Health Disparities – Facilitation Reflection

As I find myself saying every week in my blog posts, I really enjoyed this week’s facilitation. I loved that we had the opportunity to choose which population of focus we wanted to work with, and that we were given such detailed, specific case studies to start our small group discussion. My group had a really interesting discussion on how a single refugee mother would interact with the healthcare system, and the unique barriers she might face. I really appreciated the comment that someone made (I think Lawrielle said this) about not silo-ing people into their positionalities – as social workers, it can be easy to read a case study or meet a new client, and then to shift immediately into trying to categorize them or place them into a particular “box.” While many of us only do this with the best of intentions and with the goal of enabling ourselves to be better able to support our clients, this kind of client-categorizing can of course be pretty problematic. In doing so, we lost an intersectionality approach to client care, and we run the risk of treating our clients as numbers rather than unique individuals. This is an important perspective that I hope to keep in mind in my interpersonal practice work as a social worker, and I’m grateful to have been reminded of it during yesterday’s class.

Another reason why I really enjoyed yesterday’s facilitation is that I loved the opportunity to discuss two of my passions: public health/social determinants of health and refugee communities’ interactions with the healthcare system. This is the type of work I’m hoping to focus my career on – I think the combo of public health and social work is giving me some really valuable skillsets in order to prepare me for work in the field of refugee health, and of working to make our healthcare system more accommodating of refugees’ needs. In our small group discussion of some of the barriers that the woman from our case study would have faced in Ann Arbor, I was reminded of a unique health collaboration that I was able to work with in Philadelphia, called the Philadelphia Refugee Health Collaborative (PRHC). PRHC is a collaboration among the city’s refugee resettlement agencies and local clinics. The clinics receive training from social workers and public health professionals at the refugee resettlement agencies, on cultural sensitivity,  “refugees and immigrants 101” training (which is basically an introduction to and explanation of the refugee resettlement process in order to prepare providers for their work with refugees), and on how to use an interpreter. Each clinic agrees to set aside time (typically a half-day per week) to dedicate to seeing newly arriving refugees, and the refugee resettlement agency coordinates with the clinics in advance to send client information and to schedule the appointments. These “refugee clinics” account for the increased time needed to call an interpreter for the appointment, and there is a representative from the resettlement agency (typically an AmeriCorps member) who is present during the refugee clinics to coordinate follow-up care, help clients go to the pharmacy to pick up prescriptions, and to schedule any referrals needed. I found this system to be highly effective and allowed for increased quality of care to the refugee patients themselves. Here is a link to the PRHC’s website if you’re interested in reading more: http://philarefugeehealth.org/

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Final Project Reflection – Service Learning at Freedom House

For my final project, I spent time each week volunteering at Freedom House in Detroit. Freedom House is a non-profit organization that provides comprehensive services – including housing, job search, education, case management, social supports, legal, and therapeutic services – to individuals and families who are seeking asylum in the United States. Freedom House is located in the unused St. Anne’s Convent in Southwest Detroit, and you can see the bridge to Canada from the house (see photo below – note due to privacy concerns for residents I was not able to take any photos inside of Freedom House).

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Here is a bit more about Freedom House, from their website: “Freedom House Detroit is a temporary home for indigent survivors of persecution from around the world who are seeking asylum in the United States and Canada. Our mission is to uphold a fundamental American principle, one inscribed on the base of the Statue of Liberty, providing safety for those ‘yearning to breathe free’” (“About Us,” n.d.).

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When I learned that my field placement would not be with refugee and immigrant communities, I decided to research opportunities to volunteer, so that I could keep in touch with the type of work that makes me feel the most fulfilled and that reminds me of why I chose to pursue an MSW and MPH. I found Freedom House, and was immediately drawn by their unique advocacy and support services to asylum seekers, a population that is often forgotten about or neglected among the public discourse and the media. In my previous work as a case manager with a survivors of torture program, about half of my caseload was composed of asylum seekers, and I took a lot of time to learn about and attempt to understand the unique barriers and challenges that these individuals face (relative to individuals with other immigration statuses, such as refugees or green card holders). Given that this is a course in Community and Social Systems, before reflecting on my specific experience volunteering at Freedom House, I’d like to briefly share some information about the systems that asylum seekers may encounter and the unique barriers that this community faces:

 

  • Healthcare access – Until they receive a work permit, asylum seekers are not eligible for any health insurance except Emergency Medical Assistance (which has strict requirements and most will not qualify for). Upon receipt of a work permit, asylum seekers can apply for health insurance through the Marketplace (under the ACA or “Obamacare”). While Marketplace insurance is typically pretty affordable (many will qualify for subsidies to cover their monthly premiums), asylum seekers often must go through a lot of hoops before enrolling – many of the clients I worked with had to submit their work permit and proof of immigration status, along with proof of income, to the ACA Marketplace multiple times, before getting approved.
  • Mental Health access – In addition to healthcare access, access to trauma-informed, linguistically and culturally appropriate, services to address the mental health needs of asylum seekers is challenging. Due to their limited eligibility for health insurance, and the limited range of interpretation services available in mental health services, many asylum seekers struggle to find therapists (or other mental health care) that addresses their unique needs and that supports them in healing from their trauma.
  • Public Assistance Benefits – Asylum seekers are not eligible to apply for any public assistance benefits, including SNAP (food stamps), Medicaid, TANF (cash assistance) and section 8 housing (public housing assistance). Until their asylum claim is approved (which can take years), asylum seekers are not eligible for such public assistance programs, and this can place a huge burden on them, especially given that they are not eligible to apply for work permits until 180 days (6 months) after submitting their asylum application, and the jobs that many are able to find are minimum wage.  
  • Legal – The process of applying for asylum can take years, with the average wait time being between 2 to 5 years. The process can be very traumatizing for individuals, in having to recount and repeat their story of how they fled their country and having to provide detailed evidence to the courts. In addition, many asylum seekers I worked with described the frustration and stress of feeling constantly “in limbo” – waiting for a work permit, waiting for an interview from the court, and then waiting for approval of their application. This constant level of instability and uncertainty can be very stressful and overwhelming.
  • Housing – For many of the asylum seekers I worked with in Philadelphia, access to housing was a major challenge. My organization did not provide housing, and many of my clients had to live with family, friends, or acquaintances, as they were not able to afford to live on their own (especially during the time before they received work permits). I had a few clients who were homeless, and navigating the overburdened shelter system was a huge challenge.
  • Social support – The process of seeking asylum can be very isolating and lonely – many of my clients described feeling highly stressed, missing family members and friends they had left behind, and lonely in this country.

 

 

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Based on all of the aforementioned challenges and barriers that asylum seekers face, I was impressed to learn about the comprehensive level of services that Freedom House Detroit is able to provide its clients. In particular, its ability to provide free housing for clients is a major asset of the organization and is a unique model compared to other programs that I have seen. Freedom House houses approximately 30 residents at a time (including individuals and families with children), who are able to stay for 1-2 years. Immigration attorneys on-site support people in navigating their asylum claims, social workers provide case management and therapy, and a range of groups come in on a weekly basis to conduct programming, social events, and other activities for the residents. The house has a welcoming and communal feel, and residents take turns cooking meals, which they eat together, and cleaning.

 

My role at Freedom House this semester involved providing childcare in the evenings, giving parents an opportunity to attend programming in the evening or to just relax a bit. I volunteered at Freedom House for 2 hours a week, getting to hang out with the sweet, rambunctious, and silly group of kids there. The children currently there range in age from about 2 to 12, and they are friendly, loud, and fun. They seem to be very used to having visitors, and always seem excited to have somebody to play with. Each week, we play games, color, and chat, and I have really enjoyed getting to know these kids. This week, for the first time it was nice enough for us to play outside on the playground.

Currently at Freedom House, the majority of residents are African, and it is typically pretty clear when a white volunteer like me is around. The other week, I saw some new people at Freedom House – three women who were speaking Arabic and English – and who joined me in playing board games with the kids. Not wanting to make assumptions about their role, I asked the women if they were also volunteers, and they told me that they were residents at Freedom House. I think that I had gotten used to expecting those who looked more like me to be in the volunteer role, and this moment was a good check on the assumptions that I make about people.

Other challenges to my assumptions that I’ve experienced at Freedom House have come from some of the kids – one child pointed out to me one week that I have “yellow skin” and that she has “black skin.” Another girl one week asked me about what the difference is between African American and black, asking me about black people in the United States and Africans in the United States, and wondering what kinds of differences there are between these groups’ experiences. Over several weeks, a couple of the older girls asked to braid my hair, and commented on how my hair was different from theirs.
Future plans

I have really enjoyed my time volunteering with Freedom House, and I plan to continue to volunteer there throughout the summer and fall. It is a great opportunity for me to work with communities that I have missed getting the chance to work with, in a setting in which I am not in a formal social worker role.

 

References

(n.d.). About Us. Retrieved from https://www.freedomhousedetroit.org/index.php/about-us

School to Prison Pipeline – School Culture

I found this week’s facilitation to be a really engaging and unique way to get the class talking about the school to prison pipeline – by assigning the same 2 cases to each group representing a different Washtenaw County high school, we really got to see and hear the range of experiences and disciplinary practices that the two case studies would face in each school. Going through such an exercise and then sharing out with the large group was really powerful – also I really appreciated that this week brought the discussion to a very local level, one that made the realities of the school to prison pipeline discussion much more real.

I wanted to share a brief anecdote from my former work as a case manager, which this week’s facilitation brought up for me: Last year, I was working with a woman from the Central African Republic, who had two boys in the Philadelphia public schools, around ages 7 and 9. The boys attended the same school, and one day my client informed me that the school had contacted her to inform her that her sons were engaging in “inappropriate,” “over-sexualized” dancing behavior during gym class, which was concerning to school teachers. The boys were reprimanded at school, my client was called in for a meeting, and teachers were threatening to call CPS if the dancing continued (they were concerned that possible sexual abuse at home was influencing their dance moves). My client explained to me (directly in French – when she spoke with the school, they initially did not use an interpreter), that the way her boys were dancing was common in her country and that it was not at all considered inappropriate for their age. She said that the school was refusing to understand her side of the story, and was failing to acknowledge the cultural background from which she and her children had come.

These types of cultural misunderstandings are probably much more common than we’d expect, and it was so frustrating to see the school refusing to acknowledge or attempt to understand the way in which my client’s positionalities influence her behavior and the way she was raising her children. I don’t really have an answer as to how to improve communication and cultural competency in situations like these, expect for that we need more support and advocacy for our clients, and more social workers in schools!

Food insecurity

I enjoyed the discussions that were brought about by this week’s facilitation group. While we implicitly discuss poverty and its impacts throughout our social work courses, I found it refreshing and productive to talk about poverty in a more direct way and also (as many mentioned) to explicitly acknowledge the impact that food insecurity has on those experiencing poverty. I had not thought about the lack of food justice conversation in the School of Social Work, but as I listened to people share their frustrations about the lack of food justice focused coursework in the school, I realized that this is a topic that (among others that are not highlighted enough in our coursework) needs to be better incorporated into our SSW curriculum.

Another component of the facilitation this week that I enjoyed was the poverty simulation – while I did not necessarily think that the poverty simulation in-and-of-itself was effective, the critical dialogues and discussion it brought about (both in our small groups and as a class) were really powerful and helpful to my learning. My group brought up the critique that the simulation does not incorporate intersecting identities, nor does it acknowledge the level of variation of experience that would occur among those of differing racial, cultural, linguistic, gender, etc. backgrounds. The simulation attempted to put all of those experiences under one “catch-all” umbrella experience of poverty, but the reality is that, due to structural racism and other forms of oppression that serve to perpetuate existing power structures, the experience of poverty differs vastly depending upon what other identities you hold.

In addition, I often struggle with any activity that attempts to make generalizations about the experiences of vast and diverse groups of people, especially when this runs the risk of causing those participating in the activity to exoticize or to other-ize such experiences. I really appreciated the insight brought up in the large group discussion that the poverty simulation was likely targeted toward people with more privileged identities who have never experienced poverty or known anyone who has experienced poverty. I liked what Mike brought up about the simulation potentially igniting feelings of pity among such privileged participants – I have found that a lot of programs/activities/articles/resources out there seem to use this tactic of eliciting pity to motivate people to engage with a social justice issue. It reminds me a bit of some of the reflections I had during the fundraising ethics group’s facilitation, regarding the use of client narratives and/or photos to increase donors’ motivation to support your work. While of course one important way to advocate for change and to increase awareness of the social justice issue you are focusing on is to share narratives and anecdotes in order to increase empathy toward your work, I think that doing so is a slippery slope that can quickly lead to your audience feeling pity toward the work. This in turn can shift audience’s (or potential donors’) attitudes into a “white savior” complex, in which they feel it is their “duty” to “save” the communities with whom you are working. In the case of the poverty simulation, I’m sure that for some participants who had never seen or heard of anything like that before, they developed such a savior complex and felt compelled to jump and “save the day.” Again, while it is important to spread awareness of social justice issues such as the impact of poverty and of food insecurity, how can we do so in ways that elicit empathetic, but not patronizing or “savior-complex-y,” attitudes toward the work?

Criminal Justice & Mental Health

I really enjoyed this week’s facilitation presentation – I feel like each week the facilitations just keep getting better and better as we learn new takeaways from each group. I found the small group discussions really helpful and I learned a lot from my small group facilitator – I liked the activity of coming up with a pros and cons list surrounding each criminal justice-related topic we discussed. In the school of social work, I feel like we are not often forced to either listen to or to try to articulate what alternative perspectives or the “other side” of an issue might look like. As social workers, I think that most of us in the school are passionate about social justice and committed to resisting structures/forces that inhibit the advancement of social justice; however, it’s important to challenge ourselves to see and hear other perspectives (also to challenge the assumption – one that I often fall prey to – that we MSW people all have the same views on these issues, which is not necessarily the case!).

 

I was really moved by Mr. Sanders’s talk to the class after the presentation – I hope that he has the opportunity to speak before other groups (of social workers and other community members) because he is such a well-spoken and insightful person whose experience should be heard. I thought his discussion of the intersection between the criminal justice and mental health systems was really interesting, and it resonated quite a bit with what I have been seeing and learning about at my field placement site (which is a crisis intervention center for people who are experiencing mental health related crises). Many of those who come to seek services at my field site are brought there by the police, and are under a petition or court order requiring them to seek mental health treatment. While I think that ensuring that those who are severely mentally ill receive appropriate treatment is important, I think that criminalizing mental illness is another story – in doing so, we run the risk of perpetuating stereotypes that equate acute mental illness with risk for violence and other crimes, when for the majority of those struggling with mental illness, this is not the case. On the other hand, inpatient psychiatric hospitals have such limited space and sometimes provide such non trauma-informed/terrible services that those with mental illness feel that they leave such places feeling worse than when they entered. This article talks about the issue of shifting mental health care from inpatient hospitals (which are often overcrowded and not able to accommodate all patients’ needs) to jails/prisons as providers of mental health services and is worth a read if you have time: file:///Users/meganobrien2/Downloads/Lamb&Weinberger_2005_Incarceration.pdf

I definitely do not agree with this shift from hospital to prison for addressing mental health – I do not think this is a humane nor an ethical way to care for those struggling with mental illness in our communities. As I continue to witness places like my field site experiencing challenges related to overcrowded-ness and lacking capacity to accommodate the patient demand, along with seeing the same experience for inpatient psychiatric hospitals, I can see how the shift to pushing those mentally ill patients who such systems cannot “fit” into the prison system happens. I wonder what alternatives there are to address the needs of mentally ill individuals? How can we support people in accessing the treatment and care they need, while ensuring that they and others are safe from harm? I have been struggling with this question all semester, as I witness and reflect upon the community mental health system that I am being introduced to at field – I’ve noticed moments where I feel this existing system is effective, but probably have experienced more moments where I feel that this system fails….

Facilitation Reflections

Overall I think that our group’s facilitation went well this week – especially in the small group discussions, people seemed very engaged and interested in the topic. I love working with our group – you all are lovely people and working with you made the whole process feel easier and less stressful 🙂

While we tried to extensively prepare and account for potential challenges that might arise during the presentation, some surprises/unexpected hiccups still came up. As I mentioned during the “fishbowl” discussion, I feel like our transitions from activity to activity, along with assigning facilitation roles to each person beforehand, made the whole facilitation go very smoothly and made us look organized and prepared. As many mentioned in the feedback we received, the word mapping activity went much differently than I expected. While I had thought that everyone would write their thoughts on the whiteboard simultaneously, people ended up going up one at a time, which may have made some feel more vulnerable, like they were on display before the class.  While I still think that the word mapping was a good way to start the class and to get people warmed up, I liked the suggestion that we do so more anonymously. I also liked the suggestion that we start the class with the small group discussions on our own experiences with gentrification. I wonder if it would have been effective to start with those small discussions, and just before that, to ask people to write down the words/ideas/thoughts that come to mind when they hear the term “gentrification,” while a facilitator came around and collected people’s thoughts in a hat. This way, we would have gotten people engaged in a smaller (safer) space, while also gathering the collective thoughts of our classmates, which we could have shared with everyone during the small group debrief.

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I also think it would have been helpful, as Mike suggested, for us to have come up with some more probing questions to get the conversation to go a bit deeper — making sure that we got people talking about how race and class, for example, come into play with gentrification. When responding to comments made during the large-group share-out, I struggled to respond quickly while on the spot, and if I had prepared some more pointed or probing follow-up questions to pose to the class, that might have helped move the conversation to where we wanted to go. I also would have liked to have gotten into more discussion about the different frameworks we chose for looking at gentrification, because gentrification is such a broad topic. Also it might have been helpful to have picked a specific “case study” location to focus the conversation a bit more. I liked how people brought up Ypsilanti during the large group discussion – I wish we had thought to look more into the history of Ypsi or of another city so that we could have offered more context to the class.

Despite all of these suggestions and ideas for how the facilitation could have gone more smoothly, I think that overall we did well and people really enjoyed the conversations that our facilitation brought up. I couldn’t believe how quickly the class flew by, and I’m glad that we can now relax and enjoy and learn from the upcoming presentations!

Thoughts on Fundraising

I really enjoyed this week’s facilitation and the topic chosen – while fundraising and grant-writing are subjects that I have thought about through my work and field experiences, I had never engaged in a formal discussion on the ethics of raising money for an organization. I have reflected a lot on the ethics involved in the balance between raising funds in order to sustain and build up an organization’s capacity, and running the risk of exploiting clients/the communities you’re trying to serve in the process. In order to make a grant application or a call for donations more compelling, the inclusion of an individual’s or family’s narrative can be highly effective. Including a specific story can increase donors’ likelihood of contributing to your organization and their motivation to donate, as doing so can “bring to life” your organization’s work and elicit feelings of empathy from those who may not understand or be from the same communities as those that the organization serves. All of this being said, I feel pretty uncomfortable with the risk of exploiting clients for their stories, and asking them to potentially repeat the story of a traumatic or triggering life experience for the benefit of fundraising. Often, I feel like such exploitation occurs when white program managers/directors are trying to raise funds for programs benefiting communities of color. For example, the director of the refugee resettlement program at my former organization, a white social worker, was always present for the “photo-op” with a refugee family (when the photo would be on social media or included in an annual report to funders), and always seemed conveniently available to take a photo of herself holding a refugee baby, but often felt out-of-touch with the actual goings-on of the communities that the organization was serving. This past spring, I was working with a Syrian family with young kids, and the father was a survivor of torture. The resettlement program director invited my client (the father) to speak at a public film screening of a documentary about the Zaatari refugee camp in Jordan, where this family had lived for several years before arriving in the United States. I attended the screening, and for someone who is neither from Syria nor a refugee, it was incredibly emotional and difficult to watch. I cannot imagine what that experience must have been like for someone who experienced the camp and the Syrian war firsthand. While it may have been empowering for my client to be asked to speak after the film, and while it may have been presented as optional for him to speak, as a recipient of multiple programs at the organization, the client may not have felt that he was given much of a choice in the matter. I was very upset by the situation, and had not been informed that my client was asked to speak before I saw him at the event. Afterward, I called him to check in; I thanked him for speaking, but made sure to emphasize that I was available to hear him if he had been triggered or if the experience was painful for him. I also brought up the situation to my program director (a different person from the social worker who had invited my client), and requested that a more culturally sensitive and trauma-informed procedure be developed when the organization recruited clients to speak publicly about their experiences. Even in writing this blog entry a year later now, I am fuming – this kind of situation is what gives social workers and community organizers a bad name and what can contribute to loss of trust with communities.

The blog entry, “9 Principles of Community-Centric Fundraising,” addresses this ethical dilemma in principle #7, which states that “we authentically partner with community members when asking them to be involved in fundraising efforts” (p. 4), and presents a possible solution to this challenge of excluding and exploiting communities in the fundraising process. While working to raise funds for your organization is an essential component of keeping an organization afloat and allowing it to support and advocate for communities, it is crucial that the process of doing so be done in a way that takes communities’ needs and input into account.