In this Issue:


Family Development Matrix Outcomes Model for Measuring Family Progress
by: Jerry Endres, M.S.W., Community Director, Institute for Community Collaborative Studies, California State University, Monterey Bay

Legislative and Practice Strategies to Assist Battered Immigrant Women
This article was adapted from "Legislative Strategies to Ensure the Rights of Battered Immigrant Women," Leni Marin, Migrant Women's Human Rights in G-7 Countries, Family Violence Prevention Fund 1997, and Working with Battered Immigrant Women: A Handbook to Make Services Accessible, Leti Volpp, author, Leni Marin, editor, Family Violence Prevention Fund 1995

The Use of Interpreters and Translators in Family Centered Practice
by: John-Paul Chaisson, M.S.W., National Resource Center for Family Centered Practice

Refugee Trauma and Learning
by: Kitty Kelley, M.A., Catholic Social Services, Atlanta, Georgia


Resource Review

Selected Training Program of the NRC/FCP

Staff of the NRC

Copyright 2000 by the National Resource Center for Family Centered Practice

News from the Center

by: Miriam J. Landsman, Ph.D., M.S.W., Executive Director

Greetings to old friends and new readers of Prevention Report, the bi-annual newsletter of the National Resource Center for Family Centered Practice. This has been an exciting year at the National Resource Center, as we have expanded into some new areas of family-centered practice as well as continued our long-standing initiatives in child welfare, family support, and community development. In this year of reflection, we note that family-centered practice in the year 2000 has come a long way from the home based services movement of more than two decades ago. Contemporary family-centered practice emphasizes cultural diversity in the broadest sense, interactions among systems (from neighborhood-based centers to child welfare to education to juvenile justice to public health to public assistance and more), consumer driven services that view the customer as a knowledgeable partner in the service delivery system, and a focus on outcomes that inspires service providers to look at the results of their efforts, not just the expenditure of effort.

In this, the first issue of the millennium, we are pleased to feature a series of articles on working with immigrant and refugee populations and some of the unique challenges facing family-centered practitioners in an increasingly diverse environment. Communities across the country—from urban to rural—are experiencing enormous changes in their demographic composition, which include influxes of immigrant and refugee populations. Human service practitioners who deal with these most vulnerable populations are looking for information and effective practice strategies in areas where little guidance exists. This issue of Prevention Report represents one effort toward beginning to fill the knowledge gap; we recognize, however, that the issues in working with immigrant and refugee populations will require ongoing attention and development.

Several articles in this issue address the theme of working with immigrant and refugee populations. John-Paul Chaisson, Training Associate of the National Resource Center for Family Centered Practice, describes some of the key issues in using interpreters and translators in family-centered practice and provides some guidelines for using interpreters and translators in ways that promote family-centered principles. The difficulties experienced by battered immigrant women and some recommended legislative and practice strategies to address these needs are the subject of materials provided by Leni Marin of the Family Violence Prevention Fund. Kitty Kelley from Catholic Social Services in Atlanta, Georgia discusses the relationship between trauma and learning among refugee populations, offering insights into the struggles experienced by refugees in dealing with educational systems in the United States. Finally, Steve Siglin from the National Resource Center for Family Centered Practice provides a review of some current resources in the area of cultural, such as: a demonstration project that is using mediation tomediationtows from the center ____________________________________________________________________
Outcome measures and systems of evaluating program performance continue to be topics of considerable interest and demand for technical assistance and training. In this issue of Prevention Report, we continue to report on the Center's involvement in developing and validating outcome measurement systems. Jerry Endres of the Institute for Community Collaborative Studies at California State University, Monterey Bay, describes the Family Development Matrix Outcomes Model, which is being used in multiple counties in California as well as in other locations around the country. The National Resource Center is working in partnership with the Institute for Community Collaborative Studies to test the reliability and validity of this promising outcome measurement system.

In the area of training, the National Resource Center is working on some exciting new projects. Our Family Development Specialist Certification Training Curriculum has recently been updated and is now available with on-line testing capacity for the certification process. An interactive multimedia CD-ROM of instructional materials to accompany the Family Development Specialist certification training will be available early this fall. The CD-ROM reviews systems theory, interviewing skills, family-centered assessment tools, and case planning, and will serve as a useful complement to the 8-day training program. We are also in the process of developing new curricula in child development, family-centered practice for school-based personnel, workforce development, and working with families with developmental challenges. As always, the National Resource Center continues to be available for training and technical assistance in a variety of areas such as family-centered assessment, joining/interviewing, cultural competence, case management, reunification, adoption, supervision, community development, and developing and using outcomes.

The Center's Research and Evaluation division is currently working on a variety of projects of interest to family-centered practitioners. With the current focus on developing and measuring outcomes to evaluate program performance, one of our largest efforts involves developing and providing training and technical assistance on outcome measurement systems. The Center is also conducting independent evaluations of a variety of programs, such as: a demonstration project that is using mediation to resolve permanency in child welfare; a parent/child visitation project that is seeking to expedite reunification from foster care; Healthy Start, a federally funded project designed to improve health outcomes for infants and mothers; statewide adolescent pregnancy prevention programs; and community-based programs seeking to prevent delinquency and sub-stance abuse among youth. The Center's research and evaluation staff are available for technical assistance in developing and conducting evaluations of family-centered practices across the service continuum. Look to future issues of Prevention Report for summaries of completed research and evaluation projects.

We would also like to use this issue to introduce you to the staff of the National Resource Center for Family Centered Practice. "Meet the Staff of the NRC" will give you a better idea of who the individuals are that collectively comprise the NRC. Finally, for the most current information on the Center's activities, services, and publications, we invite you to visit our new and improved website or call us at 319/335-4965. Whatever your summer plans, all of us at the National Resource Center for Family Centered Practice wish you a pleasant one.

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Family Development Matrix Outcomes Model for Measuring Family Progress

by: Jerry Endres, M.S.W., Community Director, Institute for Community Collaborative Studies, California State University, Monterey Bay

Outcomes are an important element in family-centered practice. The measurement of outcomes is now required by the Federal Government Performance and Reporting Act for agencies receiving federal funding, such as through the Adoption and Safe Families Act and Family Preservation and Support Services Program. Outcome accountability challenges family-centered agencies to think differently about the way they do business and this impacts their delivery of services. The impact is felt in how they relate to the families they serve, how they communicate to funders, and how they collaborate and partner with other organizations, and affects their unique service role to families within the community. This paradigm shift cannot occur successfully without development of reliable and valid outcome measurement models, or without family support workers seeing and appreciating the benefits of using the outcomes approach. Receiving training and technical assistance and understanding collaborative implementation and evaluation are also critical for successful implementation. In addition, the field of outcomes is in its infancy and little research is available as to the relative success of any one model within the context of integrated, comprehensive human services and planning for healthy communities.

A Client-Focused Evaluation

The shift in focus from agency and service to family outcomes benefits everyone because it:
• puts resources where they are the most efficient and effective--within a family focus,
• contributes to program evaluation that is useful to all aspects of client and agency planning, and
• gives the family a central, active role in program-related decision-making.

In developing outcomes, the family-centered question becomes, "What change do we want to see?" The response must be a specific, measurable assessment of the changes we do see.

A realistic timeframe is important—too short or too long a timeframe for outcomes can lead to a perception of failure when, in fact, positive change has occurred.

The larger question asked by families, funders, and policymakers—"How do you know that the people you helped became self-sufficient?"—Can be answered easily when family progress is measured over realistic periods of time using specific indicators of measurable outcomes.

1. What is an outcome? An outcome is a determination of the extent to which a goal or objective has been achieved or accomplished. Outcomes are stated and measured in terms of changes that take place in family status.

2. What is an indicator? An indicator is some type of information that can be used to evaluate the extent to which something has occurred. Family indicators are usually either measurements or observations of a situation in which the family finds itself.

3. What are the two most important characteristics of an indicator? To be useful in evaluating the extent to which something has occurred, an indicator must be:
Reliable measurements or observations taken under the same conditions yield the same results; and
Valid accurate measurements or observations that reflect the actual changes in the family's situation.

A Simple Outcomes Exercise

Most of us accomplish outcomes every day —we set goals for which we then make a plan to achieve using the resources we have. Do this exercise with yourself to demonstrate a concrete outcome you achieved today.

Desired outcome: Sufficient healthy food of choice.

Baseline: Hungry!

What resources do you have to meet this need?

What plan can you devise which will help you use your resources to meet this need?

What timeframe is realistic for the accomplishment of this plan?

How can you measure when this outcome is achieved?

What change took place when the outcome was achieved?

What is the Family Development Outcomes Matrix?

The Family Development Outcomes Matrix is one of three matrices that make up the California Matrix Outcomes Model. The other two are called the Agency Development Matrix and the Community Scaling Tool. The Family Development Outcomes Matrix is a tool to help families recognize their strengths and assist advocates and family-centered workers with accurate information in terms of outcomes based on a family's progress over a period of time. This model is being closely studied by the Federal Health and Human Service Task Force on Monitoring and Assessment, Scales Committee. Variations of this model are in use throughout the nation.
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A Measure of Family Process and Outcomes

In our field, we constantly struggle. We know what we do helps families, but how do we show others? How do we structure the way we help so it is best for the families with whom we work? How do we document, for ourselves, for the families, and for policymakers and funders, the outcomes of our work?

There's no way to truly put on paper the complex realities of the families with whom we work, but the Family Development Outcomes Matrix, by helping to quantify the qualitative, is a tool that brings us closer to this goal. The Family Development Outcomes Matrix combines both a process that encourages skill-building for family members and the development of outcomes that enable the measuring of family progress. The most recent evaluation research shows that both are important in achieving change.

In the Family Development Outcomes Matrix, eleven Outcome Categories run across the top, referring to areas of family life—shelter, food and clothing, transportation and mobility, health and safety, social and emotional health, finances, family relations, community relations, adult education and development, child education and development, and immigration and resettlement (see chart below).

The Family Development Matrix Outcomes Model
Categories & General Indicators:


Food/Clothing Transportation/Mobility Health/Safety

Security of housing over time; Safety of housing; Stability of housing over time; Condition of housing; Income and resources for housing

Ability to afford adequate food and clothing; Quality of diet; Adequacy of clothing; Nutritional value of meals; Conditions of food preparation resources (utensils, space, appliances, sanitation) Access to transportation based on level of need; Safety, condition of transportation; Legal status of driver, vehicle (license, insurance, etc.) Environmental conditions; Health habits; Access to health resources; Status of physical health; Abiltiy to afford health care

Social/Emotional Health


Family Relations Community Relations
Quality of social support system; Presence, degree of substance abuse; Sense of personal responsibility; Quality of mental health; Ability and willingness to identify needs and access resources
Income level in context of living; Long and short-term financial goals; Budgeting skills and financial institutions and resources Family health; Ability to resolve conflict; Intrafamily communication skills; Extended family relationships Knowledge of and access to community resources; Participation in the community (ie., school. church, clubs, etc.); Social conditions in the neighborhood; Ability to communicate with others; Type of relationship with family, friends, and neighbors
Adult Education/Employment

Children's Education/Development

Immigration/ Resettlement

Employed or not; Presence or absense of career goals; Level of education, job skills, work history; Employment in field of choice; Income, hours, benefits; Availability and affordability of child care and other supportive services to support employment Age-appropriate development-physical, cognitive, emotional; Age-appropriate behavior, social skills; Verbal communication; Parents value child's education; Parent/child interaction; School behavior; attendence and readiness to learn Immigration status; Language skills based on needs; Maintaining cultural identity  

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A Strengths-Based Approach to Case Management

The Family Development Outcomes Matrix is based on a strengths model rather than a "deficit" model. It documents where a family is thriving as well as where it needs support, and allows those using it to easily identify strengths from which to start addressing needs.

A Scales-and-Ladders Tool

The Family Development Outcomes Matrix is a scales-and-ladders instrument that helps service providers assign scores to document family progress. These scores are based on an understanding shared with others who assign them and those who read and use them, regarding what the numbers mean. A scale is simply a continuum that describes different states or conditions of status. It has a beginning point and an ending point, with increments in between. Sometimes the increments are equal, like a thermometer, or uneven, like a Richter scale that measures earthquakes. The scale simply provides you with information. It is a means to collect information. Another commonly used example of a scales and ladders tool is a mileage chart on a map. When you find one city going across the top, a second city down the side, and find the box where the column and the row intersect, you are using a scales-and-ladders tool.

General Guidelines for Defining Matrix Status Levels

In-Crisis: Family cannot meet its needs. Family is unwilling or unable to work toward positive change. Family systems have collapsed or are in immediate danger of collapse. Strong outside intervention needed to move family to "At-Risk" level.

At-Risk or Vulnerable: Family is secure from immediate threats to health and safety, but has not yet developed or committed to plans for long-term growth and change. Continuing safety-net intervention provides platform on which the family can build its plans for improving its circumstances.

Stable: Family is no longer in danger, is ready and willing to change and is planning for its future. Supportive services provided to assist family members in implementing their plans.

Safe/Self-Sufficient: Family is strong and has made significant progress in improving its circumstances; it is generally secure as a result of its own efforts. Family is economically self-sufficient, and has a clear vision of its ultimate goals. Intervention is resource-oriented.

Thriving: Family systems are strong and healthy, fully functional. Family is achieving its goals and is independent of all government assistance. Family has achieved commonly accepted standards of family well-being.

Example of Shelter Category and Indicators by Status Level:

General Indicators:

  • Security of housing over time
  • Safety of housing
  • Stability of housing over time
  • Condition of housing
  • Income and resources for housing
    Owns home or has long-term tenancy
    Able to comfortably afford housing costs
    Feels housing is safe and appropriate for their needs
    Savings are sufficient to cover two months housing costs

    Owns home or tenancy is secure for at least a year
    Able to pay rent or mortgage each month and have enough income for other expenses
    Housing is safe and not overcrowded
    Savings available for occasional unexpected expenses

    Living in permanent housing, or temporary situation that will last at least six months
    Able to pay rent each month
    Housing is not hazardous, unhealthy, overcrowded
    Some savings or resources to draw on in an emergency

    Living in temporary or transitional housing and not certain where next shelter is to be found
    Unable to pay rent on time every month
    Housing is unsafe or seriously overcrowded

    Homeless or on the verge of homelessness
    Primary source of income has ceased, no resources to cover housing
    Living in dangerous conditions

A Family-Centered, Multicultural Agency Case Example Using the Family Development Outcomes Approach

During the last five years, Resources for Families and Communities Agency (RFC) in Santa Clara County, the "Home of Silicon Valley," has moved from being a new agency to setting new norms for bringing together services for a multicultural community. RFC has become a multiservice agency that its low-income communities and ethnic groups see as being on their side. Its cadre of 13 family advocates relates to families the way other agencies do not; they cross categorical funding limitations and solve problems. RFC develops its programs in response to what its communities say they need in their families. Jesus Orasco, RFC Executive Director, explains, "We act as technical advisors between community-based cultural connections and traditional social service models." He adds, "There is a difference between respecting one's culture and being one's culture."

With 85% of its budget from federal Family Preservation funding via County Social Services and 15% from local grants and fund raising, RFC acts as a bridge between family and community needs and social services throughout the county. RFC provides grants to 50 groups each year to assist families and organizes an annual, week-long multicultural festival of community groups that include African, Arabic, Bosnian/Croation/Serbian, Cambodian/Vietnamese, Central American, Ethiopian, Mexican, Persian, Somali, and Spanish where thousands of community members come to celebrate their diversity. "We respect their ability to solve problems facing families like shelter/housing, food/clothing, immigration, truancy, violence and abuse. We act as a catalyst to avoid tunnel vision to race, gender, and religion. We bring together groups that usually don't talk and help them see their combined energy and ability to solve family and community problems," says Orasco.

A Foundation for Accountability and A Tool for Agency Strategic Planning

More than ever before, service providers are being asked to account for how funds are spent and what they are used to accomplish. Strategic planning is a must if a family-centered agency is going to be effective and proactive. Family and agency outcomes play an important role in the development of this plan, in that they help structure the plan and clarify the focus of its discussion. Agencies that document client progress toward specific outcomes over time have the information they need to show progress on their goals; for example, cost avoidance—how much money was saved by providing services that would have been spent if the services had not been received.

RFC uses grassroots information gathered from the families and community groups it serves, providing the Department of Social Services monthly reports on its family advocacy results and periodic reports on its grants to communities. The Family Advocates complete a Family Development Outcomes Matrix assessment on each of their families at least every three months. This data describing their work with 500 families each year will be used to show the RFC Board of Directors how well their hypothesis is progressing—that families will seek to achieve a safe level of self-sufficiency when provided a measure of advocacy and community support.

How RFC uses an Outcomes Approach

With RFC's connections to cultural communities throughout Santa Clara County, most family members come to the RFC agency location only a short distance from the Department of Social Services. After using an intake form to gather demographic information, the advocate talks with the family member, reviewing the 11 categories of the Family Matrix. Based on this base-line assessment, each category is given a score next to the appropriate status level:

4 - Safe/Self-Sufficient
3 - Stable
2 - At Risk
1 - In-Crisis

RFC does not use "Thriving" as their goal is to assist families to reach the safe and self-sufficient level. Moreover, family advocates report that they seldom encounter families at that level.

Using his or her knowledge of community resources and advocacy skills, the advocate guides the family in areas of need. On each subsequent visit they reassess the family's status levels and after three-months they routinely reassess the case and close it unless issues they are addressing take longer. Case conferences take place between advocates who share information on resources.

The Family Matrix helps the advocates see how they have accomplished positive results. The positive change in the status level of any outcome category is an opportunity to give empowering feedback to the family. It also shows which resources were effective in a three-month period. A negative status change alerts the advocate to needs for further contacts with resources. The accuracy of the family situation is easily displayed on the Matrix. Both the advocate and the family member are motivated to improve the status levels.

Built-In Program Evaluation

Documenting and aggregating client progress (or lack of progress) toward outcomes over time can provide a foundation and structure that can both simplify and streamline every aspect of program evaluation. RFC is currently building a data system that will contain client demographic as well as Matrix data
and will be easily aggregated and charted.

  • Valuable assessment data will be available for reports and proposal writing.
  • Trends and patterns will be identifiable, to use in the planning of program activities.
  • Client data and secondary data from county sources can be linked to evaluate services.
  • One evaluation model can be used for reporting to multiple funders.
  • Over tme, accumulated information can be used to advocate for system changes with policymakers and funding bodies.

Collaboration Works

The Institute for Community Collaborative Studies (ICCS) and RFC are adapting the Family Development Outcomes Matrix so it is integrated into the functions and operations of this multicultural, multiservice agency. We began with the advocates redesigning the indicators for each status level in each outcome category. During this exercise they selected the categories they would use and with their family clients' review we reformatted the indicators to reflect the actual conditions of the local area. Second, we began the training to use the Matrix as a case management tool by developing a protocol so each case is routinely assessed and recorded. Training and technical assistance has continued over a year while data is gathered, new advocates are retrained, and most recently, an Access model for data is being constructed.

ICCS developed a Matrix Design Group that serves the Matrix users through periodic training workshops and research activities. RFC is a member of that group of regional stakeholders and contributes its family and community indicators to the ICCS web site, an electronic clearinghouse for the California Matrix model.

Due to the newness of the model, ICCS, in collaboration with the Packard Foundation and members of the Matrix Design Group, sought technical assistance from the National Resource Center for Family Centered Practice (NRCFCP). The NRCFCP is testing the Family Development Outcomes Matrix for reliability and validity. This evaluative activity is essential for continued use of the model, particularly as best practices for human services can demonstrate cost effectiveness of prevention and early intervention. On a micro level, reliable assessment can assist families in achieving self-sufficiency. Assuring a reliable model and valid measures will also help to move forward our understanding of family resiliency. On a macro level, policy makers and community planners can use the matrix model of developing and measuring outcomes for strategic planning and funding priorities.

For more information on Resources for Families and Communities, contact Jesus Orasco; (408) 277-0732; e-mail:;
For additional information on the Institute for Community Collaborative Studies contact Jerry Endres; (831) 582-3624; e-mail:;

For additional information on outcomes, reliability and validity, contact Brad Richardson, National Resource Center for Family Centered Practice; (319) 335-4965; e-mail:

Legislative and Practice Strategies to Assist Battered Immigrant Women

Editors Note: This article was adapted from "Legislative Strategies to Ensure the Rights of Battered Immigrant Women," Leni Marin, Migrant Women's Human Rights in G-7 Countries, Family Violence Prevention Fund 1997, and Working with Battered Immigrant Women: A Handbook to Make Services Accessible, Leti Volpp, author, Leni Marin, editor, Family Violence Prevention Fund 1995.

In the United States today, women and children constitute approximately two-thirds of all legal immigrants. This is in sharp contrast to the years prior to 1930, when migrant men comprised between 60 to 70 percent of newly arrived immigrants. Then, women were discouraged from immigrating because the U.S. preferred and recruited male laborers only. One major reason is that single men without families were also easily deportable when their labor was no longer needed.

Women also comprise a significant portion of undocumented immigrants and refugees who settle in the U.S. Many of them, particularly undocumented women from developing countries, are isolated in the U.S. and without sufficient knowledge of the language, culture and legal and social systems. Immigrant women suffer a triple burden of discrimination based on their sex, race and immigration status.

Battered immigrant women face a complex and harsh reality. The following vignettes illustrate some of the issues confronting them:

  • Carla, a Guatemalan woman, has lived for five years with her boyfriend, a legal permanent resident. When she asks him about getting married so that she can apply for her own legal residency, he beats her and accuses her of only wanting to be with him so she can get her immigration status recognized.
  • Tai Lin, a Chinese woman, has difficulty finding support to escape her abusive husband. She lost her factory job because she has no work permit. The immigrant service agency she approached encourages her to stay with her husband and advised her to try her best to cope with her difficult situation. Moreover, because she only speaks Cantonese, the battered women's shelter that she calls cannot communicate with her.
  • Leticia, an undocumented Filipina woman, went to civil court and obtained a restraining order against her violent husband. When her husband comes to her house violating the restraining order, she calls the police. Her husband flees before the police arrive. The officer who responds makes a report and then asks her for her "green card."

Since 1989, advocates for the legal and civil rights of battered immigrant women have targeted the need for public policy reform in U.S. immigration laws to effectively respond to those who suffer domestic violence. Under the Immigration and Nationality Act, U.S. citizens and permanent residents can, but are not required to, file
relative visa petitions so that their spouses can obtain legal permanent residency through the marriage and legally reside in the U.S. Citizen and resident spouses choose when and whether to file visa petitions and they can revoke those petitions at any time prior to the issuance of permanent residency to their spouse.

The power to keep a spouse in permanent risk of deportation provides batterers who are citizens and legal permanent residents with a coercive tool to keep abused immigrant women and family members in violent relationships. Many immigrant women live in extremely dangerous situations in fear for their lives because their batterer spouses threaten them and their children with deportation if they seek assistance from the police or report their abusive behavior. For example, if a woman tries to run away to a domestic violence shelter, the batterer spouse may go to the immigration authorities to withdraw his petition for her documentation and have her deported instead. In this way, he also escapes being prosecuted for criminal offenses related to the physical abuse of his wife.


Because of these alarming phenomena, the Family Violence and Prevention Fund (FUND) co-founded the National Network on Behalf of Battered Immigrant Women with other national immigrant rights, women's rights and domestic violence organizations. The National Immigration Project of the National Lawyers Guild and NOW Legal Defense and Education Fund are the two other co-founders and co-chairs of the Network.

Because of the efforts of the Network, key legislation was passed in 1994: the Violence Against Women Act (VAWA). Before this legislation was enacted, a battered immigrant woman had no recourse or option to remove herself from domestic violence when an abusive spouse who is a citizen or permanent resident withdraws or refuses to file a petition to sponsor his wife for legal status. But with the enactment of VAWA, battered immigrant women can now self-petition on their own behalf to become legal permanent residents without relying on their abusive spouses. She can also apply to become a permanent resident if her spouse had begun the process of applying for her residency papers and then later withdrew the petition, or if the petition is still pending. Battered immigrant women who self-petition may include their undocumented children in their application. Children who are abused by citizen or resident parents may also apply for this remedy. Finally, a woman who has not been abused herself can also self-petition to become a permanent resident if she is a parent of a battered child abused by the woman's citizen or permanent resident husband.


Immigration Status

One of the most significant fears many battered immigrant women face is related to their immigration status. Some battered immigrant women may be reluctant to discuss immigration status because they fear deportation for themselves, their children, or their batterer. If a battered immigrant woman is deported, she may lose custody of her children, may not be allowed to enter the country to see her children for five years, may return to poverty, famine, or political persecution, and may no longer be able to financially assist her family in her home country. She may be deported to a country whose laws do not protect her from domestic violence. She may be ostracized by friends and family members because she got a divorce, or sought a protection order against her abuser.


When working with a battered immigrant woman, it is important for you to avoid frightening her by asking about her immigration status. You should also be careful about recording information about immigration status that may compromise battered women in any subsequent immigration proceedings. In situations where you are required to report status, you may choose not to ask about immigration status, and to report that the immigration status of every person assisted is "unknown."

If you think your knowing her status could help protect a woman, you may want to discuss it with her (for example, if her immigration status is dependent on her marriage and she is served with divorce or annulment papers, or if she is a conditional resident). If you are a counselor, the counselor-victim privilege should apply to any conversation you have with a woman about her status, and this privilege should protect you from disclosing her immigration status in any subsequent proceeding. If you work at a legal services program, the attorney-client privilege should apply. However, even if you think a privilege may apply, we encourage you not to write down any information about a battered woman's immigration status.

Sometimes the status a woman tells you will be incorrect, since she may not know what it is, or the batterer may have lied to her about her immigration status. Do not call the Immigration and Naturalization Service (INS) yourself to verify her status.

Deportation Issues

A battered immigrant woman cannot be deported if she is a U.S. citizen, a lawful permanent resident, or if she possesses a valid visa, so long as she did not enter the U.S. on fraudulent documents or violate conditions of her visa, and was not convicted of certain crimes. If she is undocumented, or a conditional permanent resident, find her an immigration attorney who can try to help her legalize her status. Until then, help her develop a safety plan.

When to Make Sure She Sees An Immigration Attorney

You should make sure your client sees an immigration attorney if she is served with divorce or annulment papers and she falls into specific immigration categories or if she is a conditional resident who may be eligible for remedies to help her legalize her status. Unless you are at a legal services organization, you should not try to give her legal advice.


Is She Safe?

When a battered immigrant woman contacts you for help:

  • Determine whether she is safe. If she is in immediate danger, follow your program's policy on calling the police. If she wants you to call for her, tell her you will keep her on the line, and make sure you get her address and phone number. If she does not feel safe talking, suggest she go to a neighbor's house or other safe place to call where she can speak freely. Any woman—including an undocumented immigrant woman—who is in serious and immediate danger should be encouraged to call the police if she needs protection or is in fear for her life.

  • Ask her what language she most comfortably speaks. If you can find someone else who can speak her primary language, get her phone number to return the call, and find out at what times you can safely call her at that number. Assure her that you truly want to help her, and that someone will call her. If you cannot find someone who speaks her primary language, you can try to struggle through a short-term crisis call. Tell her how long the conversation will take. Reassure her that the information she tells you is confidential, and that you are not an agent of the government. Recognize and acknowledge her courage in calling you.

Be as flexible as possible. Listen to where she is coming from and what she is asking for. Be creative in helping her come up with strategies to deal with her concerns. Use open ended questions such as, "Do you want to tell me about your situation," rather than "Are you a battered woman?"

Making A Safety Plan

You may need to make a safety plan with a battered immigrant woman whether or not she is prepared to leave her abusive partner. When making safety plans:

  • Consider her options with her to help her determine what will keep her the most safe.

  • Go over with her what she will do when the next incident happens.

  • Discuss with her the warning signs of her partner's abuse, and how she can protect herself.

  • Know that she could choose to leave in the future, or she could leave at that moment.

  • Explain that police standby may be an option.

  • Be aware that there is no guarantee of her safety.


There are important considerations to discuss with her when helping her think about whether or not to leave her home. They include safety issues, taking her children with her, and bringing important documents. Documents the battered immigrant woman should try to take with her include:

  • birth certificates for herself and her children
  • passports for herself and her children
  • green cards for herself and her children
  • social security cards for herself and her children
  • documents from any public assistance
  • immunization records for children
  • documents related to health care
  • leases
  • checkbooks
  • credit cards
  • paycheck stubs
  • marriage license
  • copies of tax returns for herself and the batterer

If your client is married to the abuser, she may need to prove that she married him in good faith, so she can have access to certain legal remedies. If this is the case, she should also try to bring:

  • pictures of the marriage and relationship
  • love letters
  • names and numbers of friends, relatives and witnesses who are familiar with the wedding and marriage
  • bills, leases, or bank account records showing that she and the batterer had joint liability for any property or accounts
  • letters addressed to her or her and the batterer at the family home

Criminal Remedies

A woman may decide to call the police either to intervene to protect her during a domestic violence incident or because the batterer has violated a civil protection order obtained by the woman. If the police arrest the batterer and take the batterer into custody, a prosecutor will decide whether or not to pursue criminal charges. If this happens, there will be a series of hearings and possibly a trial. Battered woman may be able to get emergency protection orders from the police or the court which require the batterer to stay away for a short period, or may seek longer term protection with criminal stay-away orders pending a case in criminal court.

Many battered women need advocates to assist them if they are involved in the criminal process. Testifying in a criminal case can be traumatic and frightening. Immigrant woman with limited English language abilities who are unfamiliar with the U.S. court system will need an advocate with whom they can communicate easily, who can explain the unfamiliar court process, and who will support them through it.

Civil Remedies

Civil remedies against domestic violence are available for all individuals meeting the requirements of the state civil codes, and are available to help all persons who live in your state, regardless of immigration status. Civil remedies include termination of marriage, civil protection or restraining orders, restitution (paying the woman back for expenses caused by the violence, such as medical bills or broken furniture) and custody and support of her children.

Her Eligibility For Benefits

A battered immigrant woman may be worried that she will not be able to support herself if she leaves her home or if she must leave her job. Explain to her what free or low cost services you provide, and whether these services include free housing and food for her and any children she may have. Discuss whether you may be able to help her keep her job or find another.

In many states, if the batterer is the father of the children and is employed or has an income, he may be ordered to pay the mother money each month to support the children. If a woman gets divorced, her husband can also be ordered to pay her spousal support each month. Be aware of the laws in your state, and how such payments can safely be given to the woman. This can often be arranged through a registry at your local court which forwards the money to a P.O. box or an address, such as your program's address, that is not disclosed to the batterer.

Let battered immigrant women know what benefits they may be eligible for. If they are lawful permanent residents or refugees or asylees, they are currently eligible for federal public benefit programs, although this will change if current federal legislation passes. If they are temporary non-immigrants, are here through Temporary Protected Status (TPS), or are undocumented, they are currently only eligible for limited programs, namely federal housing, emergency Medicaid, WIC, and AFDC for any U.S. born children they may have.

Be aware of any changes that may occur in availability of benefits for battered immigrant women. Many proposals to cut such benefits are under consideration by the federal government and in many states. Some battered immigrant women may be sponsored by family members. The income and resources of those family members may be considered available to the immigrant and thereby impact the calculation of the immigrant's access to certain benefit programs. Thus, women with a sponsor may be specifically vulnerable to abuse by that sponsor, since they often feel an obligation to the sponsor.


Immigration is a global issue and migrant women increasingly make up the majority of migrants. Activists must build and strengthen strategic linkages that are multi-national, multi-level, and that engage the movements for human rights, women's rights, immigrant rights, and economic rights to substantially integrate the issues of battered immigrant women on their agenda. We must tackle this challenge if we are to succeed in ensuring the legal and human rights of battered immigrant women and children. And, in order to preserve these rights, practitioners and social service providers must be aware of the issues affecting battered immigrant women. Without education efforts, services will remain inaccessible to battered immigrant women and many immigrant women will be unaware of their legal rights and community resources available to them, assuring that battered immigrant women will remain fearful and isolated.

     The Use of Interpreters and Translators in Family Centered Practice

by: John-Paul Chaisson, M.S.W., National Resource Center for Family Centered Practice

One of the most basic tenets of Family Centered Practice is that the worker and the client can reach an understanding of each other through the use of good communication skills. As a matter of fact, all social services and counseling models at their fundamental levels are based on the assumption that the worker and the client can understand each other. But what happens when this is not the case- when the worker and the client speak different languages?

We do not have an accurate count of how many families in the United States speak English on a limited basis or do not speak English at all. The most recent relevant census data available is from 1990. The census reports that in 1990 over 30 million people over the age of 5 spoke a language other than English at home.

A more accurate picture might be obtained if we look at Department of Education (DE) data. In 1997, the DE surveyed State Education Agencies (SEAs) that received Title VII (Bilingual Education, Language Enhancement, or Language Acquisition) moneys. They were asked to report the number of students that they categorized as Limited English Proficient (LEP). The survey reported that 3,378,861 students (7.4% of all students) in those SEAs were considered LEP and qualified for Title VII programs in the 1996-97 school year (see footnote below). In addition, 31 of the SEAs reported increases of 10-25% from the 1995-96 school year. It might be a logical assumption that most LEP students have parents who speak a language other than English at home. If we were to add up the students and their parents, we are talking about a great number of people who might speak limited English or no English at all. And, that number continues to grow.

What is the Difference between an Interpreter and a Translator?

"Interpreter" usually refers to people who can translate information orally, while "translator" refers to someone who produces a rendering from one language to another in written form. These are not interchangeable skills, and many people who are excellent interpreters are incompetent translators and vice versa. Consider for example the many Latinos/as who have been raised in the United States. While they grew up speaking Spanish fluently with their families, they many times have been schooled only in English, which means that they never learned how to read and write in Spanish.

A common assumption is that interpreters are equally proficient when translating between their primary language and their secondary language. This is false. Most interpreters are usually more adept at translating from their second language to their primary language. This is partly due to the size of their vocabulary and their language proficiency level.

An important consideration when using an interpreter or translator is the level of the language used. There are many specialized professional fields that have their own vocabulary, such as medicine and law. The interpreter or translator needs to be versed not only in the languages they are using but also in the professional terminology used.
interpreters and translors _______________________________________________________________
When is an Interpreter Needed?

The obvious response to this question is "when the worker and the family cannot communicate." The not so obvious response is that language is a set of skills that we learn over time. There are different levels of language learning and vocabulary acquisition. Although a client might be able to speak a functional level of English ("Give me a hamburger" or "It is time to go to work"), his or her ability to communicate complex emotions or concepts ("I feel islanded" or the cultural meaning of "confidentiality") might be limited. In cases like this, the worker might ask an interpreter to sit in on a session but allow the clients to speak on their own. By providing an interpreter who can help the clients to express themselves in the language of the worker, the worker facilitates more accurate communication. Generally speaking, people who are under stress also have reduced abilities to communicate. In time of crisis even a semi-competent English as a Second Language speaker might temporarily need interpretation assistance.

Do Translators and Interpreters Need Special Training?

A common myth is that any person who knows two languages can immediately be a translator or interpreter. This myth presents itself all of the time in social services. Brothers, aunts, friends and children are more often than not volunteered to translate and interpret for educational systems, hospitals, child welfare agencies, community action organizations and community mental health organizations. Many times the workers involved have no way to measure the proficiency and quality of the translation.

Interpretation and translation are acquired sets of skills that often require many years of specialized training. The value of persons who can communicate ideas, intents and messages across languages and cultures has long been recognized. Interpreters and translators who are formally trained are widely used in international business, diplomacy and law. Certification efforts for interpreters for the deaf and hearing impaired have become the norm
after the enactment of the American Disabilities Act. However, many social service organizations, community action agencies and child welfare organizations continue to use interpreters and translators in a haphazard and unprofessional manner.

Are There Issues of Confidentiality When Using Translators and Interpreters?

Be careful when using family, friends of the client, and community volunteers as interpreters. Confidentiality could be compromised. Many organizations do not have a clear policy that covers volunteer translators and interpreters. In addition, many volunteers might not be aware of the confidentiality rules established by the organization. It is good practice to use professional translators whenever possible. However, most agencies cannot afford a professional translator and must use bilingual staff or volunteers to do the job. If this is the case, make sure that there are some policies/mechanisms to maintain families' confidentiality.

When Workers Do Not Know the Family's Language, How Can They Evaluate the Quality of the Interpreter?

It is very difficult, if not impossible, for a person who does not have a strong grasp of both languages to make an accurate evaluation of the quality of translation. Also, the worker must have an idea of some of the methodology of interpretation in its different forms. For example, many people do not understand that primary language and target language exist side by side but do not mingle. This is difficult to remember since most of us have our language structure so ingrained in our head that it is unconscious, which sometimes leads us to assume that all languages are structured the same way as ours. Context, syntax, grammatical rules, tempo, and pitch are examples of things that make a difference in how a language is organized. If you have ever watched an Asian movie that has been dubbed into English, you probably have observed a difference between what the actor seems to say and what the translator's voice articulates. The actor will speak a full sentence in Chinese and the English voice makes a very short statement or vice versa. Many times this happens when we are using an interpreter in Family Centered Work. Words are labels that we give to ideas, objects or living things. These labels have contextual meanings that are influenced by the culture they came from, so a longer explanation of a concept may be needed in a second language.

Because of the complexity of assessing the quality of translation, organizations that work with people who do not speak English as their first language should have policy that includes the assessment and evaluation of interpreting and translating skills.

Should I Use Children as Interpreters?

The first rule of Family Centered Practice is not to do damage. Using children to translate is almost always inappropriate and many times damaging to the family and the child. A worker, by giving control of communication to the child, might inadvertently be changing the family structure. Parents might become disempowered by the need to use the child as a translator. In addition, children might be exposed to information that is not appropriate or is too complex for their age.

When Speaking, Should I Focus on the Client or the Interpreter?

The interpreter is a tool for communication and, therefore, not as important as the client/family. The client/family is where your attention needs to be focused. In a clinical setting, you might consider placing the interpreter a little farther back than the client. This emphasizes the importance of the client.

In conclusion, here are some final tips on how to better use an interpreter or translator in Family Centered Work.

a) Use nonverbal cues to demonstrate interest and attention: Since joining verbally will be difficult the worker must be very attentive to their nonverbals. Relaxing, smiling, leaning forward, or using hand gestures is usually helpful in showing empathy or asking for more information. Eye contact or a gentle touch on a non-threatening area (like the top of the client's hand) might help to show empathy. However, be careful that the nonverbals you use are culturally appropriate. This is especially important when there are gender differences.

b) Be patient/Take your time: Working with somebody who does not speak your language is always going to take longer. Scheduling longer visits takes the pressure off. In addition, try not to finish words or sentences for your clients. Do not rush the clients' answers or assume you know what they are talking about. Rushing can lead to false assumptions.

c) Don't wear out the interpreter: Translation takes up a great deal of mental energy, which in relatively short amounts of time can cause fatigue. Keep sessions short (under an hour) and do not schedule too many sessions in a row using the same interpreter.

d) Learn about the mechanics of translation and interpretation: Following this article you will find some suggested readings about cross cultural communication and interpretation and translation.

Footnote: These figures are conservative estimates of the total LEP enrollment for several reasons: a) LEAs only participate in surveys if they receive Title VII funding (states like Virginia, West Virginia and Pennsylvania did not participate in the survey); b) most states do not have complete or accurate counts of their LEP students (due to time limits on services, different identification processes, and not counting private school enrollments).

For more information contact: John-Paul Chaisson, National Resource Center for Family Centered Practice, Phone: (319) 335-4965, Fax: (319) 335-4964, or e-mail:

Suggested Readings
Bremer, Katharina, & Roberts, Celia. (1996). Achieving Understanding: Discourse in Intercultural Encounters. New York: Longman.
Casmir, Fred L. (1997). Ethics In Intercultural And International Communication. Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc.
Clark, Virginia P., Eschholz, Paul A., & Rosa, Alfred F. (1985). Language: Introductory Readings. (4th ed.). New York: St. Martin's Press.
Gile, Daniel. (1995). Basic Concepts and Models for Interpreter and Translator Training. Philadelphia: John Benjamins.
Hatim, Basil. (1997). Communication Across Cultures: Translation Theory and Contrastive Text Language. UK: University of Exeter Press.
Hatim, Basil, & Mason, Ian. (1997). The Translator as Communicator. London: Routledge.
House, Juliane. (1997). Translation Quality Assessment: A Model Revisited. Germany: Gunter Narr Tubingen.
Kussmaul, Paul. (1995). Training the Translator. Philadelphia: John Benjamins.
Picken, Catriona. (1989). The Translators Handbook. (2nd ed.). London: Aslib.
Robinson, Gail L. Nemetz. (1985). Crosscultural Understanding. New York: Prentice Hall.
Samovar, Larry A., & Porter, Richard E. (1991). Intercultural Communication. (6th ed.). Belmont, California: Wadsworth Publishing.
Young, Robert. (1996). Intercultural Communication: Pragmatics, Genealogy, Deconstruction. Philadelphia: Multilingual Matters LTD.

refugee traum

a and le______________
Refugee Trauma and Learning

by: Kitty Kelley, M.A., Catholic Social Services, Atlanta, Georgia


For refugees, trauma, shelter, education, family life, and work are key components of resettlement in the U.S. Why should Americans be knowledgeable about the effects of trauma on the learning capacity of refugees? Partly, because we are responsible for educating those who live here. Partly, because it is a fascinating issue and we are capable of garnering our resources to address the topic. But, the most persuasive reason was given by a refugee who said, "Because we're here. We're here." And indeed they are.

What is a refugee? How does refugee status differ from immigrant status? Immigrants come to the U.S. by choice, with or without documentation, while refugees prove a history of persecution and are granted special options as life saving measures. Excluded in the U.S. legal criteria for refugee status are: hurricanes (e.g. Mitch) and other environmental disasters (like famine or earthquake), economic corruption (Mexico and Colombia), post-colonialist disintegration (some African nations), or revolt (El Salvador). Included in U.S. criteria are some, but not all, wars (Rwanda but not Nicaragua), some, but not all, persecution (Cuba but not Argentina) or some combinations of both war and persecution (ex-Yugoslavia and Iraq).

Indeed, several phases of traumatic life experience have befallen refugees now living in the U.S. The first phase was the war, genocide, persecution, or ethnic cleansing that took place in the country of origin. The second was detainment in refugee camps, usually in contiguous countries, where people wait between two and seven years for papers and applications to be processed or for the trouble at home to end. The third phase is resettlement. Usually, refugees chose resettlement because they could not safely return home or they believed resettlement was the best choice for themselves or for their children. It was, by all accounts, an agonizing decision.

According to policy makers and refugee experts worldwide, three "durable solutions" exist for refugees: repatriation (return home), incorporation into the host country (detainment location), or resettlement into a "third country of asylum" (in our case, the U.S.). Of the twenty-two million refugees in the world, eighty percent are women and children. About ninety percent are repatriated home when the violence stops. Few are incorporated into detainment countries due to social, political, and economic constraints. Only about two percent of refugees are resettled into those countries that agree to accept refugees. Each year, the U.S. government decides how many refugees will be accepted in two years' time and from which countries they will come. In 2000, ninety thousand refugees of fifty-four different nationalities will be admitted to the U.S. People will come from the Middle East (Iraq, Iran, and some Kurdish), Africa (twenty-four countries), Asia (Vietnam and Afghanistan, for example), and from Cuba. Ten thousand blank slots were reserved for emergencies (imagine what, in this horror, constitutes an emergency). The ethnic complexion of new arrivals changes when one wave ends and another begins.

Can you imagine what it would be like to come to Las Vegas from the mountainous region of Sarajevo, to Boston from the desert nomadic region of Somalia, or to independence and capitalism from the pernicious Communist regime of the Soviets? How about entering this Hispanic-phobic country from the Cuban landscape? Concepts such as time, individuality, competition, capitalism, self-sufficiency, independence, and nuclear family are so disconcerting to some refugees that they are thrust from the violence of war and the suffocation of detainment into the confusion and disorientation of American city life.

Refugees are grateful but not glad to be here, and they are disappointed in America—it is not what they expected. Surprised? Angered? It is important to remember that refugees wanted to go home but could not. And, the U.S. is most commonly introduced to foreigners by the media, especially by television programs that hardly represent American life, or even worse by our own braggadocio about our benevolence, freedoms, family values, economic possibilities, and equality. From the refugee's perspective, resettlement here is seen as an alternative to death or starvation or, at best, a future-oriented child-centered option that could be relatively painless if we are as we advertise: wonderfully inviting and accepting to newcomers different from ourselves. In fact, tired and poor masses, huddled, yearning to breathe free, find life in America anything but painless.


My official work on the topic of refugee trauma and learning was inspired by two events. The "decade of the brain," appropriately named because of the astounding amount of high quality brain research done during the 1990s, turned out to also be the same decade of mind-altering forms of genocide. Ethnic cleansing, rape camps, child conscription to armies, the witnessing of atrocities, and torture are normal life experiences for many of the over twenty-two million refugees worldwide. Many of these experiences cause, to one degree or another, permanent brain changes. Yes, it truly was the decade of the brain. Ask my clients and my friends who serve them.

The second event occurred last year at Columbine High School. I watched TV as horrified students were evicted from the school, met by hoards of social workers and mental health professionals, media personalities, sobbing parents, and shocked and grief stricken friends. Then came a massive focused effort—a national consortium of caring Americans bent towards the children's respite, reconciliation, and restoration to health. I found all of these responses normal and understandable and, in fact, admirable. That a nation so fragmented and diverse could rally to respond to a random act of violence was comforting and gave me hope.

The engine, however, that propelled my development of a workshop on the learning capacity of refugees was a comment made by a televised psychologist. She announced that each Columbine student was at high risk for "permanent brain damage due to severe trauma" each had experienced. I knew the implications of comparing one really horrible day, now evocatively summarized as "Columbine," with a decade of really horrible days called genocide. I wanted to share that perspective.


In this article, I will assume that readers accept the premise that trauma negatively affects learning. Relevant supporting literature is abundant if investigated within the multidisciplines, including psychology, psychiatry, public health, forensic science, neurology, traumatology, social work, pediatrics, and nursing. Especially poignant to the topic of refugees is research related to sequelae of Post-Traumatic Stress Disorder (PTSD), brain injury, migration, sexual assault, stress, war, torture, abuse, neglect, and memory. An internet inquiry can facilitate an initial foray into the subject via sites like "PubMed," the National Library of Medicine's free online search service at, or by using a variety of search key words, like "refugee," "torture," "PTSD," "UNHCR," "immigration," or "trauma."

This space is inadequate to present much relevant research because the nature of refugee health is so dense. Years of war and detainment imply nutritional deficits, lack of sanitation, limited access to health care, untreated injuries and illnesses, stress of high intensity and long duration, high incidence of intestinal parasites and chronic illness, diminished immune systems, poor disease resistance, improper diagnosis, culturally inappropriate treatment, and organ damage, to name a few. I will suggest only a few information sources.

First, the World Health Organization (WHO) has provided a wealth of information on a topic relevant to refugees: malnutrition. Second, the National Institutes of Mental Health (NIMH) provide printed materials on a broad array of topics, ranging from stress and depression to the most common psychiatric diagnosis in refugees, Post-Traumatic Stress Disorder. Third, a number of torture centers exist in the U.S. Most centers have printed materials on torture and its treatment; some are available for telephone consultation. Readers should note that the longest standing torture centers are in Europe and Canada because a higher level of care was provided for WWII torture survivors in those areas than in the U.S. Recently, a European refugee policy maker scoffed, saying "Kitty, we don't send real torture survivors to the U.S.; you Americans wouldn't know what to do with them!" His critique was well taken; however, my clients would assert that their status as torture survivors is as real as it gets.



Many of my refugee clients have suffered ten, fifty Columbines. Friends were shot in front of them, surely. But so were grandchildren, children, and parents, not on any one particular day, but over the course of years, perhaps as much as a decade. Somali sisters had been raped in front of brothers, searing helpless, emasculated rage into previously agile minds. Mothers were shot in the head, left dying on doorsteps, merely to get the attention of the rest of the family. Cambodian babies and children were yanked from their silently screaming mothers and flung from trucks against trees. Randomly inflicted mock executions of Bosnian children burned parents' brains and hearts like fire. Rape camps evolved as almost perfect genocidal techniques in ex-Yugoslavia. Women were rounded up, taken to the camps, and gang raped until pregnancy was obvious and birth resulted. When the women were
simply freed and returned home with half-enemy neonates, families and villages summarily rejected them for their implied betrayal. What better way to eliminate a generation or destroy a community? Kurdish men, stripped of their places of worship, leadership roles and manhood, were forced to hide in mountain caves for years before being "rescued" by the same Americans that abandoned them after their Desert Storm collaborations. The narratives are more profuse than our capacity to contain them within our psyches, either individually (me) or collectively (all of us).

What is trauma? The word's definition is less instructive, in my opinion, than associated words listed in the thesaurus. Synonym: shock; replacement suggestions: upset, disturbance, ordeal, suffering, pain, strain, distress, and damage. So true, so true. Are war, genocide, and ethnic cleansing traumatizing? Absolutely. But some refugees have been more traumatized than others have.

Refugees new to the U.S. are traumatized. They also are required to learn. "What," I wondered, "if refugees were met with the same response as Columbine?"


Torture is a key component in refugee work. We think that around 400,000 torture survivors live today in the U.S. Do we count them? No. From what source do such estimates emanate? Educated guess work. In the American vernacular, torture is listening to a parent's lecture, having a wretched boss, feeling trapped while listening to a boring speaker, or standing for hours in uncomfortable shoes. To refugees and ex-political prisoners, torture is nothing of the kind. Americans fail to officially acknowledge torture survivors in the U.S., and we increasingly are ambivalent about foreigners living here. However, I believe that the utter incomprehensibility of real torture and our fear that its victims will be unable to be self-supporting are the main reasons we Americans avoid dealing effectively with it.

Health screenings address only those communicable conditions that are considered a threat to the host society and generally do not include a mental health component. Effects of trauma and torture in refugees can be physical, psychosomatic, affective, behavioral, intellectual, and mental. Post-Traumatic Stress Disorder, depression, and anxiety are the most common mental health diagnoses in refugees, although identification and treatment are rare. Health issues are numerous: malnutrition, intestinal parasites, hepatitis, untreated injuries, chronic conditions (TB, high blood pressure, cancer), skin problems, chronic pain, dentition, eye diseases, or hearing and vision deficits. Affected systems include: circulatory, immunological, genitourinary, hematological, nervous, respiratory, musculoskeletal, cardiovascular, endocrine, metabolic, or digestive. Problems can be obvious or covert, pernicious and malevolent. And they all can have a negative effect on learning.


Learning is the ability to acquire new information. Again, let us revisit the thesaurus. Related word: knowledge; replacement suggestions: education, erudition, scholarship, culture, and wisdom. Appropriate to our inquiry is the complex interaction between various sets of issues, such as psychosocial growth and development, genocidal trauma, scholarship, personality, disposition, reaction of the host society, and education. Refugees must acquire cultural knowledge, new survival skills, language, and job skills. They also must reckon with their life experience and unlearn outmoded skills.


If I have successfully made my point that refugees are traumatized, then the rest of my observations should mesh seamlessly with readers' current knowledge and experience. The main thesis is simple: traumatized refugees have difficulty learning. Their difficulties stem from problems with concentration, memory, information retrieval, hopelessness, confusion, feeling overwhelmed, illness or chronic pain, sequelae of PTSD, distrust, fatigue, sleep deprivation, bereavement, being overstimulated, and visual or hearing impairments.

I will state my hypothesis using deductive reasoning. IF refugees resettling in the U.S. have been traumatized; if they must learn to adapt to our culture; if they must learn a new language; if they must restore their health; if they left family, friends, and dreams behind; if they must build a new life; and if they must get a job within sixty days, THEN they are in trouble. This hypothesis has been supported by evidence. Following are several instances where I became aware of the significance of refugees' difficulty learning.

1. A school called. A newly arrived six-year old Bosnian girl screams and pees her panties whenever the English as a Second Language (ESL) teacher comes to retrieve her from the classroom. The ESL teacher, a young, tall male, merely asks the child to "come with me," and the girl responds hysterically, clinging to her teacher's skirt. "What prevents this child from learning English?" the principal asked me. "Her parents probably don't speak English themselves and won't practice English in the home," she accused. Evidence is presented that the child has failed to learn "one word of English" during her two months in the U.S. "Don't Bosnians care about school?" the first grade teacher generalized.

2. I met with a group of eighteen Vietnamese men, all torture survivors, ex-political prisoners of the North Vietnamese communists or, as they sneer, "former guests of Ho Chi Minh." They are a fun and intriguing group, with sharp minds and amazing pasts. Some were Green Beret soldiers for the U.S.; others were the equivalent of five-star generals in our army. Either status was reason enough to be "placed in communist re-education camps."

During our first meeting, I introduced a newly funded "refugee elderly" project to the group, listing the services that could be provided. I was emphasizing the importance of passing the citizenship exam; without a disability waiver, English fluency is required. Several of the men stood and told me, through an interpreter, "Miss Kitty. We under
stand. We took the exam seven times and failed each time. Can you tell us, Miss Kitty, how can we learn English? Our minds are weak. We try and try and cannot. Please help us to pass citizenship."

3. A man languishes in the U.S. in a meaningless job in manufacturing. I discovered that, in ex-Yugoslavia, he was a psychiatrist with a flourishing hospital-based practice. His English is perfect but he tells me he cannot take the U.S. boards in order to practice medicine here, nor can he, for various reasons, take refresher classes to facilitate his passing the exam. I know from having endless conversations with him that he is truly a gifted physician and we need more like him in the caring professions. Why, at the age of thirty-six, has he ended up as he has? Eventually, he left his wife and two children in the U.S. and returned to his country saying, "I'll take my chances on being killed there. I cannot—will not—relinquish my identity." So, the war, he says, has cost him everything.

These are examples but they are not extreme examples. I have not chosen the worst cases nor the most unusual. These are ordinary people with common problems—common for refugees, that is.

Learning impairment within the refugee population relates to many issues. In my search for related information, I have been disappointed in most academic journals from the field of education. I found some information in the forays into the relationship between poverty and learning that resulted in Project Head Start. Additional information can be found in the incest or domestic violence literature. However, "trauma" is not a butterfly net used to scoop up disconnected species. I sought information in the education and immigration debate but found little research attesting to the trauma scale risk factors for immigrants, let alone refugees, nor do I feel satisfied that the educational system is responding appropriately to immigrants and refugees in the classroom.

The typical Atlanta school, for example, complies with Title VI requirements that prohibit the discrimination of any person on the basis of national origin. Most comply by offering around forty-five minutes of ESL per day. The rest of the school day is spent in mainstream classrooms. Refugee and immigrant students have told me that they sit for six hours a day not understanding a word spoken. They do not know how to ask to use the bathroom. They follow the class out the door to unknown destinations (the cafeteria, for instance), exhibit a pronounced startled response to fire drill alarms and dropped heavy books, and are always "getting into trouble" for various issues of non-compliance: not bringing pencils to school, failing to obtain the parent's required signature on forms, not finishing homework, spelling and punctuation errors, not following directions, not sitting still, and talking in class (usually asking someone for help). One nine-year old boy was accused of "constantly disappearing" from the classroom. He admitted to me that he hides in the boy's room in a stall with his feet tucked up and the door locked, often for two to three hours at a time. He said he felt too nervous and too upset (my words) to sit in the classroom. "I keep remembering," he shuddered. "I keep remembering."

Another second grader disappeared from school property, a major offense, for three hours. His teacher was flabbergasted when he returned with a Kmart bag, and she became even more annoyed when my first question to the boy was to ask if he was all right, and my second was if he had paid for his items. "Not really" was his answer to the first; "of course," he replied to the second. A fire drill the previous day had triggered symptoms, and he simply could not tolerate the stimuli or the threat of another alarm being sounded from the box on the classroom wall. It made perfect sense to me.

A common diagnosis offered by teachers is: "Refugee children have Attention Deficit Hyperactivity Disorder." No, they don't. They have PTSD.


"Trauma and learning" is a broad topic that suggests a traumatic incident, not an unending series of inhuman actions. Trauma is not a diagnosis, nor does it indicate a treatment regimen or response. Refugees suffer unique types of trauma and, because treatment is offered in different cultural venues, it is difficult to attenuate. Trauma does not end with resettlement; indeed, I believe a third set of traumatic events begins with entry into the U.S. It is called acculturation. The following are some suggested methods to address traumatized refugees in three typical learning environments: therapy and classroom settings and work environments.

Symptom Reduction, English, and School or Counseling

To fully participate in mainstream America, refugees must learn English. But, first they must be able to learn. Health care, practical solutions to current problems, and symptom reduction must precede any attempt to teach.

I applaud those schools that provide English proficiency and then mainstream classroom participation. English immersion is great when applied to healthy minds and bodies. It is an utter tragedy when forced upon the wounded minds and souls of survivors of genocide. Sure, they eventually learn English, and most succeed in life. That is a common argument in response to my demands for more English prior to immersion or for health treatment prior to counseling. But, I ask dissenters, at what cost?

Work-site English and stress management training is a practical solution for working refugees. Special individual and group learning venues for the elderly, children, teens, men and women are sometimes essential. But, just because a person comes from a group survival ethos does not mean they are comfortable sharing personal information in groups. Additionally, even if English is not required for the specific job skill of the refugee, it is mandatory for advancement, job change, or to participate in job training programs. In other words, the glass ceiling turns to concrete without the language of the dominant culture.

Repetition and Reinforcement

I have found it useful to combine visual and word combinations, alliteration, metaphors, allegory, religious teachings, cultural information, and other creative techniques. I never assume understanding, even when clients nod assent or reply affirmatively; I wait for supporting comments that imply synthesis. I employ experiential role-play whenever appropriate, and ask clients to keep a journal (written or pictorial if not literate). I employ rewards like verbal and human touch, when appropriate, as well as certificates, outings, socialization opportunities, and invitations for clients to teach others what they know (acupuncture, herbal medicine, etc.). Partnerships and mentoring programs can assist with the repetition and reinforcement process.

Stress Management

Stress management is a heady component of the learning process for refugees. They have past and current stressors from all directions. While it is assumed that refugees have many coping skills to employ—otherwise, they might be dead—many skills are no longer working or are inappropriate in the current context. It is key to reinforce that the refugee is having a normal reaction to an abnormal situation and to educate and inform her or him about relaxation and stress management. It is circuitous, really: to learn, we must relax and to relax, we must learn skills. Humor helps me a great deal in my work.

Relevance and Motivation

I try to make everything I teach relevant to the client. Understanding the client's economic, social, and family problems aids in that process. Since all interviews can re-traumatize refugees, I focus on problem solving. Topics of special concern to refugees that are essential teaching components include parenting, employment, family roles, decision making, access and utilization of mainstream services, understanding what happened to them and why, and goal setting.
refugee trauma and learning _______________________________________________________________

A significant factor in the treatment of refugees is called vicarious, or secondary trauma. Imprisoned either literally or mentally, people dissociate in order to tell their stories, often so violent and evil in nature that listeners sit stunned trying to simultaneously listen and ask ourselves "What kind of a world is this? What kind of people are we?" The answers to both questions, if possible to obtain, are unsettling. Posing the questions requires tremendous introspection and agility of mind, body, and spirit not previously experienced by myself or by most of my colleagues. If, as I assert, the most critical missing puzzle piece for refugees is resilience, then I must surely admit that maintaining my own resilience in the face of monstrosities like ethnic cleansing continues to be a challenge.

Be alert to the signs and symptoms of trouble, in yourself and in your clients, such as information overload, sickness, anxiety, depression, hopelessness, attitudinal changes, and burnout. Have at hand referral information in the relevant disciplines. I use humor, work hard to build anxiety-free environments, employ various techniques, and consider my work long-term, multimodal, multidisciplinary, and often more supportive than insight-oriented. Working in mental health settings with refugees takes specialized training. Activities that I consider essential include education and training, peer support, experience, mentoring, supervision, and stress management.

Get plenty of education yourself as well as high quality, frequent supervision. Be certain those who teach you understand your population and have more experience in the field than you do. Involve guest speakers or other experts to supplement what you know or fill in the gaps in your knowledge or experience base. Build up a professional network of concerned, highly skilled individuals with a similar client base. Do not hesitate to make long-distance calls or to use e-mail. Experts in the field are dispersed throughout the world and often are more willing to help than you might think. A key
educational element is learning about the culture of the client. You must appear knowledgeable about their country's history, especially the events precipitating resettlement.

With refugee clients, I suggest you employ concepts like "professional boundaries" cautiously. Meant to protect caregiver and client, boundaries are often perceived by non-Americans as barriers. My father advised me to be "flexible, but not limp," and I pass that along to you. I make home visits because it is practical to do so. I take people shopping for food or eyeglasses, help them select children's cough medicine, serve tea or coffee at meetings, and accompany clients on appointments with other professionals. Using a friendship and accompaniment model, I often give advice or answer personal questions because to avoid doing so is to slam the door of communication shut. My ego is not damaged; I do not feel exposed. On the contrary, I have adopted a "whatever it takes" attitude and work for the common good. I also use my intuition a great deal.

The use of interpreter/translators (I/Ts) is essential. I/Ts must be trained to work in your professional environment, and should be included as a colleague or co-professional in an egalitarian triad model. They should translate language and interpret cultural meanings, as well as act as a bridge between client and teacher. They should be considered high risk for secondary trauma if they are refugees themselves and are asked to witness or re-experience traumatic events in the professional setting.

Revisit your paradigms. Traditional western models such as punishment, withholding, and behavior modification may, when applied to refugees, backfire. For example, one student failed to attain the grade of B or above in order to participate in band, so he was forced to quit the only school activity in which he excelled. Rather than face the humiliation and his deteriorating self-esteem, he quit school—definitely not the desired effect. In another instance, an African client who persistently missed appointments was denied access to the therapist. Time has a different meaning in
African culture and the client did not understand what had happened nor did he learn how to deal effectively with American-style appointments.


Trauma negatively affects learning. Refugees are traumatized. Most vulnerable are the very young, the old, and the sick or injured. New Americans have much to learn: English, customs, work habits, culture—everything. Our traditional methods of teaching are not effective with this population, and we have been slow to recognize the facts and respond appropriately to them.

With or without special help, most refugees succeed eventually. They are strong, not weak, sick, or broken. Many factors other than war contribute to outcome, such as temperament, personality, life experience, genetics, or socioeconomic status. However, the major contributing factor in the case of refugees is war. Specifically, war introduces violence, pain, suffering, humiliation, and evil into an otherwise routine life. The connection between the assault and resettlement is obscured by years, and often clients report feeling as though something terrible is wrong with them and fail to connect their symptoms to the precipitating events. They think they cannot learn because their mind is weak. Sometimes, their case managers agree. Or, they think that age precludes new language acquisition, which is not supported by relevant literature. Therefore, we cannot place the burden of self-disclosure on refugee clients nor require that they identify their needs when they are not aware of their options.

I believe we must address trauma's adverse effect on a client's ability to acquire new information, and using models such as the one I present within this article is a beginning. I hope you will not succumb to feeling underequipped or overwhelmed and avoid dealing with this amazing and inspirational group of people. Remember: innovation, flexibility, humanity, and a big heart go a long way towards healing the many wounds of war.nd learning _______________________________________________________________
Kitty Kelley
is an applied anthropologist specializing in forced migration. She is a nationally recognized presenter and consultant for refugee programs and mainstream service providers offering services to refugees and immigrants. Kitty works at Catholic Social Services in Atlanta as a program coordinator for refugee mental health and elderly programs. She is a Ph.D. student at Clark Atlanta University Dept. of International Affairs and Development.
For More Information Contact: Kitty Kelley, Catholic Social Services, 680 West Peachtree St., Atlanta, Ga. 30308, Phone: (404).885-7242 Fax: (404).885-7281 ,e-mail:

1. U.S. torture centers: Fifteen U.S. centers are listed on the International Rehabilitation Council for Torture Victims Web site ( Additional centers include: Center for Multicultural Human Services in Falls Church, VA (phone 703.533.3302) and Refugee Mental Health Project in Atlanta, GA (phone 404.885.7242).
2. Internet sites provide massive amounts of information on related topics but are somewhat challenging to sift through.
3. National Institutes of Health and Mental Health (
4. Centers for Disease Control in Atlanta, GA (
5. Center for Applied Linguistics in Washington, D.C. (phone 202.429.9292;
6. Academic journals such as: Journal of Psychotherapy Practice and Research, JAMA, American Journal of Psychiatry, Cultural Diversity and Mental Health, Journal of Consulting and Clinical Psychology (APA), and others. Especially useful are articles on PTSD.
7. David Baldwin's Trauma Info at

Resource Review
by: Steve Siglin, Research Assistant

The books in this "Resource Review" examine the topic of cultural competency in social work practice. Each book considers the growing importance of cultural competency for practitioners in the 21st century. In addition, some of the works examine issues of cultural competency and the elderly. As the population of the United States continues to age and grow in ethnic diversity, it is imperative that practitioners have access to accurate, contemporary information on culturally competent practice methods.

Burlingame, Virginia S. (1999). Ethnogerocounseling. New York: Springer Publishing Company Inc.
Although the author of this book has spent 40 years doing individual and family counseling, she describes her approach to writing the book as that of a reporter. The analogy comes from her method of developing the text. First, she interviewed ethnic geriatric counselors from across the country to learn what they considered important and unique about their approaches to ethnogerocounseling, then she interviewed older adults from diverse ethnic backgrounds, and finally she compiled the information into a practical instruction manual of usable strategies. This "how to" guide includes actual case histories of older adults, recommended skills for working with different types of older adults, and practice exercises at the end of each chapter. Burlingame encourages practitioners to adapt the examples to their own practice situations. The book looks at principles of ethnogerocounseling as they apply to the four major ethnic groups (as recognized by the U.S. Government), but acknowledges that the practitioner will undoubtedly encounter ethnic counseling situations that extend beyond these groups. The book approaches ethnogerocounseling from a strengths perspective and encourages practitioners to know and become comfortable with their own ethnic identity in order to be comfortable with that of others. As practitioners gain some awareness of their own feelings about ethnicity, they are better able to generalize the text's principles to a variety of geriatric counseling situations.

Cox, Carole B., & Ephross, Paul H. (1998). Ethnicity and Social Work Practice. New York: Oxford University Press.
This book begins with the premise that a knowledge and understanding of ethnicity and how it influences an individual's perceptions and responses to problems will become much more critical for social workers in the 21st century. The authors point out, however, that knowledge alone is insufficient for establishing social work relationships with clients; knowledge must be accompanied by practitioner sensitivity to the culture and traditions of the client. Instead of attempting to describe the traits of specific ethnic groups, Cox and Ephross address ethnicity issues using a lens model. The lens model looks at how ethnic group members and social work practitioners perceive the helping process through their own unique lens. The authors avoid describing characteristics of particular groups in order to avoid stereotyping them, and missing the unique aspects of individuals. They see stereotyping as a major impediment to maintaining the clear lens required to establish valid social work relationships. Using the lens model as a framework, the authors examine the social workers' involvement with individuals, families, and communities within the different contexts in which they practice. They conclude the book with some specific recommendations for working with ethnically diverse populations, and a call for more qualitative research on the subject of ethnicity and social work practice.

Halpern, Robert. (1999). Fragile Families, Fragile Solutions: A History of Supportive Services for Families in Poverty. New York: Columbia University Press.
This book is a historical examination of social services in the United States as they apply to childrearing and family life. Halpern examines the organization of services, and the services themselves, and notes instances where they have been both helpful and unhelpful to poor families. He also examines the factors that have constrained service provision and reform, and the requirements he sees as critical for future service viability. He concludes that services have generally not been responsive or coherent, and he attempts to summarize the lessons learned and present tasks for the future. He sees these tasks as conceptual reconstructing a more positive vision of social services, and as concrete the actual design of support services. He discusses current reform trends and specific initiatives to shift the locus of organization, planning, and provision to the community level. He also analyzes the integration of supportive social services into broader community development efforts, while considering the ever-present scrutiny of accountability in human services. Halpern points out some of the inherent risks and benefits of historical approaches to studying social issues. On the one hand, he sees the risk of didacticism interpreting and shaping history to teach lessons that support a specific course of action. On the other hand, he thinks the historical approach provides a realistic perspective about the past and present, and enables constructive forward movement to occur.

Lecca, Pedro J., Quervalu, Ivan, Nunes, Joao V., & Gonzales, Hector F. (1998). Cultural Competency in Health, Social, and Human Services: Directions for the Twenty-first Century. New York: Garland Publishing Co.
This book presents a comprehensive perspective on the growing importance of culturally competent practice in the health, social, and human services in the 21st century. The authors provide specific information about various racial and ethnic groups for practitioners to use when making assessments and determining treatment modalities. The book is organized into three sections. The first section presents a rationale and framework for the provision of culturally competent services, including a discussion of the inherent biases that clients encounter from Western health practices. The section focuses on cultural competency in health, and child and family services. Section two discusses larger organizational issues related to cultural competent practice. This section examines the structure and costs of the health care system, the development of culturally competent leadership in the field of human services, the importance of social values within an organizational context, and the relationship between human resources and cultural competency. A chapter on culturally competent services to the minority aged is also included. Section three presents recommendations on future policy directions in the area of culturally competent practice. This section contains a review of the current climate in the health, social, and human services fields, including policy changes directed toward efficiency and cost containment. Section three also addresses employment and staffing issues, and the current role of HMOs in the service delivery system.

Lum, Doman. (2000). Social Work Practice and People of Color: A Process-stage Approach. 4th edition. Pacific Grove, California: Brooks/Cole Wadsworth.
The fourth edition of this important resource retains the generalist social work framework that was advanced in the preceding editions, while adding new features that reflect recent trends in social work practice and cultural diversity. Among these new features are a chapter that highlights the American multicultural history of women of color, a framework for black experience-based social work practice, and new sections on interventions and termination. The book presents a relevant set of theoretical frameworks that depict the various themes related to culturally competent practice. These theoretical frameworks fit within a generalist model of social work practice, and offer insights into the contact, problem identification, assessment, intervention, and termination stages of practice. The author provides an assortment of cultural studies and diversity examples to illustrate his theoretical perspectives. The book addresses the culturally diverse values of a variety of populations, including minority elderly, gay and lesbian persons of color, multiracial children, immigrants, and racial and ethnic families. It also examines relevant practice topics, including empowerment, stratification, power, and powerlessness. The book advocates a strengths perspective that encourages practitioners to not only recognize the strengths of their culturally distinct clients, but to continually assess their approach to these clients. The author argues that this is the only way for practitioners to effectively work with clients in a culturally competent manner.

Lynch, Eleanor W., & Hanson, Marci J. (Eds.) (1998). Developing Cross-cultural Competence: A Guide for Working with Children and Their Families. Baltimore: Paul H. Brooks Publishing.
This second edition book is intended for use by professionals who provide educational, health care, and social services to families of children who have, or are at risk for, disabilities. The editors indicate that this book comes at a time when service providers face an important crossroads, a time when the increased diversity of clients calls for a clearer understanding of the larger context in which service delivery occurs. They define this context as not just knowing our own worldview and that of others, but carefully considering how these views affect the children and families with whom we work. Contributors to the book include many bicultural and bilingual authors who describe practices in early intervention and intercultural effectiveness for practitioners to consider and use. The philosophy of the book is based on five principles: a prerequisite to any successful intervention is the practitioner's understanding of the values associated with their own background; all families, children, and individuals are unique; culture is not static—it is fluid and dynamic; practitioners have two roles, to develop culturally competent interventions and to help families negotiate aspects of the mainstream culture; and every intervention occurs within a larger sociopolitical context. Each chapter of the book discusses a specific ethnic population, and the appendices at the end of the chapters provide general summaries of the values, beliefs, practices, and customs of each population.


Neysmith, Sheila M. (Ed.). (1999). Critical Issues for Future Social Work Practice with Aging Persons. New York: Columbia University Press.
This book originated from five seminar presentations at the Social Work Research Center shared by the Baycrest Center for Geriatric Care and the University of Toronto Social Work faculty. The initiative presented the opportunity for scholars in the field of aging to raise important questions about social policy in aging. Participants were specifically concerned about the conditions of social inequity faced by women in Western long-term care systems. An analysis of power relations permeates the book, looking at how power works to define problems, interpret meanings, and prescribe ranges of legitimate alternatives for addressing social problems. Contributors argue that social workers are inherently involved in addressing the needs of marginalized groups, and are strategically situated to witness the inequities derived from power relations. Because of their unique position, social workers must work with aging women (and their sources of support) to increase possibilities of accessing power. In addition, authors see it as crucial that practice theory offer ways of understanding aging that supports women, and imperative that social workers articulate models of practice that do not further oppress women. Instead of providing the reader with clearly specified guidelines for practice, the aim of the book is to challenge current social arrangements and explanations that reinforce privilege, so that alternatives are created that allow people to have more satisfying lives.

Wykle, May L., & Ford, Amasa B. (Eds.) (1999). Serving Minority Elders in the Twenty-first Century. New York: Springer Publishing.
This volume of essays on serving minority elders evolved from a national symposium held at Case Western Reserve University in October 1996. The conference attracted nationally known scholars who addressed the unique problems that minority elders encounter as they strive for an improved quality of life. The essays focus on the health and well being of elders in four major ethnic categories: African American, Hispanic, Asian American, and Native American, and are divided into three primary sections: physical and functional health, mental health, and community (possible preventive and remedial measures). The essays in the first section examine some of the causes and effects of chronic illness and functional disability in minority elders. Two prominent themes of the section are the need to recognize the high degree of heterogeneity among the aged population, and the incomplete nature of the data that are available to evaluate the health and function of minority elders. The essays in the mental health section share the common theme that much of the past mental health problems of elders in general, and minority elders specifically, have remained untreated. Finally, many of the essays in section three discuss the need for policy makers to concentrate on comprehensive community-based health care programs for minority elders instead of institutional care. This section also focuses on culturally competent care of the elderly, and suggests possible directions for future research on minority elders.

Navedo Barsa, Betty R. (1998). The Independence of Urban Hispanic Elderly: The Growing Need for Social Support Networks. New York: Garland Publishing Inc.
This recent study of Hispanic elderly occurred in a geriatric clinic in the Washington Heights area of New York City. The study was undertaken to gather data on whether Hispanic older persons maintain a sense of mental well being in the face of physical illness and how social supports help mediate the effects of those illnesses. The objective was to help health care professionals and others working with Hispanic elderly learn more about these issues, so that they might develop better mental health interventions for this rapidly growing population. Participants in the study were 96 predominantly Dominican, Puerto Rican, and Cuban clients served by the clinic. Each participant was interviewed using the Older Americans' Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire. Conclusions were based on three separate hypotheses: a positive relationship would exist between the availability of social support networks and mental health, between physical health and mental health, and between self-ADLs and mental health. The expected relationships were found in the first two hypotheses, but not the third. A significant finding was that in spite of having multiple medical and socioeconomic problems, the participants perceived that their affective support needs were being met by their informal support systems (family members). One important implication for practice from the study is the opportunity for social workers to institute interventions focused on enhancing the informal support systems that are already in place for this population.

ne (319) 335-4965; Fax (319