Enhancing empathy among humanitarian workers through Project MIRACLE: Development and initial validation of the Helpful Responses to Refugees Questionnaire

Background: Empathy is an important tool needed for service providers working with people who have experienced trauma, such as refugees and torture survivors. However, the high caseloads, rigorous deadlines, and overwhelming circumstances under which humanitarian workers typically operate often make it challenging to employ empathy. The Helpful Responses to Refugees Questionnaire (HRRQ) was developed to measure empathetic responsiveness, a core skill of Motivational Interviewing, among service providers working with refugees, including torture survivors. Methods: The HRRQ was adapted specifically for measuring empathy in refugee contexts, including among asylum-seekers and torture survivors. Face validity and content validity were established by a panel of refugee resettlement experts prior to administration. The instrument was then administered via an online survey to a national sample of refugee service providers (valid N=90). Findings: The HRRQ demonstrated good psychometric properties. Interpretation: The HRRQ has several potential applications for work with refugees, including torture survivors. It could be used as a supervisory tool to assess service providers\u27 skills in this area and provide feedback for improvement, if needed. It could also be used as a screening tool for hiring new staff as part of a comprehensive screening and selection process. Finally, it may be used as a pretest-posttest to evaluate the impact of staff training in motivational interviewing. Limitations of this study and implications for future research are discussed

Enhancing empathy among humanitarian workers through Project MIRACLE: Development and initial validation of the Helpful Responses to Refugees Questionnaire

Background: Empathy is an important tool needed for service providers working with people who have experienced trauma, such as refugees and torture survivors. However, the high caseloads, rigorous deadlines, and overwhelming circumstances under which humanitarian workers typically operate often make it challenging to employ empathy. The Helpful Responses to Refugees Questionnaire (HRRQ) was developed to measure empathetic responsiveness, a core skill of Motivational Interviewing, among service providers working with refugees, including torture survivors. Methods: The HRRQ was adapted specifically for measuring empathy in refugee contexts, including among asylum-seekers and torture survivors. Face validity and content validity were established by a panel of refugee resettlement experts prior to administration. The instrument was then administered via an online survey to a national sample of refugee service providers (valid N=90). Findings: The HRRQ demonstrated good psychometric properties. Interpretation: The HRRQ has several potential applications for work with refugees, including torture survivors. It could be used as a supervisory tool to assess service providers’ skills in this area and provide feedback for improvement if needed. It could also be used as a screening tool for hiring new staff as part of a comprehensive screening and selection process. Finally, it may be used as a pretest-posttest to evaluate the impact of staff training in motivational interviewing. Limitations of this study and implications for future research are discussed.&nbsp

Assessing Refugee Poverty Using Capabilities Versus Commodities: The Case of Afghans in Iran

This study is among the first to calculate poverty among one of the world’s largest refugee populations, Afghans in Iran. More importantly, it is one of the first to use capability and monetary approaches to provide a comprehensive perspective on Afghan refugees’ poverty. We estimated poverty using data collected from a sample of 2,034 refugee households in 2011 in Iran. We utilized basic needs poverty lines and the World Bank’s absolute international poverty line for our monetary poverty analyses and the global Multidimensional Poverty Index (MPI) for our capability analyses of poverty. Findings show that nearly half of the Afghan households were income-poor, approximately two percent of the households had less than USD 1.25 per person per day, and about 28% of the surveyed households were multidimensionally deprived. Results suggest that 60% of the income-poor households were not deprived from minimal education, health, and standards of living based on the MPI criteria, and about 32% of the multidimensionally deprived households were not income-poor. These findings call for more attention to poverty measurement methods, specifically for social workers and policy makers in the field, to gain a more realistic understanding about refugees’ wellbeing

Mitigating Psychological Distress Among Humanitarian Staff Working With Migrants and Refugees: A Case Example

Ongoing acute stress in humanitarian work leads to psychological distress among humanitarian workers. Stress management within humanitarian agencies requires responses at both the individual staff member and agency levels. Stress management is often conceptualized in four categories: stress that can be accepted; stress that can be altered; stress to which individuals can adapt; and stress that can be avoided. Humanitarian workers accept the stress created by the environment in which they choose to work. They can manage stress by altering their own behaviors through improved communication skills and the implementation of self-care plans. They can adapt, with the help of staff care plans such as counseling and peer support, to the stress created by their own histories of trauma or mental illness. The stress created by the workplace can be avoided. However, without a comprehensive support plan for mitigating psychological distress, both the individual humanitarian worker and the agency overall suffer. This article reviews current literature regarding the impact of avoidable stress and the impact of adaptation programs such as staff care and stress management plans on humanitarian work, and illustrates these impacts with a case example from the Danish Refugee Council, an international non-governmental organization with approximately 300 employees working in Greece

Cost-utility of a visiting service for older widowed individuals: Randomised trial

Background. Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions. Methods. We conducted a cost-utility analysis alongside a randomized clinical trial on a visiting service for older widowed individuals (n = 110) versus care as usual (CAU; n = 106). The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer. Participants were contacted 6-9 months post-loss. Eleven percent of all contacted persons responded and eight percent participated in the trial. The primary outcome measure was quality adjusted life years (QALYs) gained (assessed with the EQ-5D), which is a generic measure of health status. Costs were calculated from a societal perspective excluding costs arising from productivity losses. Using the bootstrap method, we obtained the incremental cost utility ratio (ICUR), projected these on a cost-utility plane and presented as an acceptability curve. Results. Overall, the experimental group demonstrated slightly better results against slightly higher costs. Whether the visiting service is acceptable depends on the willingness to pay: at a willingness to pay equal to zero per QALY gained, the visiting service has a probability of 31% of being acceptable; beyond €20,000, the visiting service has a probability of 70% of being more acceptable than CAU. Conclusion. Selective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view, when targeted towards the entire population of all widowed individuals. We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions, and in what subgroups the incremental cost-utility is best. In the future bereavement interventions are then best directed to these groups. Trial registration. Controlled trials ISRCTN17508307. © 2008 Onrust et al; licensee BioMed Central Ltd

Building relationships and facilitating immigrant community integration: An evaluation of a Cultural Navigator Program

Despite the United States’ long history of immigration, large and small communities around the country struggle to integrate newcomers into the social, economic, cultural, and political spheres of society. Utilizing results from the program evaluation of one public library’s Cultural Navigator Program (CNP), the authors illustrate how communities and public institutions can promote integration and relationship building between newly arrived immigrants and long-time residents. Existing social networks, conceptualized in this article as social capital, within receiving communities were leveraged to build capacity among newly arrived immigrants and foster inclusivity and integration at the community level. As a place of intervention, public libraries are suggested as a safe and shared space where community integration can be fostered. The program model is provided as an approach to immigrant community integration. Insights derived from the evaluation inform a discussion on engaging approaches to immigrant integration. The CNP utilized community networks to deliberately and systematically facilitate integration and relationship building between newly arrived immigrants and community members. Lessons learned and recommendations for program evaluators and administrators are provided

Labour Force Participation and Employment of Humanitarian Migrants: Evidence from the Building a New Life in Australia Longitudinal Data

This study uses the longitudinal data from the Building a New Life in Australia survey to examine the relationships between human capital and labour market participation and employment status among recently arrived/approved humanitarian migrants. It includes attention to the heterogeneity of labour force participation and employment status across genders and also migration pathways. We find that the likelihood of participating in the labour force is higher for those who had preimmigration paid job experience, completed study/job training and have job searching knowledge/skills in Australia and possess higher proficiency in spoken English. We find that the chance of getting a paid job is negatively related to having better pre-immigration education, but it is positively related to having unpaid work experience and job searching skills in Australia, and better health

Vaccine delivery by penetratin: mechanism of antigen presentation by dendritic cells

Cell-penetrating peptides (CPP) or membrane-translocating peptides such as penetratin from Antennapedia homeodomain or TAT from human immunodeficiency virus are useful vectors for the delivery of protein antigens or their cytotoxic (Tc) or helper (Th) T cell epitopes to antigen-presenting cells. Mice immunized with CPP containing immunogens elicit antigen-specific Tc and/or Th responses and could be protected from tumor challenges. In the present paper, we investigate the mechanism of class I and class II antigen presentation of ovalbumin covalently linked to penetratin (AntpOVA) by bone marrow-derived dendritic cells with the use of biochemical inhibitors of various pathways of antigen processing and presentation. Results from our study suggested that uptake of AntpOVA is via a combination of energy-independent (membrane fusion) and energy-dependent pathways (endocytosis). Once internalized by either mechanism, multiple tap-dependent or independent antigen presentation pathways are accessed while not completely dependent on proteasomal processing but involving proteolytic trimming in the ER and Golgi compartments. Our study provides an understanding on the mechanism of antigen presentation mediated by CPP and leads to greater insights into future development of vaccine formulations