Unaccompanied Minor Asylum Seekers Health Promotion in a Reception Center Recommendations for Good Practice Mohanathas, Manchula Sõer, Evelyn - PDF

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Unaccompanied Minor Asylum Seekers Health Promotion in a Reception Center Recommendations for Good Practice Mohanathas, Manchula Sõer, Evelyn 2011 Laurea Otaniemi 1 Laurea University of Applied Sciences

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Unaccompanied Minor Asylum Seekers Health Promotion in a Reception Center Recommendations for Good Practice Mohanathas, Manchula Sõer, Evelyn 2011 Laurea Otaniemi 1 Laurea University of Applied Sciences Otaniemi Unaccompanied Minor Asylum Seekers Health Promotion in a Reception Center Recommendations for Good Practice Manchula Mohanathas Evelyn Sõer Master of Health Care Thesis 2011 Laurea University of Applied Science Otaniemi Master Degree in Health Care Abstract Manchula Mohanathas, Evelyn Sõer Unaccompanied Minor Asylum Seekers Health Promotion in a Reception Center Recommendations for Good Practice. Year 2011 Pages 78 In the 2000 s there was an increase in the number of asylum seekers in Finland. A particular, vulnerable group within the asylum seeker population is those minors who arrive without their family. Although according to Finnish Integration Act, unaccompanied minor asylum seekers have nearly equal access to health care services with the national population, some legislation-based restrictions exist. Asylum seekers have had traumatizing experiences and possibly lacking health care in their past. Also insecure future prospects cause distress. Therefore health promoting practices of daily work have an important role to support the minors well-being. The purpose was to study how professionals promoted unaccompanied minor asylum seekers health in their daily work in a reception center. Secondly, what were the methods and thirdly what was the content of health promotion. Lastly, the purpose was to establish recommendations for good practices. Action research method was applied. Data was collected from four professionals of a reception center through thematic interviews. Qualitative inductive content analysis method was used. Further, participants collaborative feedback was used to refine the recommendations for good practices. Findings consisted of reception a reception center s professionals daily functions that aimed to support minor asylum seekers health. The findings are depicted in four categories: emotional support, guidance, services and multi-professional co-operation. One category focuses on recommendations for improving the minors care, in particular related to availability and quality of mental health care. Recommendations for good practices that promote unaccompanied minor asylum seekers health are presented as an outcome of this study. In addition, suggestions for future developments are expressed. A good practice is functional, effective, evaluated, ethically acceptable, based on versatile knowledge and concisely described. Although reception centers in Finland differ to some extent and these recommendations cannot be generalized, they can be adapted in reception center work. To further develop recommendations for good practice, implementation and evaluation of these recommendations is needed. Also the clients perspective should be included. Keywords Good practices, health promotion, reception centre, unaccompanied minor asylum seeker Laurea-Ammattikorkeakoulu Otaniemi Terveyden edistäminen, Ylempi AMK Tiivistelmä Manchula Mohanathas, Evelyn Sõer Yksintulleiden alaikäisten turvapaikanhakijoiden terveyden edistäminen vastaanottokeskuksessa. Suosituksia hyviksi käyntänteiksi. Vuosi 2011 Sivumäärä luvulla turvapaikanhakijoiden määrä lisääntyi Suomessa. Erityinen, haavoittuvassa asemassa oleva ryhmä turvapaikanhakijoiden joukossa ovat alaikäiset, jotka saapuvat ilman perhettään. Vaikkakin yksintulleilla alaikäisillä turvapaikanhakijoilla on Kotouttamislain mukaan lähes samat oikeudet terveydenhoitopalveluihin, joitakin lakisääteisiä rajoituksia on. Lisäksi heillä on traumatisoivia kokemuksia ja mahdollisesti puutteellinen terveydenhoito menneisyydessä eikä varmoja tulevaisuuden näkymiä, nämä seikat aiheuttavat ahdinkoa. Tämän vuoksi käytänteillä, jotka päivittäisessä työssä edistävät terveyttä on tärkeä rooli alaikäisten hyvinvoinnin tukemisessa. Opinnäytetyön tarkoituksena oli tutkia, miten ammattilaiset edistivät yksintulleiden alaikäisten turvapaikanhakijoiden terveyttä päivittäisessä työssään vastaanottokeskuksessa. Toisekseen, mitkä olivat terveydenedistämisen metodit ja kolmanneksi, mikä oli terveyden edistämisen sisältö. Viimeiseksi tavoitteeksi oli luoda suositukset hyviksi käytänteiksi. Toimintatutkimusmenetelmää sovellettiin, neljää vastaanottokeskuksen työntekijää haastateltiin teemahaastatten metodein. Aineiston analyysissa käytettiin laadullista induktiivista sisällönanalyysiä. Lisäksi tutkimuksen osallistujien palautetta käytettiin hyvien käytänteiden suositusten kehittämiseksi. Tulokset koostuivat neljästä päivittäisen työn toiminnoista, jotka tähtäsivät alaikäisten turvapaikanhakijoiden terveyden tukemiseen. Tulokset kuvataan neljässä kategoriassa: henkinen tuki, neuvonta, palvelut ja moniammatillinen yhteistyö. Yksi kategoria keskittyy suosituksiin alaikäisten hoidon parantamiseen, erityisesti liittyen mielenterveyshoidon saatavuuteen ja laatuun. Tämän tutkimuksen tuotoksena esitellään suositukset alaikäisten turvapaikanhakijoiden terveyden edistämisen hyviksi käytänteiksi. Lisäksi tuodaan esille kehittämisehdotuksia tulevaisuudelle. Hyvät käytänteet ovat toimivia, tehokkaita, arvioituja, eettisesti hyväksyttäviä, perustuvat monipuoliseen tietoon ja ne ovat kuvattu tiivisti. Vaikkakin eri vastaanottokeskukset poikkeavat toisistaan joltain osin eikä suosituksia voi yleistää, voi niitä soveltaa vastaanottokeskustyössä. Jotta suosituksia hyviksi käytänteiksi voisi edelleen kehittää, pitäisi ne toteuttaa käytännössä ja arvioida. Myös asiakkaiden näkökulman pitäisi sisältyä tutkimukseen. Asiasanat Hyvät käytänteet, terveyden edistäminen, vastaanottokeskus, yksintullut alaikäinen turvapaikanhakija CONTENTS 1 INTRODUCTION UNACCOMPAINED MINOR ASYLUM SEEKERS AND RECEPTION CENTER Unaccompanied minor asylum seekers Professionals in a reception center HEALTH AND ASYLUM SEEKERS Health promotion Health care system for asylum seekers Asylum seekers health GOOD PRACTICE PURPOSE AND RESEARCH QUESTION OF THE STUDY RESEARCH METHOD Action research Participants in this study Method of data collection Data analysis FINDINGS Emotional support for minor unaccompanied asylum seekers Trust Acceptance Conversation Closeness between professionals and minors Guidance for minor unaccompanied asylum seekers Information for minor asylum seekers Support in maintaining minor unaccompanied asylum seekers daily rhythm Sexual education for minor asylum seekers... 39 7.3 Services for minor unaccompanied asylum seekers Health care services for minor unaccompanied asylum seekers Housing services for unaccompanied minor asylum seekers Personal counselor Free-time activities for unaccompanied minor asylum seekers Support in asylum process Multi-professional co-operation for promoting minor asylum seekers health Professional communication and collaboration Diverse professional knowledge Recommendations for improving minor unaccompanied asylum seekers care Health care system Special education for professionals Recommendations for good practices DISCUSSION Ethical considerations Trustworthiness Discussion of findings REFERENCES LIST OF TABLES LIST OF FIGURES APPENDICES... 70 6 1 INTRODUCTION The number of asylum seekers in Finland has in turns decreased and risen during the past three decades. According to the statistics, in the 1990 s the annual range of asylum seekers was roughly between 700 and In the years 2000 to 2007 there were between 1500 and 3800 asylum applicants. In 2008 and 2009 there has again been a growth since the more quiet years of early 2000 s, respectively 4035 and 5988 applicants, the latter being a record year (see TABLE 1, p. 7). In particular, there have been more unaccompanied minors than before, 706 in 2008 and 557 in 2009, in 2010 the amount dropped again to 329 (see TABLE 2, p. 9). Around three quarters of minor asylum seekers originated from Somalia, Iraq and Afghanistan in recent years (see TABLE 2). In order to respond to increased accommodation needs, more reception centers were established and some expanded during the years 2008 and 2009 (Ministry of Interior 2011a & 2011b). In comparison with the population residing permanently in Finland, asylum seekers have a restricted access to health care services. According to the Finnish Integration Act, asylum seekers are entitled to services in case of essential need of care, however special needs are required to be taken into consideration (Laki maahanmuuttajien kotouttamisesta ja turvapaikanhakijoiden vastaanotosta 19). Minor asylum seekers have nearly equivalent rights in comparison with the national population, however, availability and specialization of some services, such as mental health care is inadequate (Helander & Mikkonen 2002, Sourander 2007, Parsons 2009). Thereby, daily care has an even more significant role in maintaining one s wellbeing than for those who have full access to health care. Asylum seekers have often had traumatizing experiences in their past and have no secure future prospective, as they do not yet know whether they will be deported or granted residence in Finland. The majority of applicants come to Finland from countries or conditions where health care services may have been out of their reach. These life circumstances may be sources of stress and emphasize the need for an environment promoting health. In this study it was aimed to find out, how a reception center s workers promote asylum seekers health in their daily work, what are the methods and content of health promotion. Health can be promoted in daily work and it is not up to only clinical health care workers but all who encounter asylum seekers in their duties. Through the participation of a reception centers professional s, recommendations for existing good practice were established and proposals for future developments listed. 7 Action research method was applied; it emphasized the role of participants as active parties. Staff members were interviewed in an institution that housed mainly under aged asylum seekers. Participants gave collaborative feedback to refine the study s findings after the initial data analysis and refined recommendations for good practices are the outcome of this study. TABLE 1. All asylum seekers and minor asylum seekers in Finland (Finnish Migration Service 2011c) Year All asylum seekers Unaccompanied minor asylum seekers UNACCOMPAINED MINOR ASYLUM SEEKERS AND RECEPTION CENTER 2.1 Unaccompanied minor asylum seekers According to United Nations Commission on Human Rights (UNCHR) an asylum seeker is a person who has left their country of origin, has applied for recognition as a refugee in another country, and is awaiting a decision on their application (UNCHR 2010a). An unaccompanied adolescent or a young person is someone under the age of 18, who is separated from both parents and not being cared by an adult who by the law or custom has responsibility to do so (UNHCR 2010a). Foundations for regulations and policy concerning asylum seekers in Finland originate firstly from international treaties such as United Nation s Universal declaration of Human rights from the year 1948 and European Convention on Human Rights (1953). Secondly, European 8 Union immigration and asylum legislation as well as national legislation guide-line their process and life circumstances during their process in Finland. Application for asylum must be submitted at the boarder of the country or at a police station shortly after arrival and asylum process starts after police or border control officials receive the application (Ulkomaalaislaki, 95). An asylum seeker will be accommodated in a reception center for free of charge until his or her application decision period, if the applicant refuses accommodation, he or she can organize and finance it independently (Penttilä 1997). Depending on to which official asylum the application was submitted to, border officials or police will investigate an asylum seekers identity, how the person entered to Finland and which was the route for travelling. Further, Finnish Migration Service will investigate the actual grounds for granting asylum, thus the events and other reasons for which a person should be afraid of being persecuted in her country of origin or residence. Migration office will issue the first residence permit. Asylum seekers have the right to use a legal advisor (Ulkomaalaislaki, Chapter, 97) and to contact refugee organizations such as UNCHR or Pakolaisapu Finnish refugee council in Finland, in all stages of the process. In May 2011, the average waiting time for Finnish Migration Office s interview was roughly six months, on average a decision was received after ten or eleven months of additional waiting time (Finnish Migration Service 2011a). If a person receives a negative decision, she/he has the right to appeal to Administrative court within 30 days, if further negative decision is given, a person can apply for a permission to appeal to Supreme Administrative Court (Refugee Advice Centre 2010). Asylum seekers also have the right to appeal to European Court of Human Rights. This international court s rulings are based on European Convention on Human Rights (European Court on Human Rights 2010). If all these steps need to be taken, an individual s process will consume significantly more time than the average procedure time depicted by Finnish Migration Service. After receiving a residence permit based on the right for asylum or protection on the basis of humanitarian grounds, a residence in a Finnish municipality will be addressed. At the moment, there is a lack of municipalities and residential facilities offered to refugees in Finland prolonging people s process even further (Valtakunnallinen pakoalaisten kuntiin osoittamisen strategia ). Member states of European Community have been determined as safe countries (European Union Council Regulation 343/2003, (2). Thereby, if a person has entered the territory of, or applied for asylum in another European Union country prior to Finland, her /his case shall be reviewed there and she/he will be sent back to that country. Preserving family unity is an example of exception in this regulation (Council Regulation 343/2003, (6). 9 TABLE 2. Unaccompanied minor asylum seekers in Finland by nationality (Finnish Migration Service 2011c) Zimbabwe 1 1 Unknown Ukraine 1 Turkey Togo 2 2 Somalia Sierra Leone 2 2 Serbia 6 Russia Ruanda 1 Romania 2 1 Others 4 6 North Korea 2 No nationality 2 1 Nigeria Niger 1 1 Morocco Kosovo Kazakhstan 1 1 Cameron Ivory Coast Israel 1 Iraq Iran India 1 2 Guinea Ghana Gambia Ethiopia 3 5 Denmark 1 Democratic Republic of Congo Congo Burundi 1 1 Bulgaria Belarus 4 Angola Algeria Afghanistan TOTAL Reception center Asylum seekers are mainly accommodated in reception centers, although it is also possible for a person to reside in a private home if s/he independently so can organize. There are three main types of reception centers. Group homes (ryhmäkoti) for unaccompanied minors typically under the age 16, supported housing services (tukisasunnot) for 16-to-17-year-olds and reception centers for adults or families with children. Finnish legislation states that accommodation has to be organized so that family members can reside together and an applicant s special needs in terms of age, physical or psychological condition have to be taken into consideration (Laki maahanmuuttajien kotouttamisesta ja turvapaikanhakijoiden vastaanotosta 19). Accommodation in reception centers for children aged 0 to 15 is sized based on Finnish Child protection act. Accommodation for children aged 16 to 17 includes fewer, although similar services and resembles housing services. According to United Nations Convention on the Rights of the Child, adults and under aged should not be housed in the same department (Yksintulleet näkökulmia ilman huoltajia maahan saapuneiden lasten asemasta Suomessa). According to Quality manual for working with unaccompanied minor asylum seekers, for children under age of 16 food is prepared by reception staff, the ones living in supported housing facilities cook their own food and particularly in the beginning, help form reception center s workers is needed. Nutrition is part of care and up-bringing support aimed at unaccompanied minors. Unlike adults or families, each one has their personal worker. In this research, this kind of worker was referred to as personal counselor. Additional services for underage asylum seekers are hobbies supporting physical and psychological well-being. (Alaikäisten vastaanottotoiminnan laatukäsikirja, versio: 2.0). Besides accommodation, all asylum seekers are entitled to income support, essential social and health care services and interpretation services; in addition, work or study activities may be organized. Further, costs of legal help are covered on behalf of the reception center to ensure a fair and effective process. National legislation focuses particularly on children s rights by considering a child s best interest; those with special needs should receive counseling, rehabilitation and mental health services (Laki maahanmuuttajien kotouttamisesta ja turvapaikanhakijoiden vastaanotosta 19). Essential social services include initial information and interview conducted by a social worker, psychosocial support if necessary, income support and support in moving to municipality after an applicant has received a residence permit. For under-aged, the social worker appoints a legal guardian and steers cooperation with professional network in and 11 outside of the reception center. (Alaikäisten vastaanottotoiminnan laatukäsikirja, versio: 2.0). Essential health care services are composed of health examination including laboratory and x- ray examinations, assessment of need of care and vaccinating, if seen necessary. Initial examination is conducted by reception center s nurse; those asylum seekers who reside in private homes receive health info prior to moving. (Alaikäisten vastaanototoiminnan laatukäsikirja, versio: 2.0) 2.3 Professionals in a reception center Qualifications and necessary amount of staff working with children aged 0 to 15 in reception centers are coherent with Finnish Child protection act. In one unit can reside maximum of seven children and there must be minimum of seven workers, unless several units operate in the same building, there should be minimum of six workers. Not more than three units can, however be housed in the same building (Lastensuojelulaki, 59). In national legislation it is stated that qualifications for professionals working in social welfare sector are applied also for work within group homes, for other age groups no such citations exist (Laki maahanmuuttajien kotouttamisesta ja turvapaikanhakijoiden vastaanotosta). Minimum requirements or recommended professional backgrounds are neither described in manual of quality care for work with unaccompanied minors (Alaikäisten vastaanototoiminnan laatukäsikirja, versio: 2.0). For some professions working also in reception centers, such as nurse and social worker, there are well precisely defined qualifications in Finland. Thus, the counselor s background can vary a great deal depending on the consideration of the employer. The focus of services for minors aged 16 to 17 receive is more on housing and fewer support in daily functions compared to group homes, amount of staff per child is smaller. Each child has a personal counselor; together with rest of the staff they are responsible for daily care and upbringing. (Yksintulleet näkökulmia ilman huoltajia maahan saapuneiden lasten asemasta Suomessa ). In a reception center for adults there is far less staff per client and thus far less time to focus on an individual s needs. Many of the clients in reception centers have had trau
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