group manual conclusion evaluation and critical reflection

26 Jun group manual conclusion evaluation and critical reflection

Question
Working with Youth refugee Group

Principles and Values

All the sessions in this manual to work with youth refugee group are focused around Strengths based methodology. What’s more all the facilitators ought to be focused on the accompanying standards.

a) Self situated – helping individuals to partake and to do thing themselves.

b) Every individual has the potential and it sometimes obscure to themselves.

c) Strengthsconcentrates on inspiration for development.

d) Strengths based methodology helps from inside and additionally upgrades interpersonal networks.

Dennis Saleeby (1997) defined three main guidelines that explains Strengths based methodology suitable for community:

a) Facilitators or workers initiate with the assets available in the community rather than looking for new or required assets.

b) According to him this type of approach is considered as internal and it works on assets available within the community and identifies individual capabilities.

c) This process is entirely depended on relationship and individuals share their capabilities in the community entirely based on the relationship bonding.

This methodology entirely works for youth means that is it values their ideas and views and inspire them to share their capabilities with others. It helps them to empower their strengths, abilities and resiliency to use their internal capabilities to administer difficult situations and then enhancing their self-respect and self-confidence. This lets youth to interact with each other and share their experience and help each other to tackle difficult situations without the help of any facilitator.

Strengths based methodology can be very effective in group work with youth due to the fact that peer groups are probably the most influential elements for this generation. And it has been seen that these groups are mainly essential as forums where individual identity as well as group identity is emphasized (Michael Ungar, 2004). Peer support or group is considered very beneficial as it provides the ground for learning beyond family support where an individual experiments, develop perceptions, abilities, identifies values and learn to help and share (Boyden and Mann, 2005).

Another important notion connected with Strengths based methodology is resiliency – to be able to spring back through misfortune along with productively adjusts in the face of difficulties. It is entirely supportive to see youth who have experienced the war conflict and trauma directly or indirectly and have succeeded despite the challenges they may have existed by means of.

commitment of youth refugee group

Youth commitment is about their significant involvement and continued participation in a group activity with a focus outside of every individual of the group. It is important for varied reasons; individuals involved in the activity acquire some knowledge and skills by performing these activities. It helps building up self-confidence and increase sense of leadership when an individual’s opinion is appreciated. It is often seen that youth with distinguish colour feel shy and neglected, therefore it is very important to engage these individuals in the group activity so that they feel connected and important part of the group.

Creating positive connections between the youths and adults that includes facilitators or leaders and sometimes caregivers & community system is considered as the way of youth commitment. Group participation is considered as exceptionally therapeutic due to the fact that it forms the basis to help dispossessed understand that they have other group members who have gone through the similar losses and that they recognize each other very well(Alle-Corliss and Alle-Corliss, 2009). Therefore these closed groups are therapeutic and are “aimed at enhancing the socio-emotional well-being of members through provision of social skills, education and therapy using the vehicle of group process” (Hepworth, Rooney & Larsen, 2002, p. 299).

Initial selection procedure entirely depends on the observations of the group leader (Alle-Corliss and Alle-Corliss, 2009). “The purpose of the group can frequently be clarified by considering how the idea for establishing it was generated. The idea may have come from several sources, such as the group worker, agency staff member, potential clients, or the larger community”( Toseland and Rivas, 2009, p. 154).

Following few steps can be considered while developing constructive connection with the youth group:

a) Facilitators or the group leaders should develop some understanding with group and try to acquire groups’ attention and respect that helps to form trust in the group.

b) Be interactive and show interest in the youth group in order to build a positive attitude.

c) Always keep the youth group busy in the discussion and various activities and try not to let them feel inactive in any part of the conversation or activities.

d) Let the youth group decide what they want to do and let them actively make decisions rather than implementing your own decisions on them and avoid any misbehaviour.

e) Respect all decisions made and try not to offend their choice and let them know what you have got for them.

f) It is the duty of the facilitator or the group leader to provide feedback to the youth group and try to solve their issues by discussing it with them and always be prepared for a positive support.

According to Ivey (1991, p. 158), “Connection is as vital as separation…. We have twin tasks in our developmental progression. To survive, we must be simultaneously attached to others but also separate. Relationship, connection, and attachment provide a foundation for a sense of trust and intimacy. As we move through the developmental tasks of autonomy and identity, we must define our separate boundaries from our family and others”.Therefore in order to make them to recover from this trauma there is need to reinstate attachment and connections to peers who are readily available to help and support and provide care to overcome grief and loss. And this can only be done by:

a) Cultivate a trusting proceeding with association with an accessible caring individual.

b) In order to decrease social isolation participating in group is very essential.

c) Endorse possessions by overpowering settlement issues.

formation of youth refugee group

The most important part of the formation of youth group is enrolling suitable members in the youth refugee group with the idea of making an effective overreach to youth refugee group, and their associated families and keeping in mind that his procedure could consume a good amount of time. So it is insisted to start the whole process well before the start date in order to get a planned outcome.

Various overreach methods that can be utilized are:

a) PRINT MEDIA–First and foremost method could be using the print media, i.e. using brochures, posters and various other printed papers. Youths can be easily targeted by making the prints eye-catching, by using various colour combinations and different font styles and sizes. Emphasis should be made on using good words specially focusing on youth refugees, but it should be kept in mind that the words, such as war, political battle, trauma, etc. must be prohibited.

b) ONLINE & RADIO –Focus should be made on making announcements on local radio shows that focuses the specific refugee community and some other ways of overreaching should be used, such as posting online, use of social media, and through websites. These methods can be cost-effective and it can be within the limits of the agency.

c) MULTICULTURAL ORGANISATIONS –This could be the best place to overreach to the youth members, as these types of organisations are good source for many immigrants and refugees who face language problems and cultural issues. People have good attachment to these organisations and they trust them over providing various settlement facilities covering their mental health issues, traumatic issues or PTSD and trust multicultural organisations decisions of referring to other agencies.

d) SCHOOL –This is the ideal place for recruiting the youth group members as this is the place where youth spend most of their time. It is often seen in schools that many youth involve into troublesome behaviour due to traumatic disorder and it becomes the duty of school authorities to figure out these issues and appropriate step should be taken. Youth experiencing traumatic disorders could be benefitted by closed group sessions after they are recruited or identified by social workers, settlement workers, guidance department, teachers, etc. in school.

e) YOUTH AGENCIES –Agencies working with youth having mental issues could be contacted and can be asked for referring youth who could be benefited by involvement in youth group activities.

evaluation of youth refugee group

AIM

The main aim of the evaluation is entirely focused on improvising the therapeutic closed group sessions program. The expectation is to analyse whether planned methods as well as results are accomplished by the members after taking part in the closed group sessions for Youth Refugee Group.

In order to achieve a better outcome, members for the closed group sessions should incorporate youth and the facilitators or leaders and it would be very advantageous to include parents or guardians or various service providers of the youth.

PRINCIPLES

1. Every youth is welcomed in the evaluation process and it is not mandatory for anyone to stay in the evaluation group if they think that it is not suitable for them, thus everyone is free to leave anytime in the evaluation process and it will not influence their support services.

2. During the evaluation process, every youth will be provided with the Consent for Evaluation form, so that they carefully read it and sign on that form that outlines the evaluation necessities. The form will outline basic points necessary in the program:

a) The benefits and risks involved in the therapeutic closed group sessions.

b) Whom to contact for any question regarding the evaluation process or any other emergency.

3. The consent of youth will describe the willingness of the youth to actively participate in the evaluation process.

4. Every member in the evaluation process has to sign the form and hand it over to the facilitator.

5. Members do not have to fill in or submit their personal information, such as their names, age, address etc. in order to maintain confidentiality.

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PROCEDURE

References

Alle-Corliss, Lupe; Alle-Corliss, Randall (2009). Group Work : A Practical Guide to Developing Groups in Agency Settings. Retrieved fromhttp://www.eblib.com

Toseland, R. W., & Rivas, R. S. (2009). An introduction to group work practice (6th ed.). Boston: Allyn & Bacon.

Hepworth, D. H., Rooney, R. H., & Larsen, J. A. (2002). Direct social work practice: Theory and skills (5th ed.). Pacific Grove, CA: Brooks/Cole.

Saleebey, D. (1997). The strengths approach to practice. The strengths perspective in social work practice, 3, 80-93.

Ungar, M. (2004). Nurturing hidden resilience in troubled youth. University of Toronto Press.

Boyden, J., & Mann, G. (2005). Children’s risk, resilience, and coping in extreme situations. Handbook for working with children and youth: Pathways to resilience across cultures and contexts, 3-26.

Ivey, A. E. (1991). Developmental therapy: Theory into practice.San Francisco: Jossey-Bass.

PTSD RECOVERY PROGRAM FOR REFUGEE YOUTH:
Objective: The PTSD Recovery program of in this manual is designed to help refugee children suffering from PTSD understand in detail about PTSD and help them manage the symptoms. Our Agency is dedicated to helping youth aged 14-20 cope with PTSD symptoms they have been living with and to bring about therapeutic change goals through psycho-social intervention.

By educating the youth about PTSD and teaching them to use to use specific tools to help manage their symptoms, we can empower them to control their impulse and modify their lifestyle.

Program details: This program is tailored to be delivered in a closed group format with 10-15 youngsters from a refugee camp. But it can also be delivered individually if required. The program comprises 10 weekly sessions each about 1.5 hours in duration.

Before sessions begin: It would be a major challenge for our agency to convince the youth from refugee camps to walk into therapy. This would require significant collaboration with the schools/universities that provide education to the target group. Social workers should conduct workshops in close association with the educational institutes so that it becomes convenient for the youth to engage in the program as part of his/her educational plan. The institutes play a significant part in sending the message across, through fliers, notice boards or classroom announcements. It is very crucial to get the youngsters to “buy in” to the therapy as soon as possible so that we avoid drop outs and increase treatment outcomes. Once they enrol into the program other activities that engage the community can be organized at their convenience. Another challenge would be to address the family of the participants about the program. This should be done by sending them PTSD Recovery program information brochure through the youngsters to them. Inform them about the program directly or thorugh the phone. They should be assured that they will be informed about the progress of the participant and encouraged to support them during the therapy.

Before we get into the content of session one, it would be ideal that the group leader start with discussion about the goal of the sessions. This would incorporate in the youth, a feeling that their experiences are understood by the group leader, that they are not alone, that it is ‘normal’ to have these symptoms after their experiences and that PTSD symptoms are treatable.

SESSION 1:

Welcome and Introductions.

What is PTSD? Facts about PTSD

What is this PTSD Recovery program?

Group Rules and Guidelines.

What causes PTSD?

Triggers

Behaviours

Breathing exercise

WELCOME AND INTRODUCTIONS:

Suggest each member of the group to state their name, where they are from and their background. Allow them some time to talk to each other so they feel more comfortable.

Preface:

All children and adolescents experience stressful events which can affect them both emotionally and physically. Their reaction to stress is usually brief, and they recover without further problems. A child or adolescent who experiences a catastrophic event may develop ongoing difficulties known as Post-Traumatic Stress Disorder (PTSD). The stressful or traumatic event involves a situation where someone’s life has been threatened or some severe injury has occurs. This could be some violence at home, physical abuse, sexual abuse, car accident, bombings, killings etc. Following these events, the child or teenager may show confused or agitated behaviour. Sometimes when they experience repeated trauma they may develop emotional numbing towards it. Children and adolescents with PTSD avoid situations or places that remind them of the trauma. They may show intense fear, helplessness, anger, sadness, horror or denial. The youth with PTSD may re-experience the traumatic events by having frequent memories of the event, or during a play, whe some or all of the trauma is repeated all over again. They could have frequent nightmares or dreams that recall the events. They would show the symptoms whenever they are reminded of the event. Some symptoms they may show are:

· Worry about dying at an early age

· Lose interest in normal activities

· Show physical symptoms like headaches, stomach-aches etc.

· Sudden, extreme emotional outbursts and irritabilty

· Problems with sleep

· Difficulty concentrating

· Increased alertness to the environment

PTSD is treatable. This program aims to help youth with PTSD to overcome their symptoms and control their emotions.

It is very important to make the refugee feel comfortable and safe in this environment. The aid of a translator can be sought. This would help the group get oriented to the program. The group should be encouraged to read the preface by themselves or use it to discuss between each other. This would break the ice between the group members and allow them to feel they are in a safe environment, where others understand them and that there is hope for improving their PTSD symptoms.

What is PTSD?

This needs to be explained in an uncomplicated basic fashion so the youth members feel the symptoms are relatable. This can be done by a Social worker by narrating a story of a youngster like them who suffered from PTSD. This could be aided by a colourful sketch depicting the character’s story and how he/she finally gets help and overcomes the symptoms of PTSD. The story can help by keeping the youth engaged and attentive. It would be easier for them to relate to the story of someone like them. For example, the story could be about a teenage boy Ali, who comes from a Sudan, affected by war, he may experience flashbacks, nightmares, or unwanted memories which may make him feel like he is “going crazy” or that he is “different”, which means he wouldn’t want to tell this to anyone. He may feel like the whole world is bad because of his experiences. So he starts to feel lonely, like no one understands him and no-one would support him. This later makes him feel unsafe and feel he needs to be on guard all the time. To do this, he would start avoiding people, places, activities and even his own emotions.

PTSD is a normal reaction to an abnormal situation (Schiraldi, 2000). That means symptoms like anxiety, hyper vigilance, night terrors are completely normal and understandable with regards to extreme situations. PTSD doesn’t mean you are going “crazy”. IT is a very normal reaction, but it can cause difficulties in certain situations which are unfavourable. This is why this program focusses on helping youngsters handle their emotions in a desirable way.

What is PTSD Recovery program?

Our goal is to develop in the youth a sense of security by adopting an approach of respect, compassion and containment. We provide opportunities for relaxation and positive experiences so that recovery may occur.

Group Rules and Guidelines for Participating in the PTSD Recovery Program:

1. You have to attend weekly sessions, be on time and notify the group leader if taking leave of absence.

2. If you miss two sessions, you may have to repeat or discontinue the program, because each sessions builds on content from the previous session.

3. You have to complete the home assignments regularly.

4. Maintain a healthy atmosphere by treating other group members with respect and accepting others opinions and beliefs.

5. You have to turn off all cell phones and other gadgets during the sessions.

6. The agency strictly prohibits group members from attending the sessions under the influence of any drug or alcohol.

Remember: The Agency provides therapy sessions focussing on helping you manage and reduce PTSD symptoms which requires practice both at home and during sessions. If at any time you have thoughts of hurting yourself or anyone else, talk to your group leader or call 13 11 14 by phone, or go to the nearest ER.

I have read and understand the requirements of this PTSD Recovery program.

_________________________ ________________________________

Signature of member Date

Hand out reading material on “What is PTSD? What causes PTSD?” to the group members so they can read it at home. This material should contain information that is easy to understand and friendly to the younger age group. An example:

We humans and animals, have a built-in alarm system that goes off during an emergency signalling us to fight or flee. This alarm system is located in our brain. WE also have a part of the brain that has the ability to think and reason. Someone who has PTSD feels like he/she is constantly in danger because the alarm system stays fired up all the time. Imagine a house alarm that is broken, and goes off all the time without differentiating between someone who is actually trying to to break into the house or your friend who just came to your house to visit you. That is the brain cant differentiate when it is a real threat or a false threat. Our program does not plan to disable your alarm system, but help you fix it so that it goes off only when there is a ‘real’ threat and remains quiet when there is no threat.”

TRIGGERS

A trigger is an event or object or anything that incites symptoms of PTSD in you. They usually have some association with your past experiences. They tend to remind you of the bad experiences and produces a surge of feeling to escape or avoid. Sometimes you may not remember the trigger completely, it may be vague.

They can be some smell, sounds, sights, places, activities, situations, etc. It is important to identify them in the course of this session. Some common examples of triggers are: crowded public places, firecrackers, certain people, helicopters flying over, etc.

Use the worksheet below to note the different personal triggers you have noticed. This can be completed from home. Some triggers may be subtle while the others are very obvious. It is important to fill the blanks with all the trigger you can think of.

MY TRIGGERS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

BEHAVIOURS

This section makes you aware of the different behaviours you show when there is a trigger. Learning to recognize your avoidance and safety behaviours is an important aspect of treatment of PTSD. Sometimes we tend to react to an uncomfortable activity or situation by altogether avoiding it or escaping it as quick as possible. When you have PTSD, behaviours change when you try to avoid any trigger.

Avoidance behaviours: examples: Staying away from public places like cinemas, malls. Not answering the phone. Switching off the tv when there is action scenes. Staying in your room whole day.

Another group of behaviours are called Safety behaviours, which are habits intended to reduce distress after a trigger. These behaviours make you feel better.

Safety behaviours: examples: constantly looking around for threats. Always carrying a knife in your bag. Checking locks and windows constantly.

On the following list, list as many avoidance and safety behaviours as you can. This week, pay attention and try to notice the situations, places, things, people and activities that you intentionally avoid.

What I Avoid?

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Safety behaviours I use:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

If any of the group members are happy to share their triggers and behaviours it would be a good time to allow them to do so to the entire group. Give them time to complete this and bring it back next week.

BREATHING EXERCISE

In this program, we teach you to control your breathing. Learning to control your breathing is a simple way to reduce stress and anxiety. It helps calm down the part of your brain that gets triggered and helps relax your body and mind. This technique requires practice and should be done atleast 2 times a day for 10 minutes.

In this exercise you need to: 1. Take a normal breath in through your nose, keeping your mouth closed.

2. Exhale slowly through your mouth.

3. Pause and count to 4 before you inhale again.

4. Repeat for 10 mins.

The trick is to not ‘deep’ breathe, but to slow breathe.

Homework Assignment:

1. Practice breathing exercise.

2. Identify personal triggers, avoidance behaviours and safety behaviours and write in into the manual.

SESSION 2

Check Homework: This is to emphasize the importance of doing work ‘outside-the-group’ and to engage those youth who are still reluctant to open up in the group.

Review: Hold a brief review about topics covered in the last session. This could be done by a quick quiz on the areas covered in the last session. This allows the members to engage actively in the subject.

Why is it important to know Triggers, Avoidance and Safety behaviours???

Most Triggers are not inherently dangerous. But when you avoid triggers, you never get to learn the fact that they are actually safe. This would lead to unnecessary fear to grow over time and also by avoiding people and activities, you will develop loneliness and depression which worsen PTSD.

Avoidance reduces our ability to effectively manage real life challenges and responsibilities. IT may give relief for a little while but in the long run it can make PTSD worse.

EXPOSURE

In school, if you avoid the bully, the bully becomes stronger. However, when you face the bully, the bully loses its power. The same applies to PTSD. IT is important to be exposed to your fears to weaken them. Thus it is helpful to be exposed to these triggers repeatedly so that you lose fear of them.

For example, some youngsters become anxious when in crowded areas like a shopping mall. By repeatedly sitting somewhere in the mall and trying to focus on something else he/she can gradually reduce the anxiety and fear associated with it. You can distract yourself with a book or listening to some music you like.

Now, discuss some examples in life where you found that exposure helped reduce your fear about something. Some youngsters may have been initially apprehensive about going to school in Australia and meeting new people, but over time as they got repeatedly exposed to the place, they got used to the environment and may have started to like it.

Exercise: Go back to the list of triggers that you wrote down for you last session. Identify one common situation or day-to-day activity that you manage with safety or avoidance behaviours. Select from the list below the score of how do you feel about this trigger right now:

· Really good —-à 1

· Quite good —–à 2

· A little good —-à 3

· A little bad —-à 4

· Quite bad —–à 5

· Really bad —-à6

Now mark the score about the trigger everyday when you get exposed to it (2-3 days at least) and note it in the manual.

Trigger: _____________________

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

Date: Time Started: Score:

Time Ended: Score:

SESSION 3

Review of last session.

Check if Exposure exercise was completed.

Ask everyone to come in front of the class and speak about their experience, whether the exposure reduced their anxiety or not. Even by repeatedly talking about their trauma, their fear tends to diminish. Give them time to speak as much as they want. During this other members may start to relate to each other. Some maybe reluctant to speak in front of everyone. This may be normal and shouldnt be forced on anyone. Speaking openly about their issues helps members to take control of their fears.

Music therapy

Requirements: Drum or any other music instrument.

One of the hardest things for a youngster to regain after a trauma is the sense of control. This therapy aims to give back the control to the member. We let each member of the group to play the drum, the way he/she likes to. They can play it loud, soft, fast or slow. Then in the next turn they can make the Social worker play the drum the way ‘they’ want. This enables the member to make individual choices and decisions and thus a sense of control over things.

Art therapy:Legitimatizing the emotions experienced by the adolescent in traumatic situations is important for helping him/her to cope with the aftermath. Ask the members to draw something they like. They could draw something that they feel the way they want to. Ask them to explain what they are drawing during the time period.

Dance and Drama Therapy: Depending on individual choice, conduct dance or drama sessions. These help members to engage in the group and work as a team. A drama based on a war story could make the participants relate to their previous experiences. It could be based on the life of a fictional character Ali, a teenager who comes from a war-stricken country to Australia and displaying positive reactions and coping skills. The therapist could ask member how they feel Ali would react during the war and after coming here.

Through this therapy they can learn that they were helpless in one situation, they may have options in the future and this time they will be more prepared and have more control.

EXPOSURE SHEET

SESSION 4

GARDEN ACTIVITY

Invite community members and volunteers to conduct a garden activity in the community centre in association with the therapists. We could arrange a barbecue and engage in fun games between members and volunteers. This brings in more community involvement as has many advantages. Being refugees most teenagers may find it difficult to communicate in English. These activities allows them to familiarize with people who speak in English. Some volunteers could conduct English classes for the members so they can learn it in a more relaxed environment. This could be made fun by conducting English word games like scrabble, crosswords, hangman, letter matching, quiz, puzzles, etc. The volunteers can also help the members to learn cooking. They could teach them about the local ingredients and the styles of cooking in Australia and also learn from the refugees about their food and cooking. They could even combine the two styles of cooking and come up with a dish. These activities help the refugees to feel comfortable and safe in the new country they are in. They may have certain misconceptions and ideas about the people of Australia. By exposing them to a warm and friendly environment we can make them feel secure and happy.

CAMPING

Plan a camp for the weekend. During the weekend we can blend in traditional activities like hiking and forest walks. This is an opportunity for the teenagers to be made aware of leading a healthy lifestyle by incorporating daily exercise into their routine. These activities play an important role in letting those members to open up about themselves which they wouldn’t do during the group sessions. By camping and staying together, the youngsters have around the clock access to therapists and gives them more time to talk about their issues individually.

EXPOSURE SHEET

SESSION 5

GROUNDING AND RELAXATION TECHNIQUES

Grounding is a very useful tool that helps you manage PTSD symptoms. They help by helping you focus on the present rather than the past. It makes you aware of of your surrounding and distracts you from old memories or certain overwhelming emotions. There are many techniques that can be used for grounding. You can use whichever suits you best.

1. Say a grounding statement: “My name is __________; I am safe right now. The time is ________; today is ________(day).”

2. Describe your environment with your five senses: describe in detail the colour, smells, sounds,etc. example: “I am in the classroom. I am holding a pen in my hand. I am looking at the blackboard. It is black and has blue writings on it. The wall is white in colour. I smell the food in my lunchbox. I can hear the teacher talking about the assignments..”

3. Listen to your favourite song. Pay attention to the words and melody. Sing along out loud or to yourself.

4. Breathing: pay attention to your breathing. Focus on each inhalation and exhalation. Say a calming word when you exhale viz. “calm”, “safe” or “relax”.

5. Touching objects: touch a pen, keys, clothing, or the table and notice how they feel. What is their hardness, consistency, smoothness, colour, temperature,etc. Describe the feeling in detail.

6. Put your hands under a faucet and ‘feel’ the cool running water and splash on your face.

7. Eat your favourite dish. Describe the taste in detail.

8. Dance to your favourite track. Remind yourself that you are connected to the ground as you notice the sensation in your feet.

9. _____________

10. _____________

Exercise: Each member should stand up and describe their immediate surrounding in detail. Before this ask them how they feel right now. Then after the exercise ask them how they feel. Now practise different techniques by making small groups. Tell on member to ask questions to the other member about their surroundings. Encourage them to practice grounding every day for homework.

BREATHING EXERCISE 2

EXPOSURE SHEET

SESSION 6

EMOTIONAL NUMBING

Many of you come from places where you have experienced very difficult situations. Many times you may have felt the need to shut down your emotions and emotional attachments. This may have helped you to cope with many problems in the past. It may have helped you to do things which would have been difficult with you showing your emotions. You may have had to part from your family members during your travel and had to hide the emotions so they don’t hinder you from moving on. You may have had to separate from your pets or your homes, and this would have made you really upset. But you avoid these emotions at all costs because you knew it was important to move on.

In this session we try to identify and express our emotions.

NUMBING WORKSHEET

What emotions do you not feel/numb___________________________________

Why do you think it is easier to not feel?_________________________________________________________________________________________________________________________________________________

How did you kearn not to feel?_______________________________________________

What do you think would happen if you felt sadness?_____________________________________________________________________________________________________________________________________________

Whats do you fear would happen if you felt fear or anger?______________________________________________________________________

What emotions would you like to feel again?______________________________________________________________________

How does emotional numbing affect your relationsips?_________________________________________________________________

Emotion Expresion Worksheet

1) I felt MAD when ________________________________________________

2) I felt SAD when__________________________________________________

3) I felt GLAD when__________________________________________________

4) I felt AFRAID when________________________________________________

Fill in the blanks above with events/situations that you experienced this week. This exercise needs to be practiced throughout the week and preferably with a loved one. For example, your brother broke your new pen. This made you mad. So write this down in the manual.

This session should help you identify and pay attention to your emotions and gain experience communicating these emotions to others thus strengthening emotional bonds.

BEST-SELF STATEMENT (TWO WORDS)

Complete the following sentence:

‘I want to be a person who is _________________________and ___________________________.’

Example: I want to be a person who is loving and caring.

This is an important tool that reminds the youngsters who they want to be. Encourage them to come up with two words that describe who they would like to be.

THE TOOLs FOR COPING:

1) BREATHING

2) CALMING PHRASE

3) BEST SELF STATEMENT: I WANT TO BE A PERSON WHO IS _________AND _____________.

Breathing helps to bring down arousal, self-talk helps to activate the ‘thinking-brain’ and best self statement helps them know what they want to be. Once the youngsters calm down by breathing exercise and calming phrase, the best self statement acts as a road map that tells them how to proceed in a given situation in their best self.

This tool needs to be practised over and over again in a day till it becomes habitual. It can be practiced anywhere and builds the process of calming and grounding as the first response to arousal.

EXPOSURE SHEET

SESSION 7

ANGER MANAGEMENT

Anger is a very common issue amongst children and adolescents with PTSD. You can handle anger by either exploding or avoiding it. This expression of anger can affect your social life, your school life and work. This session is to help you cope with your anger and interacting with others. In the following exercise describe how they experience anger and discuss:

1. With whom do you get angry with most often?

2. What do you want as outcome from conflicts in those relationships?

3. What changes do you want to make in these to get what you want from those relationships?

4. How do you want the other person to feel about you after the conflict?

5. How do you want to feel about yourself after the conflict?

6. What do you fear most when you are angry?

7. How do you avoid anger or conflicts?

8. What happens when you avoid?

9. How do you explode when you are angry?

10. How does it affect the other person?

11. What are your body’s warning signs for anger?

Tool for Anger Management:

1) Breathing

2) Grounding Statement/self talk

3) Best-self statement

BEING ASSERTIVE:

There are three ways of interacting with other people. One way is to be aggressive/explosive. This could put you at risk of danger and conflicts with the law. It shows disrespect to others and means you want to impose your will on others. The other way is being passive/avoidant. This means you are giving in or giving up and disrespects yourself. This could help preserve physical safety but doesn’t help you care for yourself mentally. A better way to interact than the said above is the Assertive way. In this you stand up for yourself without attacking others, being firm and polite at the same time. By following this route, we can respect both ourselves and others as well.

Examples of using the three ways of interacting with people follows:

ASSERTIVE:

____Asked clarifying questions instead of making accusations

____Communicated your needs w/o demeaning the other person

____Took a time-out

____Used “I” statements (e.g., “I am angry” not “You make me angry”)

____Used polite language (e.g., no swearing or insults)

____Approached problem with a constructive attitude and tone

____Controlled your display of anger despite the other person’s reaction

____Add your own:_____________________________________________________

AGGRESSIVE:

____Made verbal threats

____Became physically aggressive

____Used inflammatory language (e.g., swearing and/or insults)

____Approached problem with the goal of “showing who is boss”

____Raised voice or used a sarcastic/demeaning tone

____Glared at or “stared down” the other person

____Add your own:______________________________________________________

PASSIVE:

____Did not communicate your thoughts and feelings

____Did a “slow burn”

____Felt paralyzed or “froze up” with anger or fear

____Withdrew or walked away in an attempt to avoid addressing problem

____Dwelled on feelings of anger and defeat w/o attempting constructive problem solving

____Became apologetic, timid or unsure of yourself when challenged

____Used a form of negative distraction (risky behaviors, substance abuse)

____Add your own:_____________________________________________________

COOLING DOWN BEHAVIORS:

____Worked off your anger through physical activity or exercise

____Spoke to a sympathetic friend or professional

____Created a soothing environment (e.g., put on music, took a shower)

____Scheduled a break from the problem with the aim of resolving it later

____Wrote down your feelings

____Did a deep breathing or relaxation exercise

____Add your own:_____________________________________________________

REVIEW OF GAINS FROM SESSION

What are the gains you have achieved through the last sessions?_______________________________________________________________________________________________________________________________________________________________________________________________________________________

EXPOSURE SHEET

SESSION 8

ACCEPTANCE

This concept might be very difficult for some youngsters to grasp. Accepting the problem helps solve the problem. The reason many of you are part of this therapy is because you accepted that you have PTSD, which is a good thing. This led to positive changes in your life. Acceptance allows us to identify the problem and doing the necessary steps to solve them. For example, if you are going home and suddenly it rains. You can accept that it is raining and take shelter in a nearby bus stop and wait till the rain settles. Or you can refuse to accept that it is raining, keep walking and get wet.

Acceptance means to deal with the situation for what it is rather than what it should be. Acceptance means to live in the present moment and focusing on the choice we have ahead.

We can have several events in life that can be hard to accept. For example:

School bullying

Parents asking too many questions

Long queues

Cashiers unable to understand your language

Failing in exams..etc.

THINKING ERRORS

Most of us make thinking errors. These thinking methods can play an important role in how we manage PTSD. The common types of thinking errors are:

1. All-OR-None thinking: This is also called Black and white thinking. In this type, we think of things in absolute terms, like ‘always’, ‘every’ or ‘never’. For example, if you scored poorly in your exams than you expected, you see yourself as a ‘total’ failure. Or say you didn’t win a running race once, then you think you will ‘never’ win the race again. You tend to use thoughts like: “No one will understand me.” Or “All crowded places are dangerous.”

2. Emotional Reasoning: In this, you make decisions based on ‘how you feel’ rather than objective reality. When you think this way, you tend to be blinded to reality and facts. For example, you are going to the shopping mall and you think, “The mall is a crowded place, so it is a dangerous place.” But in reality, it may not be so dangerous. These choices and decisions are because eof your emotions than logical thinking.

Now complete the following exercise at home:

What thinking error do you commonly have?: ______________________________________________________________________________________________________________________________________________________________________________________________________________

EXPOSURE SHEET

SESSION 9

PRACTICE

Lifestyle modification

As important as following these exercises through everyday life, is following a healthy lifestyle. This should include daily exercise and nutritious diet. Some PTSD affected individuals tend to use other means to numb their emotions. They find drugs and alcohol helping them cope with their issues. This maybe to relax, to forget the past experiences, to go to sleep, to reduce anxiety or to feel accepted with your friends.

Remember, alcohol and drugs may give temporary relief from some symptoms, but it can also make PTSD symptoms worse! They can have negative impact on you in the long run. To fully heal from PTSD in the long term, becoming clean and sober is necessary. They can make you physically or mentally dependant and impact your social and family situation. It can worsen symptoms like sleep disturbance, nightmares, anger, depression, numbing of feelings, social isolation, irritability, hyper vigilance, paranoia and suicidal ideation.

It is important to know the consequences of drinking/substance abuse on health, relationships, psychological, financial, etc.

If any of the members have history of alcohol or drug use, they can contact the therapist/social worker to discuss further management. Our agency provides all the support required to help those trying to lead a drug-free lifestyle. We provide you reading materials on consequences of alcohol or drug use and referrals if necessary.

RELAPSES

Relapse is when you go back to your old ways of coping with the PTSD symptoms. This can occur even after long term therapy. Relapses are a normal part of getting better. It is an opportunity to remember the different tools and use new skills. Relapses gives us an opportunity to be ‘tested’ and get better.

Follow-Up

It will be up to the participants to use the tools in their daily life. They can always get back to the agency for further help or enquiries. They can always contact the therapist/social worker if they require individual attention.

Post Traumatic Stress Disorder (PTSD) Recovery Program

Therapist Manual

Table of Contents

Executive Summary.3

Introduction.3

FSD Agency Context4

Issue.5

Proposal to Populaion.7

Rationale of the Treatment7

Plan for Therapy.7

Group Activities.8

.docx#_Toc396510237″>Exploration of connections between therapeutic approach.9

Impact on the Community.9

AASW Code of Ethics.9

Practical Application of AASW…10

Conclusion.11

References.12

Executive Summary
High level of stress, trauma or anxiety can result in the creation of Post-Traumatic Stress Disorder (PTSD). This particular disorder has been known to be a major problem within the society. In this report, details regarding this group work session shall be discussed. The issue will be explained in detail along with the procedure or methods that will be followed by the group to help the refugee population. These issues are related to the individuals. Therefore, to solve these issues, the agency is known for providing several policies, programs, support group, medications, and counselling as well as closed group discussions, in alignment with thepsychosocial theory.

Introduction
In the present situation of highly globalized world, it has been seen that there is high level of stress and traumas amongst the population of all age group. The FSD agency has been concerned to fix these problems in order to avoid a negative impact on the entire society. Particularly, the agency is concerned about the increasing level of stress and anxiety amongst refugee population (Westermeyer, 2002). High level of stress, trauma or anxiety can result in the creation of Post-Traumatic Stress Disorder (PTSD). This particular disorder has been known to be a major problem within the society. Any extreme event such as, crime, natural disaster, or combat can be a contribution in the rise of this particular issue. An individual who suffers from PTSD may keep having flashbacks of the event by hallucinations or intrusive nightmares.

PTSD is considered to develop after an individual faces or experiences a kind of traumatic event such as threats of imminent death, serious injury, warfare, or sexual assault. As stated FSD agency have been outlining certain measures, actions, steps, and provisions that would help the refugee population to avoid the occurrence of PTSD. The key reason that the agency states is that these people have severely faced each of the dangerous events outlined, thus being a combination of all, PTSD is more likely to be faced by them. The mission is to help the refugee population to live a physically and mentally healthy life. Similarly, the agency is aimed at reaching this population and providing them with the concerned manual, so that they can avoid the causes and reasons behind the same.

In consideration with the issue of PTSD amongst the refugee population of Australia, the FSD agency is willing to build a group work session for treating the individuals suffering from PTSD, with the utilization ofpsychosocial theory. In this report, details regarding this group work session shall be discussed. The issue will be explained in detail along with the procedure or methods that will be followed by the group to help the refugee population. The concerned paper is a therapist manual that provides an adequate definition of PTSD and makes the people well aware of the causes, symptoms, and treatment of PTSD. The key target population of this manual is the group of refugee people, currently residing in Australia mainly in Brisbane.

FSD Agency Context
Fixing Stress Disorder Agency (FSDA) is an agency that focuses upon the psychological issues that the population faces and helps in fixing these problems. The agency understands that the most important ingredient of the society is the people. Therefore, in order to have a healthy society, it is important to have a healthy population. By the term healthy, the agency does not only refer to physical health but it also refers to the psychological and mental health. There are several issues that the agency deals with. These include severe symptoms or stage of depression, alcohol and drug addicts, foster care, chronic pain, domestic violence, teenage pregnancy and several other major issues. These issues not only have an influence on these individuals but also on the entire society. The agency also provides educational camps to the general population. This is due to the reason that most of the related individuals have no idea regarding the problem faced in psychological disorders.

These issues are related to the individuals. Therefore, to solve these issues, the agency is known for providing several policies, programs, support group, medications, and counselling as well as closed group discussions (Westermeyer, 2002). The agency is also known for dealing with the cases of PTSD as well. However, now the agency will be dealing with issue of PTSD amongst the refugee population. This population includes survivors of war that have struggled through a lot of traumatic events and incidence. Through this manual the concerned agency wants to achieve the following aspects:

Ø A PTSD – free refugee population in Australia

Ø Reaching the refugee population in Australia mainly in Brisbane

Ø Providing each of the refugee people with the concerned manual

Ø Addressing their needs and requirements; so that they can lead a healthier life.

The agency context is that it has seen and helped a lot of people suffering from PTSD. The affects of PTSD are highly severe and can even lead to complete consciousness loss. Thus, the agency is attempting to help the one that is currently being discriminated by citizens in small parts of the country. The target population is the refugee people in Australia and with the utilization ofpsychosocial theory; the agency is aimed at achieving each of its objectives.

Literature Review: Issue
Post-Traumatic Stress Disorder (PTSD) is a secret scar of war or some other traumatic event that cripples amongst the society or individuals that struggle to make their way out of the shield of destruction, horror or pain (Trief, 2006). In simple words, PTSD is the disorder faced by an individual after experiencing some kind of disturbing event that relates to stress and anxiety due to the terror of the experience. At times, individuals keep getting flash backs that causes great stress to the physical and mental health of the individual. Thus, thepsychosocial theory is the best way to mitigate or reduce the PTSD level in target population.

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Figure 1: Diagnostic Criteria for PTSD

(Source:Trief, 2006)

Several wars have taken place that has a huge negative impact on the entire community. The damage is done to the whole society as all individuals are affected by the war. The most affected ones are refugee children and women (Trief, 2006). At times of war, children face huge violence and torture; whereas, women are raped and killed. Refugee and immigrant females and children that come out from the war-torn nations those end up reliving these extreme trauma and continued oppression of gender. Moreover, as these individuals approach new nations for living in a safe and peaceful environment, they end up facing more issues of distress and trauma in the process of settlement and migration.

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Figure 2: Intervention Model

(Source:Trief, 2006)

Apart from the physical traumatic experience, these children and women also face several changes, challenges and losses in the duration of acculturation/ exile and repatriation/ resettlement periods. They also face the trauma of losing family, personal property and several other emotional factors (Staggs, 2013). Dependant on several facts and samples, the ratios of PTSD vary largely in different areas. The range of PTSD individuals varies from 4 per cent to 86 per cent which involves high level of depression ranging from 5 per cent to 31 per cent. These individuals are the victims of war and violence that often end up suffering from imaginary trauma on regular basis. It also involves inability of relating to others, persistent flashbacks, hyper-alertness, constant fear and regular outburst of anguish and anger.

Ø Population: Refugee people residing in Australia, especially in Brisbane. These people are mainly from Sri lanka, Iraq, Afghanistan, Pakistan, and Iraq.They are the victims of the war and came to Australia via boat. They are not provided with work rights and age between 19 and 25 years old.

Ø Intervention: Emerging Interventions – CAM,

v Pharmacological Interventions – Oploid Antagonists, Steroids, Narcotic Medication, Atypical Antipsychotics, Mood stabilizers, Beta – Blockers, Alpha – Blockers, SSRIs,

v Psychological Interventions – CISM, CISD, Psychological Debriefing, EMDR, Normalization, Psycho – education, Psychological first aid, Coping Skills Therapy, Exposure – based therapies, and CBT.

Ø Outcomes: Final Outcomes – Perceived Utility, Resilience, Decrease in the homicides or suicides, Enhanced ability to work, Better quality of life, Better social functioning, Decrease in the severity and incidence of co – morbid conditions.

Proposal to Population
RATIONALE OF THE TREATMENT
Even though there are a number of theoretical expressions for PTSD, the most appropriate approach is the psychosocial theory of the maintenance and development of PTSD symptoms. This theory will be used by the new proposed closed group session. It helps in providing a rich therapeutically system for the conceptualization of psychological impacts that the trauma results in (Scott, 2010). This approach will be an attempt for accounting for both, the unique and typical adaptations to the influences that trauma of psychology has. This approach will help in the formation of assumptions on which individuals are helped in guiding their lives. By the virtue of interpersonal and social nature, this group intervention will help in providing an excellent environment for repairing the individuals with trust and safety.

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Figure 3: Common Reactions to Trauma

PLAN FOR THERAPY
Therapy is the most effective way for treating the individuals of PTSD. However, since the symptoms of trauma are particular, it is found that the same type of therapy will not be appropriate for all patients. The trauma survivors will be helped in the development of new coping skills in consideration with the type of symptoms. Psychosocial theory will be used by the new proposed closed group session. It helps in providing a rich therapeutically system for the conceptualization of psychological impacts that the trauma results in. The groups will be following the below stated goals (Najavits, 2002):

· Development of accurate and full understanding about the emotional and physical responses that are main features of PTSD

· Development of a mindset of patients for providing help in the maintenance of control at all duration of time and identifying the skills of patients

· Enhancement of skills amongst the individuals

· Recovering and improving the condition of all patients

GROUP ACTIVITIES
There are certain ways the group intervention will be following in order to achieve the above stated goals and solving the problems. Even though the strategies will be different according to different cases, some basic strategies shall be followed. These strategies are as follows (Kessler, 2001):

· Format of group will be generated for helping the patients in learning the skills and information. This strategy will help the patients in discovering the fact that they are not the only ones who have suffered and there are several other individuals showing variety of similar symptoms. This will be a major contribution to help them in overcoming their fears and problems and will learn to cope up

· The entire group will be formulated on the basis of a systematic structure. All levels of groups will be having a particular goal and purpose. By attending the groups at all levels, the individuals will be able to achieve their personal goals and they will be a major contribution in the achievement of goals of the group

· Tasks and work for home will be given to the patients in between sessions. These tasks will also be a major contribution to help them in recovering

· The patients will be able to learn a number of skills and their current skills will also be enhances. Help will be provided to them as to how they can deal with certain unexpected and expected problem, ignorant behaviour and interpersonal conflicts

The main fact that the group will be considering is that all of the involved group members will be in the treatment process at all times (Harned et al., 2006). Also, it is important to be acknowledging the fact that the disorder is due to the past experiences of patients that are still effecting their current situation. The group cannot change the past but it will be focusing on changing the perceptions of patients regarding their past while enhancing and improving their present. This is a critical point which will be emphasized in order create an understanding amongst the patients regarding the expectations and purpose of the group they are a part of.

Exploration of connections between therapeutic approach
IMPACT ON THE COMMUNITY
Community or society is made up of the individuals residing within it. In the present situation of hi