Traumatised refugees at the labour market

Overall conclusions of the study

Limited knowledge base

The overall knowledge base about employment-directed initiatives for refugees who are psychologically vulnerable, have trauma symptoms or who are traumatised is limited. There are few studies of specific interventions for the target group and the robustness of the studies in terms of measuring effects is low.

Evolving field of knowledge

Despite the limited knowledge base in the literature, this study also reveals a field in development. Several practices have been identified and score highly as “best practices” and therefore have a high probability for positive employment outcomes for the target group.

Work first initiatives

Work First initiatives have very good employment results compared to the other initiatives. This may be because the target groups in some instances are better assessed and have less complex problems but it also speaks to the relevance of working more stringently methodical with the target group. One of the most important conceptions in Work First initiatives is a focused and reduced use of work placement.

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Arbeid fra dag én

Learning points

• The use of SE in the integration process produces documented results, which is a prerequisite for continued funding and political goodwill.
• The implementation of SE in the introductory programme for refugees is a change that can be felt across the entire organisation. It demands a shift in mindset among all actors in public administration who are affected by the fact that refugees need to be included in companies at an earlier stage.
• It varies when an individual is ready to start a SE process. For example, a refugee needs a certain linguistic competence and there may, for instance, be health-related issues that need to be dealt with first.
• The collaboration with companies requires the same amount of resources as the collaboration with the participant.

Facts

Actors: Refugee Office in Bærum Municipality and NAV (Labour and Welfare Administration)

Contact person: Camilla Bildsten, Bærum Municipality, Refugee Office, email: camilla.bildsten@baerum.kommune.no, telephone: +47 915 98 591

Purpose: Participants start regular work or education.

Target group for initiative: All refugees in the Introductory Program in Bærum Municipality who have a minimum of Norwegian language skills and are motivated (see assessment/approval requirements below)

Number of participants with trauma in the initiative: 18 participants, of which an unspecified number have psychological difficulties.

Duration of initiative: The initiative is not time limited but limited by the duration of the introductory program. The introductory program can last up to two years but may be extended by another year if this will, for example, strengthen the individual’s potential to enter into work or ordinary education.

Arba Inkludering

Learning points

• A close and committed cooperation between employment actors, company and participant can function as a recruitment channel for the company and secure jobs for participants with reduced functional capacity.
• The counsellor must focus at least as much on the company as the individual participant. In practice, the counsellor must function both as a partner for the company and take care of the greater part of introducing the company to potential new employees in the introductory process.
• As the counsellor is closely connected with the company in the form of scheduled meetings, own office at the company and participation in staff meetings, the counsellor has better conditions for maintaining flexible contact with both participants and partners in the company.
• When the process is aimed at employment in the company it becomes easier to make skills training and workplace accommodations more specific and relevant. This boosts the participant’s motivation to acquire the necessary knowledge to be able to handle the job.

Facts

Actors: Arba Inkludering, Ikea Slependen

Contact person: Lise Markant Kølbel, work-preparatory training, Arba Inkludering AS, telephone: +47 953 65 527, email: lko@arba.no, www.arba.no | www.arbaformidling.no

Purpose: Permanent employment for participants that need support to obtain and maintain a job.

Target group for initiative: Unemployed participants with reduced functional capacity, including 30 refugees and immigrants who are motivated to work in Ikea. Reasonable Norwegian skills and satisfactory physical health is required.

Number of participants with trauma in the initiative: The initiative has included 20 refugees/immigrants with psychological challenges, including trauma.

Duration of initiative:

Business Training

Learning points

• If the municipality has not performed systematic documentation of the target group, their skills and challenges, the project must carry this out if it is to achieve results. This is especially relevant because many from the target group are traumatised or have complex challenges.
• parallel focus on social, psychological and health challenges contributes to a holistic assessment, which forms a good basis for organising tailored support with the involvement of relevant professionals.
• Tripartite conversations between the company, participant and the project contact person are useful, among other reasons because the participant ascribes greater authority to the company’s opinion concerning the possibility of getting a job.

Facts

Actors: Integrationsnet (part of the Danish Refugee Council) own and run the project.

Contact person: Maja Gammelgaard, Business Training, Integrationsnet, email: maja.gammelgaard@drc.ngo, telephone: +45 60202370

Purpose: To include socially marginalised refugees and traumatised refugees and reunited family members in the labour market of Southern Denmark.

Target group for initiative: The target group is refugees and reunited family members who received asylum in 2014 at the earliest and who do not benefit from the standard employment initiatives and who, for example, have physical, psychological or social challenges but not severe trauma or substance abuse.

Number of participants with trauma in the initiative: 86 persons are or have been participating in the project. The project will accept 144 participants in total over a three-year period. The vast majority have trauma, and many have received or are receiving treatment for this.

Duration of initiative: The project period lasts from 01/10/2016 to 01/10/2019. An individual process in the project lasts 26 weeks with the possibility to extend up to 52 weeks.

Framsteget

Learning points

• Resource focus as well as time spent on thorough mapping of resources can boost participants’ self-confidence and belief in a future in the labour market.
• Assessment forms can act as a point of departure for relevant dialogue around labour market-oriented skills.
• For participants without labour market experience and with few language skills the assessment is best achieved by way of observation during activities.
• Successful company matches requires participants who have been thoroughly assessed and who have gained an insight into their own resources and limitations.

Facts

Actors: Inda.nu

Contact person: Anna Bylin, email: anna.bylin@inda.nu, telephone: +46 70 7884440, www.inda.nu

Purpose: Participants start regular work or education.

Target group for initiative: People with non-Swedish ethnic background with reduced functional capacity or PTSD, or suspected reduced functional capacity/PTSD.

Number of participants with trauma in the initiative: 14 (out of 25).

Duration of initiative: 1 year – 2016.

Hela Familjen 2.0

Learning points

• A holistic view and specific assessment tools can help to find the causes of long-term unemployment. Including the specific FIA tool (Förutsättningar Inför Arbete).
• Time taken to work on relationships and trust can overcome resistance in families with many less than positive experiences with the system.
• By applying a few principles, it is possible, via interviews with participants, to actively work on equality so that women and men in refugee families are given uniform demands, considerations and offers.
• Interdisciplinary coordination and cooperation on complex cases can lead to faster results and better conditions for the children in the future.
• Systematic documentation of steps on the way to the labour market creates an overview of the process.

Facts

Actors: Malmö Municipality, Social Services in all five areas.

Contact person: Magnus Sjöberg, Hela Familjen 2.0, email: magnus.sjoberg@malmo.se, telephone: +46 708 306 559

Purpose: To promote employment and prevent future labour-related problems and social exclusion.

Target group for initiative: Adults with children in Malmö who have received social benefits for at least 24 months. Approximately 70% of participants come from refugee producing countries. They have been unemployed for at least 4 years, as the first 24 months is only counted after the two-year Swedish integration period.

Number of participants with trauma in the initiative: It is estimated that approx. 30% of participating refugees have trauma-related problems. This equates to approximately 151 participants out of 719 adults in total in Hela Familjen 2.0.

Duration of initiative: The average enrolment period is 18 months but there is no time limit as long as the project continues.

VAMOS – Trail of Involvement of Immigrant Youth

Learning points

• Young people often arrive with acute problems that they need help in resolving. Often there are underlying social or integration challenges.
• The trust-building process combined with offers of accompaniment to other relevant actors provides safety for the young person and can help generate trust in these systems and thereby facilitate the route to work or education.
• The trust that is created between the coach and young person can form the basis for the young person to open up about any traumas.
• The use of documentation tools, particularly at the start, can be experienced as counterproductive in relation to the trust-building process.

Facts

Actors: Helsinki Deaconess Institute

Contact person:

Purpose: To support social inclusion and the route to employment, education or other meaningful activities.

Target group for initiative: 16-29-year-olds with an immigrant background who are not working or pursuing education. The target group encompasses newly arrived, second generation immigrants and unaccompanied young people.

Number of participants with trauma in the initiative: In total, 300 participants take part – or have taken part – in the project. It is not known how many of the migrants have a refugee background.

Duration of initiative: There is no time limit but the initiative usually lasts less than a half year. The project has been financed for the period 2016-2019.

AVANTI

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Learning points

• The interdisciplinary cooperation must be anchored at the management level of those actors who provide personnel for the project. This contributes positively to uniform messages from leaders to employees down through the lines in the organisations involved and allows each organisation to assume its share of the responsibility.
• Shared physical location supports the holistic perspective and the interdisciplinary cooperation and has decisive significance for the quality of the initiative.
• Close dialogue and follow-up are crucial for participants to understand the objective and meaning of the initiative and make them capable of taking ownership of their own process.
• Extra time and tailored language courses can eventually lead to the same results for refugees with trauma as in the regular language training system.
• The holistic perspective is challenged by the long waiting list for treatment by the Red Cross.

Facts

Actors: Malmö Stad (Malmö Municipality) project owner, coordinating authority. Komvux Södervärn – Swedish for Immigrants (Sfi). Six language teachers are involved in the project. Arbetsförmedlingen (Employment Service). Three job consultants are involved in the project Röda Korset (Red Cross) – Treatment Centre for Victims of War and Torture; Avanti has 40 places at the centre. Skåne Region, Refugee Health (Flyktinghälsan). Participates with a nurse and a doctor for guidance and information.

Contact person: Pia Werninge, email: pia.werninge@malmo.se, telephone: +46 709 442 605

Purpose: To enhance health, quality of life, language skills and knowledge of Swedish society and to support the target group in achieving economic self-reliance through work or education.

Target group for initiative: Participants from 18 years and older who are registered with the unemployment service, need Swedish language instruction and who – because of war-related trauma and/or migration-related stress – experience symptoms of, or have been diagnosed with, PTSD.

Number of participants with trauma in the initiative: 102

Duration of initiative: It is possible to be enrolled for 18 months with the option of extension if progress has been made.

IPS Integration

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Learning points

• Hiring of IPS consultants with the same linguistic and cultural background as the participants strengthens the possibility of engaging with participants on familiar ground. Furthermore it ensures that they feel seen and heard in their own language. At the same time, management must be prepared to work purposefully toward implementing diversity in the workplace.
• In some cases, it soon becomes clear that the obstacles in relation to the labour market are very small and easily handled, perhaps in cooperation with an employer. In some cases, problems are resolved when the participant begins work.
• Stringent and methodical programmes that focus on regular work can generate positive employment results for refugees with trauma.
• Work with IPS requires an ongoing leadership focus on method and a continuous follow-up on methodological fidelity.

Facts

Actors: Human Recovery, a consulting company specializing in the IPS method.

Contact person: Lars Olaf Nielsen, email: lars@humanrecovery.dk, telephone: +45 51 90 56 06

Purpose: To assist participants with mental health diagnoses and psychological vulnerability to find work or begin education and thereby become wholly or partially economic self-reliant and achieve a significantly better quality of life.

Target group for initiative: Refugees and immigrants receiving different types of social benefits (integrationsydelse, kontanthjælp eller ressourceforløbsydelse). The primary obstacle to finding work must be psychological.

Number of participants with trauma in the initiative: Approximately 80 participants have completed the process.

Duration of initiative: Varies. The average duration for participants who find work is approximately 45 weeks.

Work first

Work first initiatives emphasise the start of regular working hours as quickly as possible with parallel training, support, and, in some cases, treatment.

Efforts are made toward a reduced and more strategic use of work placement than in the regular employment initiatives in the Nordic countries.

Work first initiatives are based on the methods of Supported Employment and Individual Placement and Support, where there is a high degree of evidence of the employment effects for other target groups.

The initiatives are based on participants’ own motivation and goals.

The initiatives in the Work First category are distinguished by being based on methods where there is evidence of the employment effects for other target groups.

Work on systematic follow-up on methodological fidelity in Supported Employment and with manual-based employment efforts in Individual Placement and Support are new tendencies in a professional area that traditionally emphasise the caseworker’s professional atitude.

Right now there is an ongoing randomised controlled trials with Supported Employment for refugees (with and without trauma) in Bergen. (Link: https://clinicaltrials.gov/ct2/show/record/NCT03629366

Examples

Arbeid fra dag én

Arba Inkludering

IPS Integration

Vocational asessment

Vocational assessment initiatives explore the resources, challenges and motivation of participants and use the assessment as the starting point of an individually tailored process, with employment and health-oriented support.

These initiatives have a holistic approach and use both specific tools and work placement for the assessment.

Examples

Business Training

Framsteget

Holistic and interdisciplinary

Holistic and interdisciplinary initiatives work with coordinated and broad-spectrum support.

The initiatives in this category are often directed toward participants with complex challenges.

The methods largely deal with supporting participants through labour market-oriented, healthcare and social activities running parallel to one another.

The focus is structure and coordination and keeping the entire life situation of the individual in mind.

Examples

Hela Familjen 2.0

AVANTI

Empowerment

Initiatives based on an empowerment approach are based on a mindset where participants are seen to be, and supported as, decisive actors in their own lives.

Through methods such as coaching, participants are strengthened in defining their own goals and needs and in being active in relation to handling their own health and employment situation.

This category also appears as a sub-element in the other categories of initiatives.

Examples

VAMOS – Trail of Involvement of Immigrant Youth

Investment is necessary and pays off

It is necessary to invest in the initiative for traumatised refugees to achieve results. All the examples of practice in the study were based on additional investment.

Several of the practices have documented the value of the extra investment through calculations of the socio-economic gains. The available business case calculations show that it pays off to invest in vulnerable and/or traumatised refugees. The business case calculations can provide inspiration as to how to argue for first time investments in the initiatives and show what is required to argue for moving from the project phase to operative implementation of the initiative.

Link to Business Case on Individual Placement and Support for Refugees versus standard employment efforts: https://pure.sfi.dk/ws/files/2066547/IPS_til_flygtninge.pdf

The initiative must meet the individual needs of the participants

More resources are the prerequisite for being able to spend time on individually tailored processes and support.

The practice examples show how more resources create less waiting time and more flow in cases, allowing time to identify resources, skills and motivation of participants and to create better and lasting matches with workplaces.

For an example of how additional resources enhances flow in cases take a look at the initiative Hela Familjen 2.0

The work demands a fundamental belief in the potentials of the target group

Method is not everything. A key element in all the best practices described is that success is built on employees who have a fundamental belief in the possibility of traumatised refugees finding work.

It is important for being able to identify resources and skills of the individual, it is important for cooperating with companies on job matching, and it is important for supporting participants in the initiatives to identify their own resources in their life in exile, which can be complex and difficult.

Several of the practice examples point out that standard services experience challenges when assessing resources and obstacles among the target group. Several of those interviewed in the study encounter refugees who were assessed to have significantly more, fewer or entirely different challenges than they in fact have.

For an example of how to work with identifying and enhancing work related resources take a look at the initiative Business Training

There is a need for long-term efforts and subsequent support

To be able to provide relevant support and lasting employment for a vulnerable target group the initiatives needs to be prolonged and continuous - and last also after employment has been achieved. The long-term support also concerns the follow up and collaboration with work places.

For examples of how to organize the collaboration with work places take a look at the initiatives Arba Inkludering and Arbeid fra dag én

Effective employment approaches for traumatized refugees in the Nordic countries

The number of refugees is the highest since the aftermath of World War II, and an increasing number of refugees get residence in the Nordic countries. In order to strengthen both integration and the economy it is very important to ensure that a large group of these refugees gain employment in their new country of residence.

Unfortunately, reports show that refugees and family migrants have difficulty gaining employment in the Nordic countries compared to other groups of migrants. An analysis by OECD shows that even when controlling for key socio-demographic characteristics, employment performance of family migrants and refugees is below that of other groups.

Recent Danish studies show that health might also be a factor when explaining refugees’ lower employment performance. It is estimated that 30-45 % of the refugees in Denmark are traumatized and other studies show that 13-25 % of refugees in high income countries suffer from PTSD. A Danish study shows that only 10 % of refugees in treatment of PTSD are employed. Apart from the trauma symptoms, trauma can also be an impediment for gaining employment due to its negative effect on the ability to learn a new language.

There are only few studies that highlight methods about how to support employment of traumatized refugees and none that includes all the Nordic countries in one study.

Therefore the aim of this project is to: “explore, qualify and strengthen effective employment approaches for traumatized refugees and reunified spouses and partners in the Nordic countries”

The project will study approaches which are evaluated and have evidence for its effect, as well as approaches which are yet to be evaluated but have shown promising results. The newly developed instrument of ‘promising practice’ from The Danish National Centre for Social Research will be used as a measuring tool to evaluate and categorize the approaches. The project period is from February to December 2017.

The project consists of a desk study of existing literature on effective approaches and a study of promising approaches* used in the Nordic countries. The knowledge generated by the study will be shared through various channels and in a publication. The publication will be published by October 2018.

The study will be carried out in Finland, Sweden, Norway, Iceland and Denmark. Representatives of each country will manage the project securing that new knowledge generated through the project will be disseminated and used in all of the Nordic countries.

Promising approaches is a term, that is developed and validated by the Danish National Research Center, VIVE (former SFI). To learn more about the tool go to this homepage (only in Danish)

Steering Comittee

The project is supervised by a steering comittee with representatives of the participating countries Finland, Iceland, Sweden, Norway and Denmark.

Finland

Ben Malinen
Head of Domestic Programme, Finnish Refugee Council

Sweden

Katarina Carlzén
Utviklingsansvarlig, Lännsstyrelsen, Skåne Län

Norway

Jens Lunnan Hjort
Analyserådgiver, Integrerings- og mangfoldsdirektoratet (IMDI)

Iceland

Guðlaug Hrönn Pétursdóttir
Directorate of Labour

Denmark

Karin Ingemann
Kontorchef, Styrelsen for International Rekruttering og Integration (SIRI)