"Access to medical treatment is a vital, basic need: survivors are injured mentally and often physically. They need the right mental and physical healthcare services so they can recover. Without medical treatment, injuries, illnesses, depression and anxiety can get much worse."
"Access to medical treatment is a vital, basic need: survivors are injured mentally and often physically. They need the right mental and physical healthcare services so they can recover. Without medical treatment, injuries, illnesses, depression and anxiety can get much worse."
|
|
|
MSCOS study descriptor: This outcome is about ensuring that survivors have access to adequate services to meet their health needs. This includes having access to dental treatment. It requires, for example, having sufficient funds for transport to attend appointments and funding for therapy if this is not freely available. It also includes being registered with a GP and it could include access to culturally appropriate support. There is a desperate need for therapists to specialise in evidence-based trauma therapy to help survivors. Specific group therapies should exist for survivors to complement individual therapy.
Relevant Practice Models and Frameworks
for access to medical treatment (physical and mental healthcare)
for access to medical treatment (physical and mental healthcare)
GP Clinics and Surgeries
Safe Surgeries Toolkit by Doctors of the World
This toolkit is a resource for general practices who want to provide a welcoming environment for everyone in their community and an equitable service for all of their patients. It has been developed by Doctors of the World (DoTW) UK with the aim of addressing the particular barriers to primary care faced by migrants in vulnerable circumstances, including refugees and survivors of trafficking. x
Safe Surgeries Toolkit by Doctors of the World This toolkit is a resource for general practices who want to provide a welcoming environment for everyone in their community and an equitable service for all of their patients. It has been developed by Doctors of the World (DoTW) UK with the aim of addressing the particular barriers to primary care faced by migrants in vulnerable circumstances, including refugees and survivors of trafficking. Everyone living in the UK is entitled to register and consult with a GP. It means we can prevent and treat illness early and create a healthier society for everyone. At our London clinics, DoTW UK helps almost 2,000 people every year who have been unable to access NHS services. On average, our patients have been in the UK almost 6 years, without ever having seen a GP. Most of these are migrants in vulnerable circumstances, who are often prevented from registering with a GP by administrative, language or other barriers. They include pregnant women, survivors of trafficking and people who have fled war, unable to get the healthcare they need. Until recently, the Home Office was using information held in primary care records to track down migrants. This made many of our patients too frightened to register with a GP. While this policy has changed, data-sharing can still take place if patients access secondary care and there are no legal safeguards against non-clinical information being shared with the Home Office for immigration enforcement. DoTW UK has developed a range of practical materials developed to support general practices become Safe Surgeries. These seven concrete steps to improve equity of access to their services are:
|
Training for clinicians in health care settings Safeguarding Victims of Human Trafficking & Exploitation by VITA Training
Victims of human trafficking and exploitation are presenting in healthcare settings and are not receiving the safeguarding and care they need. The solution is not just about raising awareness. VITA training aims to improve identification, support and care for victims by equipping healthcare professionals with transferable trauma-informed consultation skills along with practical, user-friendly, evidence-based guidance. x
Safeguarding Victims of Human Trafficking & Exploitation by VITA Training Victims of human trafficking and exploitation are presenting in healthcare settings and are not receiving the safeguarding and care they need. The solution is not just about raising awareness. VITA training aims to improve identification, support and care for victims by equipping healthcare professionals with transferable trauma-informed consultation skills along with practical, user-friendly, evidence-based guidance. More than 2,000 NHS healthcare professionals have received VITA Training, which is now being commissioned and rolled out to thousands of NHS doctors across London and the South East. Bespoke tailored training is available for NHS Foundation Trusts, General Practices, healthcare professional trainee programmes and other health services and teams. Their educational resources can be found here. "VITA training is evidence-based and prepares candidates for real-life encounters with victims (often by using simulated consultations). Not only will this training improve performance in appropriately managing the complex human trafficking cases that present to our services, it significantly improves communication skills overall and forces providers to reflect on how they are interacting with all of their patients." Registrar, Emergency Medicine |
Integrated Healthcare Systems
The RESPOND service is an integrated health care system with a specialist refugee health multi-disciplinary team, providing healthcare services for asylum-seekers and refugees, including those who are victims of human trafficking.
RESPOND is hosted by University College London Hospitals and works in partnership with stakeholders across health, social care and the third sector. It allows prompt access to advice from a panel of experts in migrant health and well-being, helping to streamline referral pathways and ensure each service user gets an Integrated Healthcare Plan which is tailored to their unique set of needs.
RESPOND is hosted by University College London Hospitals and works in partnership with stakeholders across health, social care and the third sector. It allows prompt access to advice from a panel of experts in migrant health and well-being, helping to streamline referral pathways and ensure each service user gets an Integrated Healthcare Plan which is tailored to their unique set of needs.
x
The RESPOND service is an integrated health care system with a specialist refugee health multi-disciplinary team, providing healthcare services for asylum-seekers and refugees, including those who are victims of human trafficking.
RESPOND is hosted by University College London Hospitals and works in partnership with stakeholders across health, social care and the third sector. It allows prompt access to advice from a panel of experts in migrant health and well-being, helping to streamline referral pathways and ensure each service user gets an Integrated Healthcare Plan which is tailored to their unique set of needs.
“Many asylum seekers and refugees are unaware of their rights to healthcare in the UK and have not been able to register with a GP. Language barriers, digital poverty and short notice accommodation moves further compound lack of access. We find that victims of trafficking may have been warned against accessing services by their traffickers, and their fear can prevent them from receiving the confidential medical care to which they are rightly entitled.
RESPOND aims to be as inclusive as possible with proactive identification of people eligible for our outreach services through community liaison, and routine use of extended appointments with interpreters. All RESPOND staff – from the clinic administrator who books and reminds service users about appointments, to the consultant clinical leads overseeing development and analysis of the service – are trained in trauma informed practice and know to prioritise compassion and respect in all communication. Staff are also supported to work in a trauma-informed way through regular supervision, reflective practice and peer review.
By adopting a RESPOND model of healthcare service delivery more widely, access to healthcare services can be equitable for all asylum seekers and refugees, no matter where they are placed geographically. There is emerging evidence from RESPOND’s work to demonstrate that our proactive outreach approach can prevent crisis and/or inappropriate presentations to emergency departments and save time in an already over-stretched primary care.
The RESPOND Outreach Health Assessment and Care Planning Pilot closed on the 31st March 2023, but other services within the RESPOND service will continue. The team is working closely with commissioners across London to secure sustainable funding for this aspect of the RESPOND offer (outreach health assessment and care planning) in the longer term, in addition to the development of a sustainable, scalable service model.”
Dr Allison Ward is the Clinical Co-lead Consultant Paediatrician at the Royal Free London NHS Foundation Trust and named Dr for Safeguarding and Looked After Children, CNWL (Camden) NHS Foundation Trust.
For further information: https://www.uclh.nhs.uk/our-services/find-service/tropical-and-infectious-diseases/respond-integrated-refugee-health-service
RESPOND is hosted by University College London Hospitals and works in partnership with stakeholders across health, social care and the third sector. It allows prompt access to advice from a panel of experts in migrant health and well-being, helping to streamline referral pathways and ensure each service user gets an Integrated Healthcare Plan which is tailored to their unique set of needs.
- The RESPOND screening tool contains prompts to ensure all patients are routinely asked about their safety. RESPOND staff are trained appropriately in adult and child safeguarding, and are aware of ensuring potential victims of trafficking are given the time, space and privacy they may need to ask for help. Service users have commented on how the RESPOND team has been the ‘first person to ask them about their well-being’. In cases where liaison with the NRM is indicated staff work with the correct professionals to support the process.
- An Integrated Healthcare Plan (IHP) is provided to all patients in both paper form and via an NHS app. It summarises the key identified areas of physical, emotional and social health needs, including infectious diseases screening and treatment,, and it highlights how these needs should be met by local health, social and 3rdsector services. The Integrated Healthcare Plan can travel with patients, so they can present it to new health professionals when they are moved to different geographical locations (as often happens due to government policy on housing of asylum seekers remains in state of flux). The IHP can also be transferred digitally via primary care records systems. This avoids patients having to repeat their health histories and go back to a square 1 situation with each placement move.
“Many asylum seekers and refugees are unaware of their rights to healthcare in the UK and have not been able to register with a GP. Language barriers, digital poverty and short notice accommodation moves further compound lack of access. We find that victims of trafficking may have been warned against accessing services by their traffickers, and their fear can prevent them from receiving the confidential medical care to which they are rightly entitled.
RESPOND aims to be as inclusive as possible with proactive identification of people eligible for our outreach services through community liaison, and routine use of extended appointments with interpreters. All RESPOND staff – from the clinic administrator who books and reminds service users about appointments, to the consultant clinical leads overseeing development and analysis of the service – are trained in trauma informed practice and know to prioritise compassion and respect in all communication. Staff are also supported to work in a trauma-informed way through regular supervision, reflective practice and peer review.
By adopting a RESPOND model of healthcare service delivery more widely, access to healthcare services can be equitable for all asylum seekers and refugees, no matter where they are placed geographically. There is emerging evidence from RESPOND’s work to demonstrate that our proactive outreach approach can prevent crisis and/or inappropriate presentations to emergency departments and save time in an already over-stretched primary care.
The RESPOND Outreach Health Assessment and Care Planning Pilot closed on the 31st March 2023, but other services within the RESPOND service will continue. The team is working closely with commissioners across London to secure sustainable funding for this aspect of the RESPOND offer (outreach health assessment and care planning) in the longer term, in addition to the development of a sustainable, scalable service model.”
Dr Allison Ward is the Clinical Co-lead Consultant Paediatrician at the Royal Free London NHS Foundation Trust and named Dr for Safeguarding and Looked After Children, CNWL (Camden) NHS Foundation Trust.
For further information: https://www.uclh.nhs.uk/our-services/find-service/tropical-and-infectious-diseases/respond-integrated-refugee-health-service
Helpful Resources
NRM Handbook
x
- Section 12.11, Early and ongoing access to healthcare services, pg. 101
- Common health problems in survivors of trafficking
- Initial check for urgent healthcare needs
- Section 14.9, Early and ongoing access to healthcare services
- Supporting survivors to access healthcare services
- Section 16.14, Therapeutic care in the context of criminal justice proceedings, pg. 207
- Therapeutic care for adults who are involved in criminal justice proceedings
- Therapeutic care for children who are in criminal justice proceedings
- Section 16.19, Medico-legal documentation pg. 223
- Section 17, The Healthcare Needs of Survivors of Human Trafficking, pg. 234
- Section 17.1, Introduction, pg. 235
Public Health Approach to Modern Slavery
New research examines the case for a public health approach to modern slavery and identifies the key components that are considered important in enabling the anti-slavery sector to address modern slavery through a public health lens.
The research, which includes a report, an interactive framework and a guide for anti-slavery partnerships, has been developed by the University of Sheffield, the Independent Anti-Slavery Commissioner and Public Health England.
The research, which includes a report, an interactive framework and a guide for anti-slavery partnerships, has been developed by the University of Sheffield, the Independent Anti-Slavery Commissioner and Public Health England.
x
New research examines the case for a public health approach to modern slavery and identifies the key components that are considered important in enabling the anti-slavery sector to address modern slavery through a public health lens.
The research, which includes a report, an interactive framework and a guide for anti-slavery partnerships, has been developed by the University of Sheffield, the Independent Anti-Slavery Commissioner and Public Health England.
Public health approaches have been applied to a range of socially complex and long-standing problems, for example, serious violence. A public health approach is a way of thinking and acting collectively to address a problem that can damage health and wellbeing including: understanding a problem at a population level; framing the problem as part of a complex and interdependent system; collating data and evidence of what works; being prevention focused; protecting health and well-being; encouraging multi-agency working and addressing inequalities, social justice and human rights.
A public health approach to modern slavery offers an opportunity for coordination of effort across the anti-slavery sector. It has emerged as a promising framework for prevention, for planning at a national and local level and as a means of bringing together existing frameworks with a humane focus. This research, funded by Research England, sought to build on initial research and emerging practice in order to further refine a public health framework to address modern slavery in the UK.
To inform the research, a series of online workshops were held with stakeholders from across the anti-slavery sector and beyond. Learning from these workshops helped to devise and design a refined public health framework to address modern slavery with multiple components including national factors, regional and local factors, service design factors and service delivery factors.
The research has the following outputs:
The research, which includes a report, an interactive framework and a guide for anti-slavery partnerships, has been developed by the University of Sheffield, the Independent Anti-Slavery Commissioner and Public Health England.
Public health approaches have been applied to a range of socially complex and long-standing problems, for example, serious violence. A public health approach is a way of thinking and acting collectively to address a problem that can damage health and wellbeing including: understanding a problem at a population level; framing the problem as part of a complex and interdependent system; collating data and evidence of what works; being prevention focused; protecting health and well-being; encouraging multi-agency working and addressing inequalities, social justice and human rights.
A public health approach to modern slavery offers an opportunity for coordination of effort across the anti-slavery sector. It has emerged as a promising framework for prevention, for planning at a national and local level and as a means of bringing together existing frameworks with a humane focus. This research, funded by Research England, sought to build on initial research and emerging practice in order to further refine a public health framework to address modern slavery in the UK.
To inform the research, a series of online workshops were held with stakeholders from across the anti-slavery sector and beyond. Learning from these workshops helped to devise and design a refined public health framework to address modern slavery with multiple components including national factors, regional and local factors, service design factors and service delivery factors.
The research has the following outputs:
- The full report of findings;
- The development of a refined interactive framework for a public health approach to modern slavery;
- A guide for policy, strategy and local partnerships to support them in adopting a public health approach to modern slavery.
Health Equity in England: The Marmot Review 10 Years On
This report has been produced by the Institute of Health Equity and commissioned by the Health Foundation to mark 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review). The report highlights that:
x
Health Equity in England: The Marmot Review 10 Years On
This report has been produced by the Institute of Health Equity and commissioned by the Health Foundation to mark 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review). The report highlights that:
"Survivor health and wellbeing is strongly related to the whole context of the survivor’s life before, during and after exploitation. The ‘Social Determinants of Health’ (SDH) research clearly demonstrates that unfair distribution of power, money and resources creates avoidable health inequalities, known as ‘health inequities’. People who are less advantaged in terms of socio-economic position (more negative SDH) have worse health, and shorter lives, than those who have more advantage. Professor Sir Michael Marmot’s book ‘The Health Gap – the challenge of health in an unequal world’ published 2016 by Bloomsbury Paperbacks provides very readable, tangible grounding in SDH. SDH research and approaches to health in the context of people’s lives can help us understand that to improve the health of survivors of modern slavery/human trafficking, all the social and resource factors matter, not just access to health professionals. Every one of the Modern Slavery Core Outcomes is a building brick towards health justice and recovery support." Dr. Laura Wood, BM MA MRCPHCH, Research Director and Child & Family Modern Slavery Lead of the VITA Network |
Access to Healthcare for Refugees
Trauma in The Hostile Environment
Migrants Organise, Episode 6: Trauma (Losing Myself: Mental Health in a Hostile Environment)
This episode is hosted by Migrants Organise, where they speak to Dr Angeliki Argyriou, Senior Clinical Psychologist at the Helen Bamber Foundation and Kasun.
They talked about the intricate and complex web that makes up NHS mental health care, and how easy it is for migrants - particularly vulnerable people fleeing trauma and cruelty - to fall through the cracks as they are moved around the country, face language barriers or encounter services that struggle to build a sense of trust and safety.
They chatted about different ways of understanding mental health around the world, and the ways practitioners could adapt their services to better meet the needs of refugees and migrants.
The Modern Slavery and Cognitive Disability Working Group brings together expertise on supporting survivors of modern slavery with cognitive disabilities. The group is currently developing a valuable toolkit to support the work of frontline practitioners with the aim of improving service provision for survivors with cognitive disabilities. The resource produced by the Working Group will be developed for professionals and include simple, accessible guidelines, with more in-depth working guides for practitioners working closely with clients with cognitive impairments who have experienced modern slavery.
You can access a summary by the Human Trafficking Foundation of the concerns, experiences and recommendations highlighted during their recent online forum here.
You can access a summary by the Human Trafficking Foundation of the concerns, experiences and recommendations highlighted during their recent online forum here.
Identification of victims of trafficking in healthcare settings When victims of trafficking cross paths with a medical practitioner this is a key opportunity: if they are able to spot the signs of trafficking, take safeguarding steps and build trust, they can support survivors to access services to ensure protection from further exploitation.
Trafficked people may live for years under the control of their traffickers, and the impact on their physical and mental health can be profound and enduring. They may not be able to talk about what's happened to them straight away x
When victims of trafficking cross paths with a medical practitioner this is a key opportunity: if they are able to spot the signs of trafficking, take safeguarding steps and build trust, they can support survivors to access services to ensure protection from further exploitation. Trafficked people may live for years under the control of their traffickers, and the impact on their physical and mental health can be profound and enduring. They may not be able to talk about what's happened to them straight away. Rachel Witkin, Dr Jane Hunt and Prof. Cornelius Katona's article on Identifying Human Trafficking in Adults in the BMJ outlines key indicators of trafficking and how clinicians can support survivors in a trauma-informed way Thank you to Minh Dang, Executive Director of Survivors Alliance, for her contributions to this article. What you need to know:
|
Mental Health as the Cornerstone of Effective Medical-Legal Partnerships Mental health-medical-legal partnerships are proposed as effective models for working with asylum-seekers, with potential benefits to mental health, physical health, and legal outcomes.
x
Pineda, L., & Punsky, B. (2022, July 21). Mental Health as the Cornerstone of Effective Medical-Legal Partnerships for Asylum-Seekers: The Terra Firma Model. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0001343 Objective: Challenges and traumas faced by asylum-seekers before, during, and after migration are com- pounded by the stressors of the asylum-seeking process, potentially compromising mental health. Poor mental health outcomes, in turn, complicate asylum-seekers’ capacity to navigate the asylum-seeking legal process (e.g., hindering an individual’s ability to provide an organized statement of their premigration experiences). Medical-legal partnerships are models of care that address legal problems as social determinants of health. However, when implementing medical-legal partnerships for asylum-seekers, standard definitions focusing on physical health do not appropriately capture the crucial role of mental health services. Since 2013, the Terra Firma Program has provided services for asylum-seekers in the South Bronx, New York, by integrating mental health, medical, and legal services along with enrichment activities, and concrete services. The present paper describes the benefits of this approach to working with asylum-seekers; highlights the importance of the mental health component, including mental health staff’s dual therapist-evaluator role as a trauma-informed and ethical vehicle to support clients’ asylum cases; and advocates for these partner- ships to be recognized as mental health-medical-legal partnerships. Method: Drawing from Terra Firma’s experience with over 800 asylum-seekers, the authors provide a framework for addressing asylum-seekers’ needs through mental health-medical-legal partnerships. Results: Terra Firma’s work with asylum-seeking children and families provides evidence in support of the establishment of mental health-medical-legal partnerships and highlights the importance of the MH component in addressing asylum-seekers’ legal needs. Conclusions: Mental health-medical-legal partnerships are proposed as effective models for working with asylum-seekers, with potential benefits to mental health, physical health, and legal outcomes. |