the participants in
the presence of a group
leader.
 A salutogenic talk-therapy
will be conducted.
 Situational resources
include developing an
awareness about the
entitlements for refuges in
Australia and access for
healthcare systems.
 Personal resources involve
personal development of
courage, confidence,
employment, energy and
time.
 The internal factors that
impact mental health are
gender, emotions,
hormones, physical
strength, immunity and
personality.
Outputs/Strategies
Talk therapy
The workshop will utilise
various theories of the
salutogenic approach such as:
 theory of social support,
person cantered theory,
self-efficacy theory and
narrative theory.
 focus on the health
continuum model, person’s
story and history, salutary
factors, understanding the
tension and adaptation.
Outcomes:
Improved literacy
on health
Absence of
depression
Reduction in
hostility
Increased
happiness,
development in
empathy,
positivity in
psychology
Underlying assumptions &
external factors
The external factors that
impact mental health are
sociocultural relationships,
status of employment,
intergenerational conflict,
cultural shock and
difficulties in working
together.
.
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