A lot of literature has been generated on identifying and treating newcomer/refugee trauma. As the newcomer passes through the “honeymoon stage” of arriving in the U.S.A., the realities of resettlement tasks can be daunting. During the resettlement process, both adults and children may begin to exhibit symptoms resulting from trauma and loss. Identification, and referral to trained professionals can be key elements in ensuring health and wellness.

The Impact of War

Before would-be refugees even have the chance to flee their home countries, they often experience trauma. Seeing war and violence firsthand puts them at a higher risk than the general population for developing anxiety disorders, mood disorders and post-traumatic stress disorder (PTSD). Resettlement in a new country can spur attachment disorders and worsen anxiety and depression.

It can be hard to measure the prevalence of PTSD and similar disorders in refugees. This is largely because of communication barriers, which may prevent complete understanding or development of trust between refugees and mental health professionals. Estimates have determined that the percentage of refugees experiencing PTSD is anywhere between 4% and 86%.

Symptoms of PTSD can vary. But in general, the diagnostic criteria include:

  1. Flashbacks (unwanted, intrusive memories of traumatic event(s).
  2. Severe emotional response to stimuli that is reminiscent of traumatic event(s).
  3. Negative thoughts about oneself or the world.
  4. Difficulty maintaining close relationships.
  5. Feelings of being sad, hopeless, or numb.
  6. Hypervigilance.

Many more symptoms exist and each person experiencing trauma will present differently. However, no matter what, it is clear that many, if not most, refugees leave their home countries with severe emotional damage (

Unfortunately, trained trauma therapists and interpreters are often not readily available in smaller metropolitan areas. Please refer to State and Federal resettlement agencies which are likely to have visibility on the mental health resource networks in the local area.

Understanding basic elements surrounding the impact of trauma and Trauma-Informed-Care will provide necessary guidance for volunteers, to ensure that they do not inadvertently cause further harm, and indeed provide necessary care and support to mitigate the impact of trauma.
Key Principles of a Trauma-Informed Approach. While there is no prescribed set of policies or practices for a trauma-informed approach, there are general principles that promote recovery and resilience for individuals impacted by trauma.

  • Safety – Staff and the clients they serve feel physically and psychologically safe.
  • Trustworthiness and transparency – Organizations conduct operations with transparency building and maintaining trust with clients, family members, staff, and others.
  • Peer support – Support from other trauma survivors helps a survivor establish safety and hope, build trust, enhance collaboration, and share experiences to promote recovery and healing.
  • Collaboration and mutuality –Recognizing that clients are partners in their treatment and purposefully levelling the power dynamics between clients and staff contributes to safety and healing. Likewise, sharing power and decision making within the organization (e.g., from administrative personnel to director-level) creates a more resilient organization.
  • Empowerment, voice, and choice – Clients are supported in self-advocacy, shared decision-making, and goal setting; staff are the facilitators, rather than the controllers, of recovery.
  • Cultural, historical, and gender issues – The organization offers access to gender-responsive services, acknowledges the survivor’s racial, ethnic, and cultural identity, and recognizes and addresses trauma stemming from a survivor’s lived experience.

A variety of various therapies have emerged that may provide activities that the volunteer support group may consider obtaining training.

  1. Sand Play Therapy – Sand play therapy is a nonverbal, therapeutic intervention that makes use of a sandbox, toy figures, and sometimes water, to create scenes of miniature worlds that reflect a person’s inner thoughts, struggles, and concerns. This is a form of play therapy; other methods
    include imaginary play with toys and puppets or bibliotherapy that uses literature to help a patient interpret stories or fiction and how such writings may relate to the patient’s own difficulties. Sand play is practiced along with talk therapy, using the sandbox and figures as communication tools. (
  2. Equine therapy for refugees – Equine therapy for refugees can help with the wide range of mental health issues that a refugee may face. Refugee populations struggle with trauma and mental anguish; self-harm, suicide attempts, aggression and issues with anxiety and depression are common. Equine therapy for refugees is a shelter in the storm of trauma. It provides an
    outlet for a myriad of emotions and fosters self-confidence and respect. Through equine therapy, refugees experiencing trauma can learn to self-regulate their emotions, and, bit by bit, begin to heal (
  3. Plant Therapy – How gardening can improve the mental health of refugees Published: June 26, 2018. A new study on the Myanmar former refugee community in the regional city of Coffs Harbor revealed the importance of gardening, and in particular how this connection has a positive impact on the mental health of people who have faced severe trauma and are now
    settling in an unfamiliar place. Research has found spending time in nature can significantly improve mental health. Gardening offers a way to be in nature that is both productive and relaxing. Like all forms of exercise, it is also a source of “happy hormones” (serotonin and dopamine). (
  4. Art Therapy – Creating drawings, paintings, or sculpturing around the topics of houses and environments from the past can help refugees to retain their identity through art, creating safe spaces for the future helps to look ahead, retain resources, and regain control. (


For most volunteers, the thought of responding to mental health issues can be daunting. However, for those who have limited exposure to mental response, here is additional information that can serve as backgroundbackground for the volunteer support group.

Many refugees have been victims of severe violence that has profoundly affected their physical, psychological, and spiritual lives. Individuals and families have sustained multiple losses, including family, country, social position, social network, language, and status. Many have been confined in refugee camps for long periods-in some cases as long as 15 years. Ultimately, if they find themselves living in the United States, these patients bear the emotional toll of the violence they have experienced and of their refugee status.

  1. Arrange for a culturally appropriate interpreter – Work with an empathetic interpreter who can accurately translate verbal and nonverbal communication and who is emotionally in tune with patients. The ability of refugees to adjust to American life is, in large part, a function of their educational level before the trauma and disruption. The interpreter also serves as a “cultural broker” when the patient and the psychiatrist have different concepts of psychiatric treatment.
  2. Take the time to learn the full scope of the patient’s life experiences. Working with refugees who have survived violence and torture is complicated and not formulaic. Therapy must address the interface of psychiatric disorders related to trauma with an understanding of cross-cultural needs.
  3. Take a trauma history, noting its effect on the patient-psychological, medical, and social. Cultural sensitivity and awareness of the effects of massive trauma are crucial. Listen to the patient’s story and stay with the patient through the difficult process of coming to terms with the trauma and adjusting to life in their new reality.
  4. Focus on targeted treatment. Actively treat depression, sleep disorders, and nightmares with appropriate medications. Therapy generally affords a rapid reduction in the most obvious symptoms (such as nightmares and startle reaction); nevertheless, patients remain highly vulnerable to stress.
  5. Ask about intolerance from others. Inquire about aggressive behavior or intolerance, which can cause family and social problems.
  6. Prepare for chronic conditions. Be prepared for chronic course of mental disability, with remissions and exacerbations. The clinical symptoms displayed by refugees who are victims of violence are quite similar-regardless of their cultural background. PTSD is almost always the result of torture and trauma, and MDD is often associated with the losses that the refugees have
    endured. Symptoms of psychosis may be present, as well as chronic brain damage from head trauma.
  7. Build a therapeutic alliance. Provide a safe, confidential, trusting relationship with a mental health professional-the most helpful aspect of the therapeutic encounter. Stress reduction is also essential and is achieved by ensuring that patients have housing, a social network, and adequate food, and by providing continuity of care in the community and alleviating symptoms with medication.

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