Download Critical Appraisal of Web-based Health Information

The Value and Meaning of a Drop-in Centre for Refugees and
Asylum Seekers
20th June 2017
Dr Hannah Spring, Fiona Howlett, Claire Connor
York St John University | www.yorksj.ac.uk
Introduction
• Introduce our research project involving a drop in centre for
asylum seekers and refugees in the North East of England
• Background to study
• The study findings
• Implications for occupational therapy practice
• Open discussion and ideas
What is an asylum seeker?
Some Definitions
Asylum Seeker
Refugee
An asylum seeker is someone who has
lodged an application for protection on the
basis of the Refugee Convention or Article 3
of the European Convention on Human
Rights (Refugee Council, 2017)
Refugee status is awarded to someone the Home
Office recognises as a refugee as described in the
Refugee Convention. A person given refugee
status is normally granted leave to remain in the
UK for 5 years, and at the end of that period can
apply for Indefinite Leave to Remain (Refugee
Council, 2017)
Some Definitions continued
Refused/Failed A person whose asylum application has been
Asylum Seeker unsuccessful, with no appeal or claim for
protection in process. Some refused asylum
seekers voluntarily return home, others are
forcibly returned despite the risks to their
lives. Some become part of the homeless
population.
Economic
Migrant
Someone who has moved to another country
to work. Refugees are not economic migrants.
The Refugee Council (2016)
Migration and impact on
occupation
65.3
million
Less than 1%
forcibly displaced
worldwide in 2015
(UNHCR, 2015)
…of the world’s
displaced population is
supported by the UK
Substantial barriers to integration
Lack of Healthcare access
Work Prohibition
Lack of clarity on status
Poor Housing
Restrictions on how allowances are spent (food vouchers only)
Rationale
•
Ethically questionable to pursue exploration of personal
experiences leading to arrival in the UK
•
Findings by Smith (2015) identified asylum seekers and
refugees value highly services that offer practical and
emotional support and offer occupationally focused
opportunities
•
Numerous services operate in the UK to support asylum
seekers and refugees (many focussed on ESOL)
•
To date no evidence that considers the value and meaning of
these services, or how they are received
Rationale
•
Occupational preferences could inform future service
development at a local level and more widely
•
Research could inform potential opportunities for
occupational therapy provision among this growing
population
•
Study aimed to explore
–The value and meaning of a drop-in centre service offering
social and occupational support for refugees and asylum
seekers
–The occupational preferences of the service users
The Drop-in provides…
Occupational Support
Food
Clothing bank
Hairdressing
Sewing machines
Crafts
English classes
Games tables
Social interaction
Food bank
Advice and support
Outing/trips
Homeware
Volunteering opportunities
Tea, coffee and chat!
A lifeline!
Origins of service users
County
Attendees
County
Attendees
UK
8 (Volunteers)
Guinea
1
Eritrea
40
Congo
5
Sudan
16
Sri Lanka
1
Pakistan
2
Sierra Leone
1
Albania
6
Cameroon
2
Kurdistan
2
Ethiopia
3
Syria
17
Niger
1
Iraq
3
Gambia
1
Iran
16
Vietnam
1
Cuba
1
Uganda
1
Ghana
1
Methods
•
Phenomenological philosophy exploring the lived experience
of attending a drop-in service for asylum seekers and refugees
•
Ethics approval grant by York St John University School of
Health Sciences ethics committee
•
Semi-structured interviews
•2 interviewers = 2 participants
•Interview scheduled adapted from Bishop & Purcell (2013)
•
Recruitment
•Two-step process
•Rapport building followed by gatekeeper selection (non-maleficence &
beneficence)
•Right to withdraw
Culture and methodology
•
•
•
Cultural awareness training
Preliminary visit to drop-in
centre
Relationship and rapport
building
The Rationale for Cake
Data Analysis
•
Audio-recordings and transcripts
•
Full team debriefing after every interview
•
Cross-cultural and bi-lingual members of the research team
•
Interpretative phenomenological analysis
•Allows the interpretations and beliefs of the researchers and participants
to co-exist
•
Separate write-ups
•Added breadth and depth to the analysis
•Large data set
Findings
7 F 11 M
Six Major Themes
Results
Sense of Community (Strongest theme)
“Makes you feel like you belong to something, you know
you come here, you see people, people you can interact
with, talk with and feel welcomed in the community. (F1)
Integration
“I come here so that I can come and understand the
world and come to learn some English and how to
talk to people.” (M12)
“We can get familiar with other ideas, other opinion and
if we make mistake they can tell us, you know […]they
can tell us and correct us.” (F14)
Results
Meaningful Occupation
“I am coming here[…] I say em..like cut hair..volunteer
here. I am two years working in this drop in.” (M16)
“So that gives me time, you know a routine in my
daily life, you know to come here to help. Yeah to have
a routine in life because you kind of get bored when
just staying at home.” (F1)
Altruism
“People from other countries can’t speak English proper,
I can interpret.[…] I can help them yeah, but not very, I’m
not saying very good, but I can help them as much as I
can.” (M2)
Results
Practical advice
“I’ve got a new flat and got plenty of stuff from here[…] I
haven’t got enough money to spend for the kitchen stuff
and for example more clothing.” (M7)
“People bring things for children like nappies[..] there
aren’t other drop ins where you could get that kind of
help, you know.” (F1)
“Not for anyone if [not] for chairperson. She is the mother
here she listens to everybody, she tries to solve problems
as much as she can. She make people welcome[..] So I
would recommend her to anyone.” (F8)
Results
Areas for development
“People from outside coming to encourage women to
participate and do something at least, not just come
and just sit and have a cup of coffee, maybe that will be
helpful.” (F18)
“The kids need to have some area for playing.” (F14)
“If you provide people food, I think it is a good idea[..]
because people coming from far away[..] Like I am
coming from just near, for me it’s alright.” (F10)
Interpretation
The Need to Experience Community
And to Make a Contribution (Altruism)
While participants were sincere in their gratitude for shelter and
asylum in Britain, there was a clear sense that the drop-in centre
met a cultural need for community among the service users
which was not being fulfilled in the wider community.
• Restricted integration strategies – unable to ‘plug in’ through
usual channels because of the asylum process.
• Cultural experience and expectations – focus of daily
interaction is very different in Western culture.
• The expectation of altruism – social capital v social norm.
Interpretation
The Need for Occupation/Occupational Preferences
Occupations focussed on integration stood out as meaningful, with
acquisition of language frequently mentioned. Practical assistance was
important to all participants, though this was more marked among
newer arrivals whose right to remain depended on making a successful
claim through administrative channels.
Leisure occupations were a priority for many service users, both as a
way of experiencing community and as a means of passing the time.
Women and children’s activities Both male and female participants
expressed the need for this.
All occupational choices were framed in a group context, even
potentially solitary pursuits such as the crafts.
Future implications for
Occupational Therapy
• Appropriate Cultural Approach: Western-trained therapists could
use the Kawa Model (Iwama, 2006), designed specifically for use
with clients from collectivist cultures.
• Scaffold integration and cultural exchange: To preserve dignity,
respect and cultural safety alongside integration.
• Use Occupational Therapists: Dual-trained in mental and physical
health, with the skills to address life transitions, occupational and
environmental adaptation.
• Occupational Justice: Making the case for service provision at local
and national level, and lobbying for change in policy and legislation.
Strengths and Limitations
• Strengths
•Group Size
•Backgrounds and age range of the research team
•Cultural diversity – bilingual members
•Gatekeeper = phenomenal
•Buy-in to the structure of the research process
• Limitations
•Time constraints – we could have done more!
•Generalisability and transferability
•Location
•Opening times of the Drop In Centre
The future
• Based on the findings, a further research project will take place
next year at York St John university with a focus on women and
children.
• New philosophy ‘compassionate research’
• Hoping for publication in the Journal of Occupational Science
(Spring 2018).
• We hope to take our work to the World Federation OT
conference in 2018.
The Project Team
Our contact details
• [email protected]
• [email protected]
• [email protected]
References
•
•
•
•
•
•
•
.
Iwama, M.K. (2006) The Kawa Model: Culturally Relevant Occupational
Therapy. Edinburgh, Churchill Livingstone Elsevier.
Kronenburg, F., Pollard, N. & Sakellariou, D. 2017. Occupational therapy
without borders, Edinburgh, Elsevier.
Liamputtong, P. (2010) Cross cultural research and Qualitative Inquiry.
Turkish online Journal of Qualitative inquiry 1(1) 16-29
Lunden, E. 2012. Refugee resettlement through the lens of occupational
therapy. University of Puget Sound.
Morville, A. 2014. Daily occupations among asylum seekers: experience,
performance and participation. Lund University.
Oofras: Occupational opportunities for refugees and asylum seekers.
Available: http://www.oofras.com/
The Refugee Council (2016) Available from:
www.refugeecouncil.org.uk/policy_research/the_truth_about_asylum/the_fa
cts_about_asylum [Accessed 16th December 2016]
References
•
•
•
•
•
•
Refugee Council (2015) Terms and definitions: glossary of terminology
relating to asylum seekers and refugees in the UK [Online]. Refugee
Council. Available: http://www.refugeecouncil.org.uk/glossary
Smith, H. 2015. An exploration of the meaning of occupation to people who
seek asylum in the United Kingdom. British Journal of Occupational
Therapy, 78, 614-621.
United Nations 1948. The universal declaration of human rights
Whiteford, G. 2005. Understanding the occupational deprivation of
refugees: a case study from Kosovo. Canadian Journal of Occupational
Therapy, 77, 78-88.
World federation of Occupational Therapists 2006. Position statement on
human rights.
World Federation of Occupational Therapists 2014. Position statement on
human displacement (revised)