University of Vermont

University Communications

Connecting Cultures: Mental Health Program Helps Refugees in Vermont

Release Date: 11-20-2008

Author: Lee Ann Cox
Phone: 802/656-1107 Fax: (802) 656-3203

"We heard people start to shoot — BANG! BANG! BANG! — around us they were shooting," a Rwandan refugee told Ned Castle for In Their Own Words, his collection of images and personal histories of Vermont refugees. "So we started to run… At that time when you heard people shooting, the best thing was to run, and think about stuff later… I saw a guy I knew. I asked him, "Did you see my mom." He said, '… I think your mom is dead.'

"…we started to cry — (my brother) and me. We cried — ran and cried. We spent three days walking… walked like 100 miles… We needed to stop to sleep — we hadn't slept those three days. When we got there — the day after — Mom came with our sister and the baby. They said they reached the bridge when the shooting started. My mom held my sister and they jumped in the river."

When refugees arrive on American soil — in steadily increasing numbers, now nearly 5,000 in Vermont — resettlement efforts are centered on basic necessities, finding a home and hopefully a job, functioning in an utterly foreign culture. Talk to them and they tell you they are grateful. They know that they are the lucky ones. And yet. A fresh start and a welcoming community cannot shut off an inner slideshow of suffering, violence, loss and fear. The young man's story above is both singular and part of the commonality among refugees. They all fled from something.

According to Karen Fondacaro, director of UVM's Behavior Therapy and Psychotherapy Center, 50 to 80 percent of refugees are estimated to have significant mental health issues, primarily post-traumatic stress disorder, and symptoms related to anxiety and depression. So in July 2007 she stepped into the void, with a team of passionate graduate students, launching Connecting Cultures, a groundbreaking clinical science program with three components: community outreach, direct mental health services, and research that will allow them to formally assess their approach and offer a map for other refugee resettlement communities. To Fondacaro, the psychological and physical, spiritual and cultural are inseparable, fundamental aspects of survival.

"When you look at the poverty and hunger refugees are facing, if someone is also in the midst of full-blown PTSD," she says, "it's a big issue. I've treated trauma for over 20 years now but some of the stories we're hearing now are so horrific it's taught us more about how you treat this problem."

Flipping the script
Connecting Cultures, at its heart, is based on sensitivity — to the different cultures and beliefs among clients, to their perceptions of power, to their emotional and physical comfort. Fondacaro and her students began outreach efforts by merely hanging out for a couple of hours at a time at the Association of Africans Living in Vermont, becoming friendly, safe, familiar faces. Then they held two community breakfasts, one for men and one for women, with talks on parenting skills that were translated into three languages. The format works, and they plan to repeat it focusing on other issues such as alcohol and substance abuse.

In the clinic (which has recently been remodeled for the program courtesy of the local junior league), the team provides one-on-one counseling with the use of an interpreter. They've also been trained to conduct the psychological evaluations that are critical for asylum seekers, who lack the security of refugee status.

Central to the therapeutic techniques used, Fondacaro explains, is giving the person control over their story, letting them decide how and when to talk about the pieces. "They say," for instance, "'Well, I can talk about when I was being hung by my hands, but I can't talk about seeing my parent get killed just yet.' So they get to pick which pieces they want to talk about first. They are already having nightmares about it, they are already inundated, but they get some control."

Patrick Giantonio, executive director of Vermont Refugee Assistance, calls Connecting Cultures an extraordinary resource, particularly for those applying for asylum. "You can't evade those worst moments of torture; as you go deeper and deeper into the darkest moments of someone's life," he says, "oftentimes they come apart. But this is the moment when they most need to keep it together. It's incredibly useful to have them receiving treatment while having to recount these difficult times."

Giantonio, who speaks three languages common to African refugees, has often served as an interpreter in the private therapy sessions, a process he says has been profound for him to witness. "It's tough. It is so courageous for them to enter the process of healing," he says. "And it's courageous for the (graduate) students also because hearing the stories is not easy. This is an incredible group of people."

All of the work is done through a mishmash of funding — small grants, donations, fees from clients receiving other services at the Center, though they pride themselves on serving the underserved, so there's no self-sustaining revenue stream. Much of Fondacaro's work, then, is inevitably seeking financial support. "It's a constant struggle," she says, especially as their work becomes more known.

But it's a calling for Fondacaro, as well as her students who make the program succeed in part, she says, because they devote far more hours than required. "I just fell passionately in love with it," says Fondacaro. "Who wouldn't want to do this work? I'm so lucky."

Their mission, they know, is not to erase the stories. For someone who has endured severe trauma, the goal can only be to turn the story around. "Hopefully," Fondacaro says, "they can create a different meaning from it and who they are now. You incorporate it into your life, know that you've existed with it, but not live it every day."

How to help
If you would like to help support the program, checks can be made payable and mailed to Behavior Therapy and Psychotherapy Center, Department of Psychology, University of Vermont, 2 Colchester Ave., Burlington, VT 05401.

Special thanks to Ned Castle and the Vermont Folklife Center, where In Their Own Words can be viewed.