FEATURED PROGRAM FOR SEPTEMBER 2005:

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International FACES – (International Family Adolescent and Child Enhancement Services), Heartland Health Outreach

Administering Organization
National Child Traumatic Stress Network (NCTSN) - Heartland Health Outreach

Program Objectives and Unique Needs Addressed
To enhance the quality of life for refugee children, adults and families by providing culturally and linguistically appropriate, comprehensive mental health services for those children, adults, and families suffering from trauma-related distress or serious emotional disorders exacerbated by their refugee experience.

Program Description
International FACES, a program of Heartland Health Outreach, the health care partner of Heartland Alliance for Human Needs & Human Rights, provides comprehensive, cross-cultural, linguistically appropriate community-based mental health services to refugee children and families. Outreach is seen as the cornerstone of the program and occurs throughout the treatment process. Outreach includes identifying refugee children who can benefit from services, engaging the children and their families in services, providing services in a community setting, and supporting them as necessary after the active treatment phase has ended. The model incorporates components of the Assertive Community Treatment model (ACT), an evidence-based practice model of service, as well as components designed specifically to meet the needs of refugee families.

Resource Materials Used in Program
International FACES has many documents translated into the languages spoken by the refugee families we serve. In some cases documents are picture documents (e.g.: nutrition documents for Somali Bantu). Program staff also utilize the documents available through the Refugee Health Information Network administered by Georgetown University.

International FACES has several PowerPoint presentations staff have used in presenting the services and the NCTSN components.

Groups Served by Program
Refugee children and families who have experienced trauma as a result of war and/or displacement.

Program Funding
International FACES is funded by: the federal Department of Health and Human Services, Office of Refugee Resettlement (ORR), administered by the Jewish Federation of Metropolitan Chicago; the federal Office of Refugee Resettlement, with a collaborative grant to the Illinois State Board of Education, administered by the Jewish Federation of Metropolitan Chicago; the Illinois Department of Human Services Division of Mental Health; the federal Department of Health and Human Services, Substance Abuse and Mental Health Administration (SAMHSA) through the National Child Traumatic Stress Initiative.

Program Staffing and Required Staff Training
International FACES is staffed by a licensed clinical psychologist, licensed psychotherapists, licensed dance-movement therapist, licensed art therapist, licensed occupational therapist, early childhood specialists, and mental health counselors who also serve as case managers and interpreters. These counselors, who are themselves refugees, are trained on the job. Languages spoken by staff include: Albanian, Amharic, Arabic, Berber, Bosnian, German, French, Lingala, Oromania, Russian, Spanish, Swahili, Tigrenya, and Ukrainian. Most other languages can be accommodated with the help of trained interpreters from Heartland’s Cross-Cultural Interpreting Services.

Staff Training: All staff receive initial orientation and training through Heartland Health Outreach. Additional training is provided by program staff.

Defining Program Success
International FACES uses the University of California Los Angeles Trauma Scale, the Child and Adolescent Functional Assessment Scale, the Child Depression Scale-short version, Consumer Satisfaction Survey, and the Family Satisfaction Survey to measure client’s functional improvement, decrease in symptoms, and satisfaction with services. Several of these documents have been translated into various languages.

Program Additional Comments
The application of ACT to refugee children occurred “organically” at the agency, by staff adopting aspects of ACT programs for homeless and seriously mentally ill (SMI) clients that they found fit the refugee experience. In particular, the notion that refugees, as is the case for homeless and SMI clients, can benefit from comprehensive services provided by a team that combines expertise across multiple disciplines makes intuitive sense. The expansion of the ACT team to include ethnic case management staff (the primary vehicle for delivery of refugee mental health services) is innovative and holds promise for application with other diverse populations and in cross-cultural settings. It is unknown if ACT is being used with children elsewhere, and outcomes for ACT with children have not been documented in the literature. While Multi-Systemic Therapy, wrap-around, and systems of care, approaches contain elements similar to ACT, they are not the same.

In 1978, the need for mental health services to refugees, was identified both internally within the organization as well as externally through the Illinois Bureau of Refugee and Immigrant Services. In 1982 formal services began to be specifically designed to meet the mental health needs of individuals who were traumatized due to war, displacement and human rights abuses. The Refugee Mental Health program defined mental health as not just the absence of illness, but as having the resources to live successfully in a new culture and as such designed the services to utilize staff who could bridge the gap and work both cross-culturally as well as provide services in the language of the refugee. In 1995, in response to the mental health needs of large numbers of refugees from Bosnia, HHO established interdisciplinary in addition to cross-cultural mental health services especially for these refugees. In 2000, mental health services specifically designed for children and adolescents were established to meet the needs of youth who were traumatized due to war, displacement and human rights abuses.

Program Outcomes
Although ACT has been shown to be effective in over 50 controlled studies, none have been conducted with programs using ACT for children in general and refugee children in particular. However an extensive program evaluation of the International FACES model is currently under way.

International FACES uses the University of California Los Angeles Trauma Scale, the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Depression Scale-short version, Consumer Satisfaction Survey, and the Family Satisfaction Survey to measure client’s functional improvement, decrease in symptoms, and satisfaction with services. Several of these documents have been translated into various languages.

The most important measure is the CAFAS, because it is collected on every child receiving services; the CDI and the UCLA are collected only for children old enough to complete a self-report measure in English or Spanish.

Program Evaluation
The program is currently collecting clinical outcome measures at intake and every three months. These include the CAFAS which is completed by staff on all children served by the program, as well as the CDI and the UCLA scales collected for children over age 11 who are able to complete these measures in English or Spanish.

Preliminary findings suggest that children receiving services show steady improvement on the CAFAS even after three months of treatment. Statistically significant improvement on the CAFAS relative to first administration was observed after six and nine months of treatment. In addition, a statistically significant effect was found for the number of service contacts children received in predicting improvement on the CAFAS after nine months of treatment. In other words, the more service contacts the children received over the course of treatment, the greater was the improvement in functioning observed. This suggests that children’s improvement can be attributed to the services provided.

Other Key Elements
Components of the Model Based on ACT:

• Multidisciplinary team includes psychotherapists, art, occupational, and dance therapists, psychiatrist, and ethnic case managers from refugee communities served.
• Low client-to-staff ratio.
• En-vivo services are provided to clients at locations that are most comfortable to them
• Comprehensive services address mental health as part of a range of needs that refugee children and families have as they are adjusting to their new life.

Specialized Refugee Program Components:

• Multicultural counseling staff provides cultural and linguistic competence and work as part of a mental health team.
• Coordination with refugee resettlement services within the same agency allows IFACES to establish relationships with families before they need services, reducing stigma.
• Program Operations

Program Contact
Mary Lynn Everson, MS
Heartland Health Outreach
4753 N. Broadway, Suite 400
Chicago IL 60640
Phone (773) 751-4071 Fax (773) 741-4181
Email: meverson@heartlandalliance.org
www.heartlandalliance.org

Program Dates
This program began in 2002 (Refugee Mental Health Program in 1982); it is still operating.

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