Services for Survivors of Torture Medical Care Survey

Title: Services for Survivors of Torture Medical Care Survey

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The Office of Refugee Resettlement (ORR) Division of Refugee Health (DRH) seeks to learn more about the medical care provided to individuals served by Services for Survivors of Torture (SOT) programs. Specifically, DRH seeks to better understand SOT program capacity, partnerships with other organizations, and technical assistance and training needs related to medical care. As part of this effort, the National Capacity Building Project’s Medical Task Force (MTF) is conducting a program survey. This survey is voluntary; however, we encourage each program to participate. The survey should take about 30 minutes for one person from each program to complete. We are asking every program to complete the survey by DATE. The results will inform the medical care recommendations MTF makes to DRH. We appreciate your time and effort in completing this survey.

Thank you,

Richard F. Mollica, MD

Director, Harvard Program in Refugee Trauma

+1 781 999 0502

Jillian M. Stile, PhD

Senior Advisor, Harvard Program in Refugee Trauma

+1 917 499 1354

Please note, it is best to have the Program Director or Medical Director, if applicable, complete this survey. Please feel free to download this Word version of the survey to review prior to completing the survey online. Once you have the information you need, please complete the survey online. If you do not know the answer to specific question(s) you may leave the response blank and proceed with the remainder of the survey. The information you provide will not be shared with other SOT programs. Individual program responses will not be shared with ORR – instead, the Medical Task Force will combine responses from all programs before sharing information with ORR. The information shared will not include names or other identifiable information. However, because of the relatively small number of organizations participating in the study, there is a possibility that a response could be correctly linked to you.

If you are ready to begin the survey, please click “next.”

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to document the medical needs of the Services for Survivors of Torture Program and the provision of services to individuals served by that program. Public reporting burden for this collection of information is estimated to average 40 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, collaboration, and reviewing the collection of information, and completing the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0531 and it expires DATE.

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Instructions

Navigating through the survey 

• You may take this survey on any device, including cell phones or tablets. However, for convenience when typing we suggest taking the survey on a computer. 

• If you would like to gather the information before responding you can download a Word version of the survey so that you can print it and fill it out, then enter your responses all at one time. To download the Word version, click here: [LINK] 

• As you work through the survey, your responses are automatically saved after each page is completed (after each time you hit ‘NEXT’). You may change a response by clicking on the BACK button at the bottom of the page (not your browser's 'back' button). Use the NEXT button to advance to the next page.  

• When you have completed the survey, please click on the SUBMIT button at the end of the survey. You may submit the survey even if there are some questions that you do not answer. Once you submit the survey, you will not be able to return to it without contacting us. 

• If you have any questions or concerns, please contact Jillian Stile, Senior Advisor, Harvard Program in Refugee Trauma at 917-499-1354 or jstilephd@gmail.com to discuss them.

If you are ready to complete the survey, click “Next.”

Glossary of Terms:

Medical Director or Coordinator: A licensed medical doctor, nurse practitioner, or physician assistant who oversees the medical care of survivors, helps develop and maintain a network of primary care and specialty providers, supervises referrals, follows up to ensure timely and appropriate service delivery, and collects outcome information.

Primary survivor of torture: Torture is the deliberate and systematic dismantling of a person’s identity and humanity through the infliction of physical and psychological pain and suffering. Primary torture survivors are individuals who meet the definition as outlined in the TVRA. This category includes individuals who were forced by perpetrators to either torture or witness the torture of another person.

Secondary survivor of torture survivor: Based on a whole-family and public health approach, ORR defines a secondary survivor as a relative or other individual closely associated with a primary survivor, who is impacted by the torture and subsequent trauma in a way that threatens their health and ability to function. 

Question #1: Do you have a Medical Director (See Glossary) on site in your Survivors of Torture (SOT) program? Yes ___ No ___

• If yes, is this a volunteer position ___ or paid position ___?

• If yes, how many hours per week? ______

Question #2: On average, how many survivors of torture and/or asylum seekers have you treated over the 12-month fiscal year October 1 2020 – September 30 2021 [unduplicated count]? ______

• Primary Survivors of Torture (See Glossary) ______

• Secondary Survivors of Torture (See Glossary) ______

• Current Asylum Seekers ______

• Please estimate the percent of children/adolescents treated. ______

• Please estimate percentage of females ______ and males. ______

Question #3: Do your patients have access to a psychiatrist, nurse practitioner, or a primary care practitioner who can prescribe psychotropic drugs?

Select one:

Always
Very Often
Sometimes
Rarely
Never

• If yes, is the prescriber on-site or off-site? On-site ______ Off-site ______

Question #4: Do you your patients have access to primary healthcare?

Select one:

Always
Very Often
Sometimes
Rarely
Never

• If yes, is the primary healthcare provider on-site or off-site? On-site ______ Off-site ______

Question #5: Does your organization have any case managers at your site? Yes ___ No ___

• If yes, how many full-time equivalents? ______

• 

Question #6: Do you have any community health workers at your site? Yes ___ No ___

• If yes, how many full-time equivalents? ______

• 

Question #7: Is your clinical staff able to help patients successfully use the medical healthcare system?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #8: If you want to see the health records of your patients (e.g., x-rays, lab reports, biopsy results, etc.), how often are you able to obtain them from the primary healthcare system?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #9: Do your patients have access to medical specialists (e.g., orthopedics, women’s health, dermatology, pediatrics, and other medical and surgical specialists)?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #10: Do your patients have access to women’s healthcare?

Select one:

Always
Very Often
Sometimes
Rarely
Never

If Yes:

Do your patients have access to Obstetric Care?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Do your patients have access to Preconception Counseling?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Do your patients have access to Contraception?
Select one:

Always
Very Often
Sometimes
Rarely
Never

Do your patients have access to Pregnancy Terminations?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Do your patients have access to Pediatric Care?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #11: Do you or a partner agency have a specialized program for gender-based violence? Yes ___ No ___

Question #12: Do you or a partner agency have a specialized program for to traumatic brain injury (TBI)? Yes ___ No ___

Evaluation: Yes ___ No ___

Treatment: Yes ___ No ___

Question #13: Do your patients have access to dental care?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #14: Do you use the Bio-Psycho-Social (BPS) approach in your clinical diagnosis and treatment?

Select one:

Always
Very Often
Sometimes
Rarely
Never

If Yes:

In using the BPS approach, do you ask about the Trauma Story?

Select one:

Always
Very Often
Sometimes
Rarely
Never

In using the BPS approach, do you elicit the medical problems of the patient?

Select one:

Always
Very Often
Sometimes
Rarely
Never

In using the BPS approach, do you elicit the psychological/psychiatric problems of the patient?

Select one:

Always
Very Often
Sometimes
Rarely
Never

In using the BPS approach, do you elicit the social needs of the patient?

Select one:

Always
Very Often
Sometimes
Rarely
Never

In using the BPS approach, do you elicit the spiritual needs of the patient?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #15: Do you have survivors of torture on your staff who provide therapy and social services? Yes ___ No ___

• If yes, how many? ______

Question #16: Rate the frequency of each of these therapy approaches in your organization.

Case Management

Select one:

Always
Very Often
Sometimes
Rarely
Never

Supportive Psychotherapy

Select one:

Always
Very Often
Sometimes
Rarely
Never

Narrative Therapy

Select one:

Always
Very Often
Sometimes
Rarely
Never

Meditation/Mindfulness

Select one:

Always
Very Often
Sometimes
Rarely
Never

Cognitive Behavioral Therapy

Select one:

Always
Very Often
Sometimes
Rarely
Never

Eye Movement Desensitization and Reprocessing (EMDR)

Select one:

Always
Very Often
Sometimes
Rarely
Never

Art Therapy

Select one:

Always
Very Often
Sometimes
Rarely
Never

Music Therapy

Select one:

Always
Very Often
Sometimes
Rarely
Never

Massage/Physical Therapy:

Select one:

Always
Very Often
Sometimes
Rarely
Never

Play Therapy:

Select one:

Always
Very Often
Sometimes
Rarely
Never

Other Therapy (Describe): ___________________________

Question #17: Do you request that your patients evaluate your medical care services?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #18: In communicating with your patients, how frequently do you use the following approaches?

Telephone interpreter

Select one:

Always
Very Often
Sometimes
Rarely
Never

Trained on-staff interpreter

Select one:

Always
Very Often
Sometimes
Rarely
Never

Family/Community member

Select one:

Always
Very Often
Sometimes
Rarely
Never

Other staff (e.g., receptionist)

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #19: Do you have a training program for your medical interpreters? Yes ___ No ___

Question #20: Do you offer supervision for your medical interpreters? Yes ___ No ___

Question #21: Is your clinical staff familiar with using the Refugee Health Screen-15 (RHS-15) in screening patients? Yes ___ No ___

• If yes, how often do they use the RHS-15?

Select one:

Always
Very Often
Sometimes
Rarely
Never

Question #22: Do you have an organized selfcare program for your staff/trainees? Yes ___ No ___

Question #23: Do you have a designated person on your staff responsible for the staff’s self-care? Yes ___ No ___

Question #24: How often does your clinical staff meet with their designated supervisor(s)?

Select one:

Weekly
Twice monthly
Monthly
Semi-annually
Annually

Question #25: How often does management staff meet with their designated supervisor(s)?

Select one:

Weekly
Twice monthly
Monthly
Semi-annually
Annually

Question #26: How often do your staff train affiliated medical providers?

Select one:

Weekly
Monthly
Semi-annually
Annually
Never

Question #27: How often do your staff train refugee and community service providers in your local community?

Select one:

Weekly
Monthly
Semi-annually
Annually
Never

Question #28: Do you have any on-site healthcare professional training programs?

Yes ___ No ___

If Yes:

Medical Interns and Residents? Yes ___ No ___

If yes, how many trainees per year? ______

Clinical Psychologists? Yes ___ No ___

If yes, how many trainees per year? ______

Social Workers? Yes ___ No ___

If yes, how many trainees per year? ______

Nurses/NPs? Yes ___ No ___

If yes, how many trainees per year? ______

Mental health counselors? Yes ___ No ___

If yes, how many trainees per year? ______

Medical Technicians? Yes ___ No ___

If yes, how many trainees per year? ______

Open-Ended Questions

Please write in your comments:

Question #29: How do you care for the medical and psychiatric needs of people in detention, Including families and children?

Question #30: What are your biggest challenges to providing medical care to your patients who are torture survivors and/or asylum seekers?

Question #31: How do you recommend that SOT programs improve their medical care of torture survivors?

Question #32: What recommendations do you have for SOT programs to provide self-care to staff to avoid burnout?

Question #33: What training or technical assistance do you recommend to enhance the medical care of torture survivors?

The questionnaire is anonymous but for administrative purposes we ask that you include your name and organization. You can also choose not to include this information.

Personal Information

Name: ________________________

Name of Organization: ________________________

Location (City/State): ________________________

Thank You Page: Thank You!

Thank you for completing the survey. We will send you a follow up email to confirm that we have received your response.

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