RHS-15 handouts

This set of handouts, and the description that follows, was generously shared by Jennifer Shuart of Lowell Community Health Center's Metta Center in July 2016. Ms. Shuart is available to consult if you have further questions; contact healtorture@cvt.org for an introduction.

We began administering the RHS-15 screening in July 2015 at Metta.  What we observed prior to this is that clients were referred after a negative screening for behavioral health, but when they came in for the intake appointment really had no understanding of counseling or desire to engage in treatment.

We try to complete the screening first and then discuss the concept of engaging in treatment.  It goes without saying that screenings can take a direction of their own for various reasons.  What we have found is that it is best to meet with the individual after being seen by the medical provider as frequently there are things said in the medical appointment that are confusing (e.g. I had a 15yo tell me he was concerned because the doctor told him he didn’t have enough blood in his body.  The issue was that he was anemic, but that time with the individual in being able to remedy concerns is so crucial). 

In general, when we introduce ourselves we say that we work with the doctors and nurses at the health center and that we are able to meet with all the newly arriving people aged 14+ to complete some of the paperwork and ask them a few questions.  After the screening, we try to normalize the fact that coming to the US is an overwhelming process and that things are so different with many stresses.  The choice to use the term stress and not trauma is quite intentional.  As we discuss stress we provide a list of some of the things that can cause stress (see the handout) and then for some people how stress can present (see handout).  However, we also are very clear that even though sometimes stress can present as physical issues that they should still be examined by their doctor.  For parents, we also try to provide support and information about how stress can present in children and for teenage children who may be taking care of parents the understanding of how stress can present in adults.

The introduction of behavioral health is explained as a support because coming to the US can be very challenging and sometimes people don’t have the friends/family members/pastors/elders etc. that they would before to talk to.  We explain that services are voluntary and available as a “consult” (at a medical appointment and just need someone to talk to in that moment) and on an ongoing basis.  We are also careful to explain confidentiality clearly. 

Lastly as part of the process of learning about the area, we try to give information about the free activities that are happening in the community.  As these are always changing and there are so many different languages that we provide services to, it is not feasible to provide this information in the individuals language. 

Some things that we have learned along the way are that the concept of the jars may not be quite as helpful to some of the individuals and that the Wong-Baker Faces scale is easier to understand.  Also, and in particular for the Middle Eastern refugees, with regard to the trauma questions, they describe a feeling of being “choked” as part of the physical feelings that they are experiencing. 

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