Social

Clients needing assistance in obtaining food, clothing, housing, job training and placement, ESL and education are referred to the Program’s Social Service staff which is comprised of a licensed clinical social worker, a French and Wolof-speaking social/legal services coordinator, a Tibetan social services provider and an education/volunteer coordinator. Over the past five years our Program has developed relationships with many community, faith-based, and volunteer organizations that can provide clients with food, clothing, and shelter. One development that has been very advantageous to asylum seekers was the 2004 New York court decree making asylum seekers eligible for Medicaid. Our social service staff makes every effort to enroll our qualified clients in Medicaid which provides them with broad access to healthcare. When clients obtain asylum and become eligible for employment authorization, we refer clients to job training and placement services offered by refugee resettlement agencies and other organizations. But before clients become eligible for these services, they are assisted in preparing for their eventual entry into the job market by a team of 40 Program volunteers. These trained and supervised volunteers provide small classes and individual tutoring in reading, writing and speaking English as well as basic literacy skills. They also help clients learn to use current computer technology, prepare for Graduate Equivalency Diplomas, or enroll in school.

Medical

All clients are offered a medical evaluation and comprehensive medical care. Clients are encouraged to accept appointments with a primary care physician (PCP) associated with our Program. The PCP provides and coordinates ongoing medical care. All PCPs affiliated with our program are attending physicians in the Bellevue Primary Care Medical Clinic and have faculty appointments at NYU School of Medicine. All have received specialized training in caring for torture survivors. Presently, 11 PCPs (9 internists and 2 pediatricians) are affiliated with our Program. Additionally, resident physicians and senior medical students under direct supervision from attending physicians also care for patients (with the patient’s permission). This serves an important educational mission of our Program while ensuring provision of high quality care. Program clients have access to all necessary medical, laboratory and radiographic services. Medications are provided from the Bellevue Hospital Pharmacy. Pediatric medical care is available for both children who have been tortured and the children of torture survivors. Gynecological services are provided by a female Physician’s Assistant specializing in Gynecology, who has been associated with our program since we began. Inpatient and emergency care are also available. Individuals can be referred to subspecialty clinics at Bellevue including Dermatology, Orthopedics, Neurology, Rehabilitative Medicine, Ophthalmology, and Plastic Surgery as necessary. The level of specialized medical services available through our Program enables us to provide outstanding care and expand medical understanding of the needs of torture survivors.

Psychological

Clients needing and interested in receiving mental health services are matched with appropriate clinicians for individual, group, or family therapy. The Program also provides psychiatric and psychopharmacological evaluation, treatment and follow-up. Clinicians and supervisors are trained in and utilize evidence-based techniques for clients with PTSD, depression, and other psychological symptoms. These include Cognitive Behavioral Therapy, Narrative Exposure Therapy, Breathing Retraining, Relaxation Techniques, Supportive Group Therapy, Family Therapy and Play Therapy. The Bellevue/NYU Program has done pioneering work in ethnoculturally specific supportive group therapy for torture survivors. These groups have been demonstrated to be successful in ameliorating isolation and effective in improving psychological functioning. Our groups are designed to focus more on adaptation than emotional exploration. The content of group discussions comes from the group participants and frequently includes topics such as: loss; navigating the asylum process; cultural adaptation; anger and frustration; the role of faith and religion; and sharing successful coping mechanisms. This model of group support has become central to our Program, which has two French-speaking African groups, an English-speaking African group, and a Tibetan group. Another treatment approach used at the Program is Narrative Exposure Therapy (NET). NET combines elements of oral history traditions, Cognitive Behavior Therapy, and “testimony therapy” in an effort to integrate patients’ trauma narratives into their lives and reduce symptoms of posttraumatic stress disorder (PTSD). This therapy has been demonstrated to diminish traumatic stress in refugees living in camps in the former Yugoslavia and East Africa. While most of our clients are adults, we also provide services to children affected by torture and war trauma. Family therapy is often utilized if the family is together to address shared experiences of traumatic events and distortions/miscommunications that can arise in situations of severe stress. In cases in which a parent has been killed or disappeared, family therapy has been used to assist the surviving members in processing the trauma of their loved one’s death, clarifying children’s worries about their own safety, and providing a safe environment for the family’s unique experience of grieving. Play therapy is used to provide young children with an experience of mastery and reworking, so that they can move past their traumatic memories. Behavioral modification techniques and school interventions are used when youngsters demonstrate behavioral difficulties resulting from war trauma or torture experiences.

Legal

Clients needing legal assistance are referred to our Social/Legal Services Coordinator who is an experienced paralegal. Approximately 80% of our clients are asylum seekers. When they do not yet have an attorney we work with non-profit organizations, such as Human Rights First to find them pro bono representation. When appropriate, Program clinicians provide medical and psychological affidavits for clients seeking asylum, and often testify on their behalf. This documentation from health professionals can be crucial in allowing judges to accurately evaluate the merits of a survivor’s claim. Since the Program began we have assisted in obtaining grants of asylum for 467 clients. This year alone, 68 clients have been granted asylum, promising to surpass our asylum grant record of 77 last year. We also refer clients to Physicians for Human Rights and Doctors of the World for medical documentation in asylum applications. Once asylum is granted, our Social/Legal Services Coordinator continues to work with clients to help them obtain employment authorization and family reunification. Since the Program began we have assisted in reuniting 48 families, 20 of whom were reunited this year.