Vancouver Island Counselling Centre for Immigrants and Refugees (VICCIR) 2018 Annual Report

vancouver island counselling centre for immigrants and refugees (viccir)

2018 Annual Report Escaping horrors at home

Syria after the bombings

Frightened children

Escaping into Jordan

Shell shock at every age Zaatari refugee camp in Jordan

Xenophobic crisis in South Africa

Vancouver Island Counselling Centre for Immigrants and Refugees (VICCIR) Finding refuge in Canada VICCIR provides guidance on the journey from trauma Registered clinical counsellors Experienced interpreters A whole family approach Different modalities of therapy Training & consultation

viccir.org

Our interpreters

Art therapy for children

Our team of counsellors

Training in Victoria

3939 St Peter’s Rd., Victoria, BC  778 404 1777  info@viccir.org

Recognize yourself in he and she who are not like you and me. carlos fuentes If you have much, give of your wealth.

If you have little give of your heart. rumi

Our Mission To provide specialized counseling and training services to: •

•

•

Assist refugees and immigrants who suffer from the effects of trauma and torture to the extent that their daily living is compromised.

Train professional counsellors in the treatment of trauma and torture and provide ongoing training and support to VICCIR interpreters.

Educate, train and counsel sponsorship groups, teachers, school board personnel, public health workers, first responders, and the general public to address and resolve vicarious trauma they experience and to assist them to better meet the unique needs of migrants to Canada.

Our Values Inclusiveness: we serve immigrants and refugees of all ages from all countries in the world who reside on Vancouver Island. Although clients are encouraged to financially contribute towards their treatment, no client is refused treatment and all clients are provided care regardless of their financial circumstances with the most traumatized clients given priority counselling.

Confidentiality is essential to building the necessary trusting relationships between the counsellors and the clients, so information can be freely shared knowing that it will be held in the strictest confidence.

Respect for the personal, religious and cultural diversity of our clients is accomplished by ensuring the appropriate counsellors and interpreters are assigned to meet the ethnic and language needs of our clients.

Service Quality is of utmost importance to ensure the best possible results for our clients through the use of professional counsellors and trained interpreters who receive ongoing trauma treatment training and guidance provided by the Director of Services and a professional interpreter including regular debriefing with counsellors and interpreters after counselling sessions.

Welcoming ‘the other’ through our interactions and training of individuals and agencies involved with immigrants and refugees, we help facilitate the positive integration of immigrants and refugees into Canadian society, which is the ultimate outcome of our services.

3

Table of Contents The Story of VICCIR

5

Report from the Director of Services

6

The VICCIR Model

7

Training at VICCIR

8

Funding VICCIR’s Work

9

2018 Financial Statements

9

Refugees in Canada in 2018

10

2018 Highlights

11

The VICCIR Logic Model

12

Our Board

14

Goals for 2019

14

2018 Statistics

15

Summary

18

VICCIR is located in the The District of Saanich is within Coast and Straits Salish territory, the traditional territories of the Lekwungen peoples known today as Songhees and Esquimalt Nations and the W ̱ SÁNEĆ peoples known today as W ̱ JOȽEȽP (Tsartlip), BOḰEĆEN (Pauquachin), SȾÁUTW ̱ (Tsawout), W ̱ SIḴEM (Tseycum) and MÁLEXEȽ (Malahat) Nations. The First Peoples have been here since time immemorial and their history in this area is long and rich.

4

The Story of VICCIR

If a counsellor does not speak a client’s language, one of VICCIR’s interpreters serves as a bridge, both linguistic and cultural.

In more than fifteen years of service abroad as a psychotherapist, trainer and supervisor, Adrienne Carter witnessed the devastating effects of displacement and trauma on the human spirit. Upon return to her Victoria home, Carter was determined to create a safe haven for those immigrants and refugees on Vancouver Island who had lived similar experiences in their countries of origin and were suffering the impact of trauma. To that end, in the Spring 2015, she and colleague Linda McLagan found support to shape a modest program of counselling to immigrants and refugees, a program to be operated under the umbrella of a settlement agency.

VICCIR’s objectives for all clients are to: • • •

Reduce the debilitating symptoms of trauma; Increase the personal resiliency and self-mastery required to improve quality of life; and Help them to find within themselves an eagerness to participate in the communities that welcome each of them.

VICCIR’s work in the community is another important part of the overall mission. It is focused on how to welcome ‘the other’, to discover values that we share and to struggle with how we manage our differences. VICCIR’s work in the community has many different areas of focus: a telephone conversation with a frustrated teacher about a new student who is exhibiting aggressive behavior; presenting a regional daylong workshop to mental health and public health workers about trauma; providing consultation to a settlement agency; collaborating with police and community services concerned with domestic violence; meeting with academics to share our interests in participating in research projects.

Carter and McLagan’s plans were altered by the Fall 2015 announcement of the arrival of a wave of Syrian refugees to communities in Victoria, the Saanich Peninsula, the Western Communities, Cowichan Valley and north to Nanaimo.

There was little doubt that the modest program lacked capacity to provide adequate services to an increased population of children, women and men devastated by unimaginable horrors, including torture.

This was the genesis of VICCIR, and the reason why counselling services are central to the organization’s activities.

Over the course of VICCIR’s short history, the influence of the world’s refugee crisis and increased anti-immigrant sentiment has underscored our longer-term vision: for all citizens to contribute to communities that thrive on diversity of origin, culture, religion and interests, and are strengthened by shared common values.

Looking Forward VICCIR’s capacity has grown immeasurably since our founding in the Spring of 2015. Over 40 professional counsellors and skilled interpreters have answered the humanitarian call of those fortunate enough to have found shelter here on Vancouver Island from some of the world’s current disasters.

Our Professionals In the Fall 2015 and with surprisingly little recruitment, counsellors and interpreters came forward to offer their services pro bono to the immigrant and refugee population.

Each counsellor has a graduate degree in psychology, social work, counselling, adult education, or child development; most have specialized training in a model or technique of therapy and are registered with professional bodies. All receive training in trauma counselling. The interpreters also receive training to enable them to become more professional as interpreters and also to work competently with counsellors.

In 2018 VICCIR counsellors, interpreters and staff worked doggedly long hours without remuneration, driven by a commitment to making a positive difference for the people they serve directly and the communities that are our home.

VICCIR is the sole service provider on Vancouver Island for immigrants and refugees who seek relief from the symptoms of trauma, the only centre that trains interpreters to work with informed counsellors.

Our Services Our counselling services are grounded on the recognition that each individual IS unique, and treatment plans are tailored accordingly. Cultural norms are respected as is the value of expressing oneself in one’s own language.

5

Report from the Director of Services

We also have Jasmin Gerwien as trainer and supervisor for interpreters. While she lives in Edmonton, we are able to continue using her services through Skype. Jasmin offers initial orientation training to all the new interpreters and she also offers online supervision. In addition, she does many interpreting sessions herself with our clients through Skype. It always feels as if she is personally present during the therapy sessions and our clients are always glad to see her. Although she lives at a distance, she remains a very integral part of the VICCIR Team.

Dear Friends, Another year passed in the life of VICCIR. Thanks to all our supporters, we continue to grow and develop our organization. Clinicians, interpreters, Board members, administrative personnel, grant writers and all our other volunteers continue to make growth possible. With increased financial donations and the winning of occasional grants, we are able to maintain and continue to serve refugees and immigrants of all ages who are working on overcoming the effects of trauma.

Thanks to funding from the City of Victoria, we have been able to get a part time Administrative Assistant, Ana Escalante. Without her knowledge and expertise VICCIR would find it difficult to function. Thanks, Ana, for all your help.

In early 2016 we moved into our present location at St. Peter Lakehill Anglican Church where we were warmly welcomed by the church community who themselves are continuing to sponsor refugee families.

Then a very special thanks goes to Rachel Davey. Rachel is the one who applies for grants and other funding possibilities. She also helps to organize fund raising efforts, writes the Annual Reports and does many of the jobs that are generally done by Executive Directors. Yonabeth Nava is also a part of our VICCIR team. Her help in gathering and analyzing statistics has been invaluable.

During 2018 we also worked closely and developed partnerships with a variety of other community resources such as ICA (Greater Victoria Inter-Cultural Association) and VIRCS (Victoria Immigrant and Refugee Centre Society), various School Districts and ELL teachers, Public Health, Mental Health and Addictions, AMSSA (Affiliation of Multicultural Societies and Service Agencies of BC), VAST (Vancouver Association for the Survivors of Torture) and the Cowichan Intercultural Society (CIS) in Duncan.

We continue to look for an experienced therapist with good multicultural understanding who would be willing to share the workload of the Director of Services, including administration, clinical supervision and trainings. This would give the opportunity for me to begin thinking about retirement.

We offered trainings and presentations to our own counsellors, to sponsorship groups, the Tapestry Conference for Teachers’ Pro D Day, at the University of Victoria Schools of Nursing and Social Work.

On behalf of all the survivors of trauma and torture, thank you to all of you – our clinicians, interpreters, volunteers, donors and members of the Board for the exceptional job that you have all been doing. Thank you for your compassion and generosity.

Many of our counsellors and interpreters have been part of the team since the beginning of VICCIR. Some have retired, but other very experienced counsellors have joined the team more recently. Special thanks go to Soraya Centeno, Hilary Mackey, Nan Hsieh, Deborah Patton, Sherri Hohert, Jean Ellis, Monika Brandstaetter, Maryory Alvarez, Idalid Diaz, Diane Tompkins, Joanne Campbell, Suzanna Reubstaat, Jennalise Janowski, Lee McLeod and Carin Kietabl.

Thank you to all of you.

With my deepest gratitude, Adrienne Carter, MSW, RCSW, Registered Clinical Therapist VICCIR Director of Services

At present we have three practicum students, Ana Pavon and Toby Macklin are both Masters level counselling students from Yorkville University and Fanie Collardeau is a PhD Psychology student from the University of Victoria.

The contributions of these practicum students have been major. This is the third year that VICCIR has been accepting practicum students and each year the students’ input has been significant. We learn from them and they learn from us. We are hoping to continue accepting practicum students.

6

The VICCIR Model

for specific groups, use trained paraprofessionals, and are linguistically appropriate.

VICCIR has developed a unique client-centred approach to therapy as a result of the lack of funding and the generosity of those who volunteered. The primary components of this model are:

The VICCIR model embodies a multidisciplinary, culturally sensitive and linguistically appropriate approach, which in our case is delivered by trained professionals.

1. A client-centred approach to treatment. Decisions are made based on the needs of the client and other family members rather what resources (counselling modalities, availability, time) are available at the time.

2. Clients are matched with the counsellor who best suits their needs and may work with more than one counsellor.

3. Trained clinical interpreters are available to enable the client to use their mother tongue if preferred.

4. A team approach is taken, with a group of counsellors and interpreters often working with a whole family.

Team members work in close communication with each other.

5. Clients are seen as individuals, couples, with individual family members and as a whole family. This includes a significant number of children and teens who are referred to VICCIR from schools.

6. Clients of all ages, genders and ethnicities are welcomed with no limitation placed upon them because of immigration status or length of time lived in Canada.

7. Different therapeutic modalities are offered simultaneously to individuals, couples and families, according to their unique individual situations and needs.

8. No limit is placed on the number of therapy sessions and clients are able to return or continue their therapy over an extended period of time.

The benefits of the VICCIR model are illustrated in one example of the many complex and difficult family situations that the VICCIR team encountered in 2018.

A family from Syria, newly arrived in Canada, came for counselling at VICCIR, supported by their sponsorship group. The family was comprised of a single father, teenage daughter and two younger children. The father had been imprisoned and tortured in Syria. He was left as the sole parent shortly after arriving in Canada and had no experience of parenting. The three children had all been abused in Syria and their mother had not been able to care for them. The family was traumatized and not able to begin their new life in Canada.

There was a long waitlist for the children to see a therapist at Child and Youth Mental Health, but at VICCIR the whole family could get therapy immediately. Each member of the family was assigned a counsellor and interpreter.

The counselling team worked with the whole family, and also with the sponsoring group, who provided transport and invaluable help in other ways. The father and teenage daughter, who had been doing much of the parenting, were each assigned a counsellor. The younger children worked with the VICCIR Art Therapist. Sometimes the whole family did art therapy together. The interpreters made it possible for all of this to be done in their native language.

It is interesting to compare this model to the report entitled Supporting the Mental Health of Refugees to Canada issued by the Mental Health Commission of Canada in January 2016, which was intended ‘to provide organizations working towards a coordinated response for incoming refugees with evidence-informed information and best practices for a coordinated mental health response’. Here is just one section from the conclusion to this report which demonstrates how the VICCIR model aligns with best practices in the field:1

The family described their weekly visits to VICCIR as the highlight of their week. After eight months, the children finally saw a therapist at Child and Youth Mental Health.

They had one session after which the therapist said there was no need for any further involvement from them. The children are now all doing well at school. Life continues to be difficult for all of them, but they have learned resilience, coping skills and a way to process their trauma. They are now able to embark on their new life in Canada.

Strong evidence shows that successful interventions for treating mental health problems in refugees use a multidisciplinary approach, are culturally sensitive or adapted

1  https://www.mentalhealthcommission.ca/sites/default/files/2016-01-25 _ refugee _ mental _ health _ backgrounder _ 0.pdf

7

Training at VICCIR

refugee mental health.

Even though all VICCIR counsellors and interpreters work pro bono, they all understand the importance of ongoing training and sharing of best practices and willingly give up even more of their free time to participate and share. In the Fall of 2018, there were three training sessions, two for counsellors and one for interpreters.

During 2018 a total of fifteen training and presentation sessions were delivered by the Director of Services and other experts. Two of the training sessions were for VICCIR counsellors and one for VICCIR interpreters. The other training sessions were provided to Sponsorship groups, teachers as part of their professional development, the VICCIR Board of Directors, and for counsellors, settlement workers and interpreters in Nanaimo.

Presentations were made to the University of Victoria School of Nursing on Global Psychosocial and Mental Health as well as to the School of Social Work and postgraduate psychology students at the University of Victoria. Other presentations were made to the Soul Café and as part of fundraising events.

VICCIR counsellors came together to share and experience alternative and holistic approaches to therapy. Presentations included art and play therapies, homeopathy, EMDR, somatic and energy therapies, meditation and yoga, school liaison, choir for adults and cultural bridges to therapies.

A group of VICCIR’s amazing team of interpreters gathered for training, delivered by Jasmin Gerwien by Skype from Edmonton. Jasmin is a highly qualified professional interpreter who previously worked with VICCIR. She and the team shared information and ideas about interpreting techniques.

The Director of Services provided approximately 500 hours of supervision and consultation to VICCIR counsellors and interpreters as well as individuals who refer clients and those who are referred, settlement workers and members of sponsorship groups. This is in addition to the Director of Services seeing clients, including all of the recipients of support from IFHP. VICCIR has a website and sends a regular email newsletter out to subscribers on a monthly basis. In 2018 VICCIR became a presence on social media. VICCIR’s Facebook page has more than 200 followers (a 150% increase!) by the end of 2018 as well as more than 50 followers on Instagram.

Practicum Students at VICCIR

Our Partners

Thanks to the depth and range of experience of VICCIR’s Director of Services, Adrienne Carter, students from the University of Victoria (UVic), City University and Yorkville University were approved to do their practicum placements for their Master’s in Counselling at VICCIR. UVic also approved a practicum placement at VICCIR for a PhD psychology student with joint supervision from the Director of Services and a Psychologist from UVic. This opportunity enables these students to experience both multicultural therapeutic approaches as well as trauma therapy.

2018 saw VICCIR continue to broaden its impact and work with likeminded partners and organizations such as: the University of Victoria, the Cowichan Intercultural Society (CIS); school districts in Greater Victoria; the Inter-Cultural Association of Greater Victoria (ICA); the Victoria Immigrant and Refugee Centre Society (VIRCS); the Anglican Diocese of British Columbia; the Central Vancouver Island Multicultural Society (CVIMS); Public Health Victoria and Saanich; the University of Victoria departments of Psychology, Social Work, Nursing and Research; the Victoria Coalition for Survivors of Torture (VCST); Child and Youth Mental Health Victoria, Saanich, Duncan and Nanaimo; the Vancouver Association for Survivors of Torture (VAST); the Ministry of Mental Health and Addictions; the Victoria Multifaith Society; City University, Langford BC; Yorkville University; the Multifaith Summit Council of BC; Pearson College Metchosin; and many individual sponsorship groups and members.

Community Engagement VICCIR offers training sessions. Training on refugee and immigrant’s mental health is offered to counselors, organizations, schools, sponsors, medical personnel, interpreters and family members. Consultation is also offered for sponsorship groups. The Director of Services also provides supervision for the counselors and translators who are serving refugees and delivers numerous presentations on 8

Funding VICCIR’s Work

2018 Financial Statements

In 2018, VICCIR benefitted from a grant provided by the City of Victoria Strategic Plan Fund. Strategic Plan Grants are awarded annually by Council through a competitive process and are for eligible organizations working on a project or program that supports the actions and outcomes of the City of Victoria’s 2015-2018 Strategic Plan Objectives.

Revenues

Actual

Budget

Interim Federal Health $4,681.00 Program

$4,000.00

Donations

$2,339.00

$5,000.00

Client payments

$5,170.00

$9,000.00

Honorariums

$1,129.00

$1,000.00

City of Victoria Grant (net of unearned of $2,840)

$7,160.00

Membership fees

$240.00

$400.00

Fundraising events

$6,575.00

$3,500.00

Sundry

$129.00

$200.00

In-kind services

$370,070.00

$370,070.00

$397,493.00

$393,170.00

Advertising

$163.00

$600.00

VICCIR also received significant support from individual donors who chose to give, despite the fact that their donations were not eligible for a tax-receipt – thank you!

Bank charges and interest

$70.00

$40.00

Fund raising events

$905.00

$1,000.00

Insurance

$1,913.00

$1,950.00

Other funding sources in 2018 included:

Miscellaneous

$379.63

$425.00

Office

$780.00

$6,500.00

Rent

$12,000.00

$12,000.00

Telephone and internet

$608.00

$550.00

This grant enabled VICCIR to contract much needed services for administration. Ana Escalante began as a parttime contractor in September 2018 after working pro bono and supporting VICCIR since the very beginning. The grant also enabled VICCIR to access some fundraising consultation offered by Rachel Davey, in advance of receiving charitable status. VICCIR also successfully applied to the Community Gaming Grant in 2018 and received $6000 in early 2019. After a long and patient wait, VICCIR became a federally registered charitable organization on January 1 2019, which has enabled the organization to access many more funding opportunities in 2019.

• • • • •

Expenses

The Interim Federal Health Program Payments from clients Honorariums in return for training and presentations

by Adrienne.

Membership fees Fund raising events

Training

$100.00

Travel

$386.00

Contracted Services

$7,160.00

Web site development and support

A combination of these revenue sources totalled just over $27,000 in 2018. However, by far the most significant contribution came from our counsellors, interpreters, Director of Services, Board Directors and other volunteers who all offered their time, dedication and expertise pro bono.

There would be no VICCIR without their amazing contribution. A conservative estimate of the value of the in-kind services in 2018 is over $370,000.

In-kind Services

9

Clinical Services

$225,456.00

$225,456.00

Interpreters

$75,064.00

$75,064.00

Director of Services

$60,800.00

$60,800.00

Administration Assistant

$3,750.00

$3,750.00

Other

$5,000.00

$5,000.00

$394,434.63

$393,235.00

Refugees in Canada in 20181 In 2018, according to the United Nations Refugee Agency’s global report,2 Canada admitted the largest number of refugees who were resettled and had the second highest rate of refugees who gained citizenship. The UNHCR’s annual global trends report shows Canada took in 28,100 of the 92,400 refugees who were resettled in 25 countries during 2018. About 1.4 million refugees were in need of resettlement in 2018, but only 92,400 were resettled. The data also show Canada gave citizenship to the second largest number of people who had arrived as refugees. A total of 18,000 refugees became Canadian citizens last year, a substantial increase over 2017, when just over 10,000 refugees were naturalized. The number had been declining over time.

According to an article in The Star,3 the stress of resettlement triggers trauma in Syrian refugees after the initial euphoria of arrival fades. The article goes on to say: ‘“They arrive here with a sense of relief after fleeing war and conflicts. Then they try to acquire the skills and tools to adjust to a new life. This stage is task-focused,” explained Ben Kuo, a clinical psychology professor at the University of Windsor in Ontario. “After one or two years of settlement, the adults start to question the purpose of their new life.”’

The article goes on to say: Mental-health outcomes have fallen into a data gap when it comes to assessing how well Syrian refugees are integrating into Canadian society. The federal government’s early effort to gauge resettlement of government-assisted refugees and privately sponsored refugees who came to Canada between November 4, 2015 and March 1, 2016 noted that mental health issues “will become more pressing over time for the Syrian population as they continue to settle and feel safe.”

This certainly reflects the experience of VICCIR counsellors and interpreters, and it is to be hoped that once the data has been gathered, the government and funding agencies will understand just how vital this work is. As the article makes clear, mental health issues tend to present after one or two years, however the coverage for mental health counselling through the Interim Federal Health Program (IFHP) only covers the first year. There is an urgent need for this coverage to be extended to include at least the first three years after settlement into Canadian society.

1 https://www.cbc.ca/news/politics/canada-resettled-most-refugees-un-1.5182621 2 https://www.unhcr.org/statistics/unhcrstats/5d08d7ee7/unhcr-global-trends-2018.html?query=canada 3 https://www.thestar.com/news/canada/2019/02/08/after-initial-euphoria-fades-the-stress-of-resettlement-triggers-trauma-in-syrian-refugees.html

10

Highlights of 2018

final thanks goes to all the VICCIR volunteers who helped at the concert, and the counsellors, interpreters, staff and board members who work pro bono to ensure that VICCIR can continue its important work.

SOS Fundraiser On Sunday, March 11, 2018, Step One Services Society (SOS) organized a fundraising event for VICCIR. Titled Building our Community–Creating a Safe Haven, the event included a silent auction as well as music presented by a local marimba band. The event was successful in that a combination of direct donations to VICCIR, along with proceeds from the auction, took in over $2000.

UVic Connections Adrienne Carter made a presentation at the University of Victoria to more than 50 PhD and Masters level nursing students and some of their professors. VICCIR also welcomed Yvonne Haist’s class of more than 20 students from the UVic School of Social Work. They had a tour around the VICCIR premises and enjoyed a presentation about VICCIR’s work and example of somatic therapy.

Research VICCIR was involved with two very interesting research projects. The first, led by Dr Mehmoona Moosa-Mitha was in collaboration with VIRCS and the University of Victoria and involved setting up focus groups of refugees. In addition, Ana Pavon, a VICCIR counsellor was invited to attend a meeting in Vancouver as part of another University of Victoria research project into chronic pain. VICCIR also took part in discussions with Dr Catherine Costigan of the University of Victoria regarding a qualitative research project to assess the quality of the therapeutic work VICCIR is doing with clients as well as the success of therapeutic modalities used, and the combination of modalities used.

This research will take place in 2019.

December Benefit Concert On December 15 2018, more than 200 people gathered for the Celebration of Hope fundraising benefit concert for the VICCIR. it was a huge success and raised $4500 to provide mental health services to immigrants and refugees on Vancouver Island. We celebrated not only hope, but generosity, inclusion and diversity. The music moved the audience to tears, laughter and song and the food was plentiful and delicious. The amount we raised exceeded our expectations and was thanks to those who bought tickets and gave donations. The performers, the Al Wehda Ensemble and Tam and Friends, provided their musical talent at no cost, and thanks to our generous sponsors (Serious Coffee, Thrifty Foods and Saraya Hot Bread) the refreshments were provided free of charge. The many different Syrian dishes provided by Ghada Rasheed disappeared very quickly! A 11

The VICCIR Logic Model In order to achieve the goals and mission of the program in 2016, we updated our logic model which depicts specific inputs, activities, outputs and outcomes necessary to achieve the goals of the program.

LOGIC MODEL-Vancouver Island Counselling Center for Refugees and

Mandate: To improve the mental health of Refugees and Immigrants in Van

Inputs

Outputs

Activities

Board of Directors and Program Staff Professional Volunteers Counsellors and interpreters

Number of NP and P Volunteers

Individual Counseling -Adult -Children -Teens

Number of therapies Delivered

Couple Therapy Family Counseling

Non-Professional Volunteers

Number of organizations collaborating with VICCIR

Support Groups

Collaboration with stakeholders and partners: Ministry of Mental Health, Ministry of Health, Victoria Immigrant and Refugee Center Society, Intercultural Association of Greater Victoria, Coalition for Survivors of Torture, University of Victoria, Vancouver Island University, Yorkville University, City University Victoria, Cowichan Intercultural Society (Duncan), Churches, Masjid Al-Imam Mosque, Congregation Emanu-El Victoria Synagogue, Anglican Dioceses of BC, Victoria multi faith society, Affiliation of Multicultural Societies and Service Agencies of BC

Therapy Groups

Training for: -Counsellors, organizations, schools, sponsor families, interpreters Collaborative approach with . immigrant serving organizations, support groups and sponsorship groups on behalf of clients Supervision of Counselors and Interpreters Presentations/worksh ops/research

Immigrants and Refugees in Vancouver Island

Advocacy

Funding Structure

Social Media Engagement, blogs Fundraisings

12

Number of training sessions delivered Hours of supervision

Collaborative Approach

Physical Space (Max 4 people at a given time and 1 group therapy)

Number of presentations delivered Number of followers in social media Number of blogs published Number of fundraisings and total collection from fundraisings Total in-kind contributions Total collection from donations Grants submitted vs approved Total collection from grants.

d Immigrants

ncouver Island (R&IM)

Outcomes Short-Term (6 months)

Create culturally sensitive parenting courses Develop coalitions with immigrant- serving organizations.

Develop more support and therapy groups Engage in a partnership with a psychiatric and medical consultant Promote volunteer engagement with the program Increase awareness of mental health needs of R&I Expand the organization’s volunteer structure

Medium (6-36 months)

Create culturally sensitive parenting courses Improve the organization strategic plan Expand the organization’s volunteer structure Develop coalitions with immigrantserving organizations.

Long-Term (>3 years)

Increase integration and participation of Canada’s newest migrants into communities Increase collaboration among Immigrantserving organizations Develop coalitions with immigrant- serving organizations.

Improve the mental health and well-being of Refugees and Immigrants in Vancouver Island Develop a funding model that will allow VICCIR to be selfsufficient

Develop a funding structure that will allow for compensation for counsellors and interpreters

13

Rev4. Sept, 9, 2019

LOGIC MODEL-Vancouver Island Counselling Center for Refugees an Level 2- VICCIR’s Programme

Outputs

Activities

Number of therapies delivered

Individual Counseling -Adult -Children -Teens

Number of Clients with Symptoms Reduction

Couple Therapy

Number of Clients who Demonstrate Improvement of Coping Mechanism

Family Counseling Support Groups Therapy Groups

Short-Term (6 months) Learning Self-regulation coping skills Building trust safety Providing emotional support Providing normalization

Advocacy Workshops

Increasing the sense of hope

Conferences

Decreasing the number of psychological, physical and emotional symptoms

Research Expert Panels Community Engagement

External Factors Competing programs among immigrant-serving organizations, availability of counselors, funding transportation to therapies, delivered sessions also depend on the readiness of the client

Assumptions All organizations are willing to support VICCIR, R&I who attend the program are willing to receive th lead to improvement in I&R mental health and their well-being

14

nd Immigrants

f

Outcomes Medium (6-36 months) Reinforce healthy skills Learning Selfregulation coping skills Building trust safety Providing emotional support

Long-Term (>3 years) Decrease the number of psychological, physical and emotional symptoms Improve the mental health and well-being of Refugees and Immigrants in Vancouver Island

Decrease the number of psychological, physical and emotional symptoms Provide psychoeducation Helping clients to process their trauma

herapies. That decreasing symptoms in the screening form will

15

Our Board

Goals for 2019

In 2018 the VICCIR Board of Directors continued to support our immediate goals: to assist refugees and immigrants heal their wounds of trauma, and to support efforts in our communities to assist with their integration.

1. Achieve charitable status, and so be able to …

2. … create a diverse portfolio of funding to sustain the organization into the future.

3. Make a smooth transition from being reliant on pro bono work to being able to provide compensation for contracted services, whilst still …

4. … preserving what is uniquely valuable and most beneficial to clients in the VICCIR model.

5. Create a succession plan for the Director of Services.

Identify a counsellor and experienced supervisor who understands cultural issues to begin training and role sharing.

6. Increase the number of experienced counsellors and interpreters and find a consultant psychiatrist whose approach aligns with the VICCIR model.

7. Increase the hours for the current contracted roles, the administrative assistant and fundraiser/grant writer.

8. Complete the planned research with Dr. Catherine Costigan of the University of Victoria.

Thuy-Dan Dang and Don Brown stepped down from the VICCIR Board of Directors. We thank them both for their dedication to and support for the organization.

We welcomed three new Directors to the Board in 2018: Sara Kharsa, Ghassan Al-Wafai and Robert McNamara (see below for photos and bios). Information on all the VICCIR directors can be found on the VICCIR web site.

Sara Kharsa, MD Sara attended university in Syria to become a medical doctor, then continued her studies and graduated from Egypt before arriving in Canada in 2016. Sara has a great interest in mental health and believes in cultural integration, and she has also been part of the team of interpreters at VICCIR. Ghassan Wafai, MD Ghassan was born and raised in Homs and began his medical studies at university in Syria in 2008. He then continued his education in Egypt 2012 where he got his Bachelor of Medicine and Surgery (MBBCh) in 2016. He says: “I truly believe that VICCIR is playing a crucial part in all the immigrants’ and refugees’ lives, as most of them need a way to be able to move on from their past experiences, memories and trauma. This is a huge obstacle and very difficult to overcome; this is where VICCIR comes into the picture.”

Robert (Bob) McNamara, B.Com (Hons.) Board Treasurer Bob is a retired Chartered Accountant with 40 years of experience in public accounting. He was fortunate to join a Winnipeg accounting firm on his graduation from university in 1973 and retired in 2013 as a partner. His career gave him significant experience with various not for profit agencies, governmental entities and small and medium business. Bob says: “I have been a Victoria resident since 2015 and am very happy to be able to assist in the good works being done by VICCIR in our new home city.”

16

2018 STATISTICS Compiled by Dr Yonabeth Nava Since opening in 2015, VICCIR has successfully delivered a total of 889 therapy sessions to the population of refugees and immigrants of Vancouver Island. The number of sessions has increased substantially throughout the years. For example, in 2016 VICCIR delivered 81 individual, family and couple counselling sessions. This number tripled in 2017 (233 sessions) and then doubled again in 2018. In that year, the 21 volunteer counsellors and 8 interpreters delivered a total of 569 counselling sessions to 85 clients, including 437 individual, 40 couple and 92 family therapies.1 Several clients accessed more than one type of modality.

Many clients in 2018 started their therapy in 2016 and/or 2017; therefore, to calculate the average number of sessions per client, we decided to add the sessions each client received since they started therapy at VICCIR. As a result, the average number of sessions per client for those who initiated therapy in 2016/2017 was 11 with the maximum number of sessions being 45 (this includes individual, couple and/or family therapy). Clients aged 18 or younger had a higher average number of sessions (12).

If we only consider counselling sessions from 2018, the average reduces substantially to 5 sessions per client with the maximum number of sessions being 20; however, given that the majority of clients either did not start or finish therapy in 2018, calculating the average number of sessions for one year in isolation is not accurate, as it does not correctly reflect service utilization for VICCIR clients.

Another interesting variable explored is the number of clients with cases that were reopened in 2018 (clients from 2018 who had received therapy in 2016 or 2017). There were 27 clients who received therapy in 2016/17 and then returned for more counselling in 2018. 32% of VICCIR clients in 2018 had a reopened case.

Characteristics of VICCIR Clients • • •

In 2018, VICCIR clients ranged in age from 4 to 74 years (mean 35.1 y±18.5 y).

60% of them were women and 40% were men.

As shown in Figure 1, in 2018 VICCIR clients mainly came from 27 countries grouped in 4 different world regions.

The majority of clients came from the Middle East, in particular from Syria. Since 2015, VICCIR clients have come from 47 different countries.

1 Unit of analysis is the client.

Figure 1. Distribution of Clients in the main 4 Regions (Africa, Central and South America, Europe and Africa) African countries: Eritrea, Gambia, Nigeria, Rwanda, Somalia, Sudan.

Central & South American countries: Brazil, Colombia, Mexico, Peru, Venezuela.

European countries: England, Spain, Hungary, Kosovo, Poland.

Middle Eastern countries: Iran, Iraq, Jordan, Lebanon, Saudi Arabia, Syria.

Other countries: Canada, China, Afghanistan, Philippines, USA.

• •

•

One out of three clients were refugees in the first year.

27% of clients were former refugees (anyone who came to Canada as a refugee at any time in their lives and who has lived in Canada for more than a year).

31% of refugees in the first year were 18 years or younger.

The main organizations referring clients to VICCIR in 2018 were settlement agencies (ICA and VIRCS), schools, private sponsorship groups and medical professionals, with self-referral and referral by family members and friends becoming more prevalent. Referrals from schools increased rapidly from all the districts (Victoria, Saanich and Western Communities) and from elementary, middle and high schools.

To explore the number of sessions per region we created a boxplot which shows the number of sessions in the different world regions. As shown in the plot, clients from the Middle East have higher median number of sessions as well as higher variability in terms of the number of sessions recorded (wider interquartile range). With the exception of 2 outliers for Central/South America and Other, clients in the Middle East had the relatively highest median number of sessions per client, when compared to other regions. (See Figure 2, overleaf).

17

Clients received several formats of therapy, including individual, couple and family therapy, with many receiving two or three formats at the same time. Thirty two percent of VICCIR clients received more than one format of therapy.

Additionally, clients received multiple modalities of therapy which includes somatic therapy, Eye Movement Desensitization and Reprocessing (EMDR), intergenerational trauma, art and play, trauma processing therapy and family art therapy. The majority of clients received Cognitive Behavioural Therapy (CBT) often in combination with other therapeutic modalities. 48% of clients received two or more counselling modalities offered by more than one counsellor, and the majority of individuals receiving art and play therapy were younger than 17 years of age (93%).

Clients who received therapy struggled with different psychological and physical health issues. An important proportion of our clients had relationship problems (78%) and the majority of clients had mood disturbances and/or anxiety (70%); Approximately half of our clients had experienced trauma and 10% experienced torture. Moreover, clients also reported health issues such as sleep disturbances (31%) medical problems (22%), and chronic pain (13%). It is interesting to note that people suffering from sleep disturbance also reported chronic pain and vice versa, demonstrating a high correlation between chronic pain and sleep disturbances. Chronic pain was more common among former refugees (35% prevalence for former refugees versus 21% for first year refugees).

Figure 2. Number of Therapies by World Region When exploring the number of sessions for first year refugees versus former refugees, we observed that the median number of sessions was relatively similar for both groups but former refugees had more outliers (higher number of therapies) when compared with first year refugees. Furthermore, first year refugees had more variability in terms of the number of counselling sessions recorded. For instance, Figure 3 illustrates a boxplot showing the average number of sessions for first year refugees versus former refugees.

In this graph, it is evident that former refugees have more outliers than first year refugees and the interquartile range for former refugees is narrower. This means that first year refugees recorded more sessions than former refugees for the period 2016-18. However, given the presence of several outliers in former refugees, we can conclude that some of them have higher service utilization than first year refugees. This creates an area for further exploration as it suggests that service utilization for first year refugees and former refugees might be different which could be explained by first year refugees initially having to manage settlement issues which might take precedence over processing their trauma.

Most importantly, as shown in Figure 4, from the total number of clients who received treatment in 2018 (85 clients), 69% reported a reduction in their symptoms (Figure 4). Clients who chose not to commence therapy after intake were not assessed for the reduction of their symptoms.

Figure 4. Mental Health Symptoms Reduction in Clients

Figure 3. Number of sessions for First Year Refugees vs. Former Refugees.

18

The table below shows a comparison of the number of returning and new clients and projections for 2019. Each year the number of clients increases when compared to previous years. This means that, when there is no limitation on the number of sessions a client may access, an increasing number of clients continue therapy from one year to the next. Further, the number of clients as of May 31, 2019 is already 69. Given this we estimate that the number of clients in 2019 will be double that in 2018. This pattern suggests that given the way that VICCIR works and the resources available, especially counsellors who are willing to work pro bono and available space, the organization will be working almost at full capacity in terms of the number of clients seen and the total number of sessions provided.

Year

Total # clients

Total # new clients

Total # clients from previous year

2016

35

35

N/A

2017

90

64

26

2018

85

57

28.

2019*

69

37

32

*to May 31 2019 To date, all referred clients who have chosen to access therapy have been served, however if numbers increase (as they appear to be doing in 2019), a greater number of counsellors and more space will be required, in order to avoid reducing the number of sessions available to clients or starting a waiting list.

19

Summary By the end of 2018 VICCIR has been in existence for four years thanks to the selfless service provided by all of our staff. Thanks to the counsellors and interpreters for the very skilled work they have been providing pro bono to assist our refugee and immigrant clients on their healing journeys. Thanks also to our administrator, grant writer and board members for their continued support and excellent work.

To date we have provided therapy to 220 clients who have either been referred to us or referred themselves. Mental Health services were provided to entire families who asked for such a service.

Clients who are suicidal or in crisis were seen within a very short time, often on the same day as the referral.

Refugees and Citizenship Canada. Both reported a strong reluctance among Syrians to seek professional mental health services, most choosing family and friends as the first and most important line of support. This has not been our experience at VICCIR. When mental health services exist and are easily accessible in their own language, refugee clients will seek them out.

The report also mentioned that due to stigma, refugees do not seek out mental health services. At VICCIR we have found that stigma is not the major obstacle. It is simply because mental health services are generally very difficult to access. There are often very long waitlists and services are not offered in their mother tongue. At VICCIR we have been able to remove the language barrier by using qualified interpreters and we have a very short waitlist as of this time. Also, family members of all ages can get treatment at the same place often simultaneously.

Our group of interpreters representing several language groups are well organized. All the interpreters are being provided with training and supervision. They remain with the clients from the beginning to the end of the therapy.

Self-perceived mental health among Syrian refugees was noted to be very high both in the initial months of arrival, but also later on. Clients may come for a few sessions during their first year, but often return for further sessions during their second and third year.

We do have some concern about the growing number of clients (as they appear to be doing in 2019). In order to continue providing the service needed we would need to have more counsellors, more space and a higher budget.

Our counselling and supervisory staff has been working pro bono for the past four years and that will not be sustainable in the future. We will need to begin paying for counselling and supervisory services very soon.

Two reports were published in June 2019 from the House of Commons Standing Committee on Citizenship and Immigration and the Evaluation Division of Immigration,

However, we are hopeful that the necessary funding will become available and VICCIR can continue to serve the mental health needs of refugees and immigrants.

Many thanks to all our counsellors, interpreters, staff, volunteers, donors and supporters.

To donate go to viccir.org/donate

20