While new immigrants tend to arrive in Canada healthier than refugees, some will have experienced trauma before or during their migration and may require trauma treatment. Health care providers should consider the effect of trauma on their clients' lives and their health. Trauma-informed care offers a framework for providing health services that promote mental health among trauma sufferers and contribute to their long-term recovery. Clients are treated with sensitivity to avoid re-traumatization (Harris & Fallot, 2001).
are designed to address the impact of trauma and facilitate recovery in clients who have experienced trauma
aim to create an environment that acknowledges the effect of trauma and tries to create a sense of physical and emotional safety. Using this type of approach does not necessarily require a disclosure of trauma. Safety and empowerment are embedded in policies, practices and staff relational approaches for the client under a trauma-informed service.
Evidence suggests that programs and services for refugees should be trauma-informed to ensure that service providers recognize the effect of trauma on survivors and incorporate this knowledge into service delivery (Fallot & Harris, 2001; Blanch, 2008). Using a trauma-informed approach with refugees recognizes the profound effect of pre-migration trauma and validates their experiences of injustice and multiple losses (Agic, 2012). That said, it is important not to require refugees or immigrants to discuss their trauma (Arthur et al., 2013; Gardiner & Walker, 2010). Nevertheless, it is useful to remember that refugees are required to write a full account of their trauma(s) with the help of their lawyers to pass their refugee hearing.
Understand the effect of traumatic pre-migration experiences on refugee health and well-being, recognizing the very important contribution of resettlement difficulties to the mental health problems of refugees and immigrants. A trauma-informed approach begins with building awareness among staff and clients of how common pre- and post-migratory traumatic experiences are, keeping in mind that post-migratory experiences are most distressing for refugees.
Ensure clients' physical, emotional and cultural safety and prevent re-traumatization (e.g., by providing sufficient space for comfort and privacy, preventing exposure to trauma triggers and allowing adequate time to develop rapport and a trusting relationship). A trauma-informed service also demonstrates an awareness of the potential for vicarious trauma and burnout among staff.
Focus on natural resilience; prioritize skill building (e.g., learning English); encourage meaningful activities (e.g., work or volunteering, sports such as playing/coaching soccer, and religious activities); and link clients to community resources (e.g., housing, income support).
Involve clients in setting priorities and fostering personal control. Empower clients to take a central role in their care.
Demonstrate respect. Provide information and encourage questions and ideas. Be explicit about a newcomer's right to refuse to answer a question, but be ready to help them if they want to answer with support, decline a recommended program or service, or request an alternative option or raise another option. Recognize that power imbalances exist in relationships, while allowing the expression of feelings without fear of judgement (Arthur et al., 2013; Elliot et al., 2005).
Understand that perceptions of violence and safety, and people's responses to trauma, are determined by their past experiences, which are in part culturally influenced.
Help clients identify their strengths and (further) develop resiliency and coping skills. Teach and model skills for recognizing and managing triggers and difficulties, and co-develop skills to assist with calming, centring and staying present.
Creating an environment that acknowledges the effect of trauma and tries to create a sense of physical and emotional safety can be done without requiring a person to disclose their experience of trauma.
It is important to not require refugees of immigrants to discuss their trauma.