Good Practice Team day I Training 17/10/2010: Difference between revisions

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===Case 1===  
===Case 1===  


''Issues covered:''


Interns are an important aspect of our organization. However, participants need to realize the reasons we accept them, the conditions required for accepting an intern and the process needed to plan, monitor and manage the intern.
Male around 40years old/Country of Origin: Iraq/Marital Status: married, 3 children/minors - all in Cyprus/Date of Entry to Cyprus: May 2009/Date of Application: May 2009/Claim: Iraqi abducted and tortured in 2006 for two days, by people belonging in a Religious group (Shias) controlling the area he lived in.


''Relevant articles:''  
'''Conflict Analysis:''' Individual/Family level, Cultural, Political participation, Economic level


* [[Policy: Joining Future Worlds Center]]
 
* [[Policy: Signing an Honour Declaration]]
'''Individual/Family Level:'''
* [[Policy: Signing a Confidentiality Agreement]]
• Experiencing high anxiety regarding lack of status.
* [[Policy: Working in multiple projects]]
• Feelings of mistrust; sadness; guilt towards immediate family members (bringing them to Cyprus away from their lives); depression; and worthlessness.
* [[Policy: Official Language]]
• Clash of the male’s traditional role in Iraq – feeling embarrassed (in need of social welfare and unable to provide for his family).
* [[Policy: Hosting interns]]
• Feeling isolated as he was not in contact with his extended family as much as he would like to.
* [[Procedure: Inviting and Hosting interns]]
• Felt pressured by his eldest son’s attitude towards him.
• Felt pressured by not being able to meet his wife’s and sons’ needs.
• Feelings of agitation and anger due to his ongoing medical problem and due to having to wait for long periods of time in order to be examined at the hospital.
• Being distant from the immediate family members due to being highly emotive because of experiencing all these difficult circumstances.
• He and so his family has a temporary residence permit which allows them to have access to basic needs, until their case is examined. A fact which further contributes to the feelings of insecurity and lack of safety for him and his family - present status is limited and future status uncertain.
 
 
'''Cultural Level:'''
• Not belonging in the host culture was a major issue for him.
• He did not speak the language – in need of interpreter  depended on his wife and children, created difficulty to attain services and to attend his and his family’s needs
• Difficulty in making friends and relationships with locals or others from his other countries, as well.
• Ignorance of Laws and rules and mentality of the host culture making it hard for him to achieve what he was aiming for.
• Felt inadequate in regards to his traditional role as the head of the family.
• His eldest son started to adopt the western type of mentality and he was against that.
• Feels that some people hold racist attitude towards him
 
 
'''Economic Level:'''
• Lack of transportation (could not buy a car)  public transportation in Cyprus is not adequate for their needs.
• Unemployed and as an asylum seeker he is only allowed to do specific types of work which he could not do due to his medical problems. He was in constant need of Social Welfare to provide for his family which caused him anxiety and embarrassment.
 
Political/Participatory Level:
• He was in need of legal consultation regarding his rights as an asylum seeker.
• The asylum seeker’s status is inhibiting him to be active regarding his political convictions  feels afraid to express his ideology openly
• Local Authorities do not treat him with the proper respect when he is requesting assistance and/or services
• Not integrated in the host culture and local society therefore he does not feel being a member of this society, thus he cannot participate on a political level in the community. And even if he wanted as an asylum seeker has no access to political participation in the hosting country’s affairs.
 
''OBJECTIVES:''
To help him with his overall problems and to provide Psychological, Social and Medical services to him and his family members, as well.
 
'''Psychological:''' Decrease the intensity of depressive and PTSD symptoms; teach him to apply coping mechanisms; rebuild relationships with immediate family; and to assist his adjustment in the host culture.
Help him to deal with his youngest son’s disorder (AHDD) and his family members’ anxieties and dysfunctions.
Social: Making sure that the client is fully aware of his rights regarding his social needs, securing availability of appropriate housing for him and his family, access to health care, Welfare benefits, registration at Labor Office; ensuring children’s access in education; helping to assign the child with the AHDD at a school where they offer special education services; learn the Greek language in order to be integrated in the society.
Medical: Being properly examined at the hospital; receiving the appropriate treatment regarding his health issues; receiving the appropriate treatment regarding his son’s disorder; to be examined by the Medical Board regarding his torture experience and obtain the medical certificate in order to support his asylum claim.
Legal: Explanation of his rights as an asylum seeker in Cyprus – point out to the authorities that he is a victim of torture – his case should be prioritize – medical examination to confirm claim
 
 
''METHODS:''
Psychological: Psychotherapy: Individual one-hour sessions on a weekly basis. The therapist used the Cognitive Behavioral Therapy (CBT) and Person-Centered Approach (PCA).
Social: Social Counseling Individual and family sessions and telephone conversations as often as needed. Conducting needs assessment, explaining procedures, legal rights regarding social needs. Actions taken to facilitate his integration in the local society.
Medical: Medical Assessment: Underwent medical assessment by the Unit’s Medical Director. 
Legal: Legal Advice: Discussion and presentation of his rights as an asylum seeker in Cyprus.
 
ACTIVITIES
The Unit employed an interpreter for offering him the following services.
Psychological: For the psychological assessment: wrote down the client’s social and psychological history.
Spent time in sessions for building a robust therapeutic relationship; promoted trust by using active listening, paraphrasing and summarizing. PCA’s techniques were used to provide the three core conditions (unconditional positive regard, empathy and congruence) in order to treat his depressive symptoms.
CBT’s techniques were used in order to attack his PTSD and depression. CBT techniques include: explanation of the model of how Thoughts, Emotional Responses and Physiological Responses interrelate and they affect Behavior; finding realistic coping mechanisms and applying them in his life; did relaxation sessions and taught him how to apply relaxation techniques (i.e. controlled breathing); the use of many diagrams in the sessions in order to portray what the therapist wanted to emphasize on.
The therapist accompanied the client’s eldest son and his mother to the meeting with the headmaster of the school in order to resolve problems which appeared to the child’s behavior. 
Social: During the first meeting with the client, the social history was recorded, and his needs were identified and prioritized. Assisting him and his family to leave the Reception Center of Asylum Seekers – contacting landlords, help in the search of accommodation. Resolving problems regarding Welfare services and Labor Office through contacting the officers in charge as well as employers. Contacting and using other institutions/organization’s services in order to resolve client’s problems. Available language courses were introduced to the client. 
Medical: Made an appointment with a woman gynecologist for his wife and dealt with her ongoing treatment.
Legal: recording personal details, claim and facts relating to his case. Consultation on his legal rights and advice as to his case. Letter to the responsible authority noting that he is an alleged victim of torture and his case should be prioritize/expedite procedures for case assessment – referred to the medical committee for examination. Escorted at the first instance interview conducted by the responsible authority (Asylum Service). Escorted at the Medical Committee examination. 
 
 
 
OUTCOMES
Psychological: Helped him cope with his depressive and PTSD symptoms; Assisted him to manage with his daily anxieties and stressors and lack of confidence regarding being in a different culture; Helped him build a social network; Facilitated meetings regarding his son’s disorder (school, children’s hospital, AHDD-ADD Association, Neurological Institute etc); Helped him handle difficulties with interpersonal relationships; Gave him incentive to adjust in the host culture.
Social: Left the reception center – found a house for him and his family. Enrolled to Greek lessons; the problems with labor office were resolved after the social counselor arranged appointment with a governmental doctor and he obtained a written diagnosis of his problem, suggesting that he is not able to work – welfare benefit was granted for the family.
Legal: The client applied for asylum on May 2009. He had his interview on November 2009 and was examined by the Medical Committee on April 2010. While, process not quick enough for a victim of torture, yet for average of delays in asylum procedures in Cyprus it was relatively ok.
Corina mentioned the lack of data-system set by the government, which would detect vulnerable groups upon application, in order to prioritize such cases. Also complained on the incompetence and lack of expertise of the members composing the Medical Committee, as she was present and witnessed the process with the client. There was no interpreter, no psychological assessment and almost none of the Istanbul Protocol guidelines were followed.
 
As the issue of the Medical Committee and referrals came about and an intense conversation as to the changes on the procedures by the government followed and it was agreed that more actions (apart from the report to the Ombudsman and UNHCR) should take place. Awareness is necessary and publications in order to put more pressure on the responsible authorities.


===UNHCR: Understanding the procedures - [[Corina Drousiotou]]===
===UNHCR: Understanding the procedures - [[Corina Drousiotou]]===
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