Using the International Classification of Functioning, Disability and Health (ICF) to describe the functioning of traumatised refugees.
(73/107)
The aim of this project was to use the International Classification of Functioning, Disability and Health (ICF) to develop an interdisciplinary instrument consisting of a Core Set, a number of codes selected from ICF, to describe the overall health condition of traumatised refugees. We intended to test 1) whether this tool could prove suitable for an overall description of the functional abilities of traumatised refugees before, during and after the intervention, and 2) whether the Core Set could be used to trace a significant change in the functional abilities of the traumatised refugees by comparing measurements before and after the intervention. In 2007, eight rehabilitation centres for traumatised refugees in Denmark agreed on a joint project to develop a tool for interdisciplinary documentation and monitoring, including physical, mental and social aspects of the person's health condition. ICF, developed and approved by WHO in 2001, was found suitable because it offers a common and standardised language and a corresponding frame of reference to describe health and associated conditions in terms of functioning rather than symptoms and diagnosis. Traumatised refugees are in most cases severely affected mentally by the traumas they have been subjected to, physically by injuries suffered during torture and war, psycho-somatically with pain, and socially by cultural uprooting, as well as by social difficulties in the exile community. The rehabilitation perspective thus seems to be more meaningful than the traditional treatment perspective because it takes into account the very complex situation of this group. The aim of the project was to find out whether any functional changes could be monitored using the instrument. The aim was neither to study nor to describe the effect of rehabilitation approaches, such as conditions related to traumatised refugees' networks or environments that might affect the refugees' living conditions. It was also not the intention to discuss the cause of the potential changes of the functional abilities. The project selected a Comprehensive Core Set of 106 codes among 1,464 possible codes (1) used by an interdisciplinary group of international and national experts in rehabilitation of traumatised refugees. The Comprehensive Core Set was furthermore reduced to a Brief Core Set of 32 codes by the interdisciplinary team (key persons) at the centres included in the project. From each centre six clients were randomly selected from those who fulfilled the inclusion criteria. All were scored within a four week period after the start, before any intervention was initiated, and up to a month after the first scoring. The results from this project led us to the conclusion that it is possible to develop an instrument based on the ICF classification. The instrument is useful for a general description of the total health condition (physical and mental functional ability as well as the environmental impact) of traumatized refugees. The tool helps describe changes in the functional abilities used in connection with the preparation of the plan of action. It can also be used to describe the refugees included in the study and their general condition. The ICF Core Set for traumatised refugees has not yet been validated, but the results of the project provide a basis for further development. (+info)
The land of milk and honey: a picture of refugee torture survivors presenting for treatment in a South African trauma centre.
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Intake data obtained from 55 refugee torture survivors accessing trauma treatment services at a centre in Johannesburg, South Africa, paints a picture of suffering beyond the torture experience. The intake forms part of a more comprehensive monitoring and evaluation system developed for the work done with torture survivors accessing psychosocial services. The diverse sample with different nationalities highlights that torture occurs in many countries on the African continent. It also highlights South Africa's role as a major destination for refugee and asylum seekers. However, "the land of milk and honey" and the process of arriving here, often poses additional challenges for survivors of torture. This is reflected in the high levels of Post Traumatic Stress Disorder (69%), anxiety (91%), and depression (74%) for our sample, all of which were significantly correlated. The loss of employment status from before the torture experience until the time of intake was great for this sample, impacting on their recovery. In addition the presence of medical conditions (44%), disabilities (19%), and pain (74%) raise serious questions regarding interventions that focus mainly on psychosocial needs. No significant gender differences were found. The paper begins to paint a clearer picture of the bio-psycho-social state of torture survivors accessing services in South Africa, as well as highlighting many of the contextual challenges which impact on recovery. (+info)
Transitory Ischemia as a form of white torture: a case description in Spain.
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Transitory Ischemia is a form of torture that has been insufficiently described and studied in forensic and psychiatric studies of torture. It is usually left out of medical evaluation reports and not explored in detail under the Istanbul Protocol. Although ischemia, when experienced during brief periods of time, does not produce any detectable sequelae, prolonged periods of ischemia can be detected by either clinical examination or electromyography. The authors describe the use of brief periods of ischemia as a torture technique against a non-violent activist in Seville (Spain). (+info)
Group therapy model for refugee and torture survivors.
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The paper discusses the Center for Torture and Trauma Survivors' therapy group model for torture survivors and describes two of its variants: The Bashal group for African and Somali women and the Bhutanese multi-family therapy group. Group therapies in this model extend to community healing. Groups develop their cohesion to graduate to a social community club or initiate a community organization. New graduates from the group join the club and become part of the social advocacy process and of group and individual support and community healing. The BASHAL Somali women's group that developed spontaneously into a socio-political club for African women, and the Bhutanese family group that consciously developed into a Bhutanese community organization are discussed as two variants of this new model of group therapy with torture survivors. (+info)
Social ecology of child soldiers: child, family, and community determinants of mental health, psychosocial well-being, and reintegration in Nepal.
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Reconciliation in Cambodia: thirty years after the terror of the Khmer Rouge regime.
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During the Khmer Rouge regime one quarter of the Cambodian population was killed as a result of malnutrition, overwork and mass killings. Although the regime ended 30 years ago, its legacy continues to affect Cambodians. Mental health problems as well as feelings of anger and revenge resulting from traumatic events experienced during the Khmer Rouge regime are still common in Cambodia. These conditions continue to impede social coexistence and the peace-building process in society. Thirty years after the Khmer Rouge regime this article gives an overview on the status of the country's current reconciliation process and recommends potential future steps. (+info)
Comparison of two methods of inquiry for torture with East African refugees: single query versus checklist.
(80/107)
PURPOSE: First to compare two methods of inquiry regarding torture: i.e., the traditional means of inquiry versus a checklist of torture experiences previously identified for these African refugees. Second, we hoped to identify factors that might influence refugees to not report torture on a single query when checklist data indicated torture events had occurred or to report torture when checklist data indicated that torture had not occurred. METHOD: Consisted of queries to 1,134 community-dwelling East African refugees (Somalia and Ethiopia) regarding the presence-versus-absence of torture in Africa (single query), a checklist of torture experiences in Africa that we had previously identified as occurring in these groups, demography, non-torture traumatic experiences in Africa, and current posttraumatic symptoms. RESULTS: Showed that 14% of the study participants reported a torture experience on a checklist, but not on a single query. Nine percent responded positively to the single query on torture, but then failed to check any torture experience. Those reporting trauma on an open-ended query, but not on a checklist, had been highly traumatized in other ways (warfare, civil chaos, robbery, assault, rape, trauma during flight out of the country). Those who reported torture on the checklist but not on the single query reported fewer instances of torture, suggesting that perhaps a "threshold" of torture experience influenced the single-query report. In addition, certain types of torture appeared more apt to be associated with a singlequery endorsement of torture. On regression analysis, a single-query self-report of torture was associated with traumatic experiences consistent with torture, older age, female gender, and nontorture trauma in Africa. CONCLUSION: Inconsistent reporting of torture occurred when two methods of inquiry (one openended and one a checklist) were employed in this sample. We believe that specific contexts of torture and non-torture trauma, together with individual demographic characteristics and severity of the trauma, affect the self-perception of having been tortured. Specific information regarding these contexts, demographic characteristics, and trauma severity are presented in the report. (+info)