Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 3

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BuildaBridge Refugee Project Year 3 Report Philadelphia Refugee Mental Health Collaborative BuildaBridge International Mission - To engage creative people and the transformative power of art making to bring hope and healing to children, families, and communities in the contexts of crisis and poverty. Vision - A world where all children are resilient, experience self-efficacy, and have a vision for their future. BuildaBridge dedicates its resources to building the capacity of creative adults and local communities to fulfill this vision.

Philadelphia Refugee Mental Health Collaborative Mission – To connect newly arrived refugees to culturally and linguistically appropriate mental health care, including support groups, therapy, and community-building arts and education projects. Vision – All refugees have access to quality mental health supports, including alternative treatment modules and funding for them, including a network of trained professionals committed to serving refugee populations, appropriate translation services and treatment centers.

Narrative Summary

During Year 3 of the Philadelphia Refugee Mental Health Collaborative (PRMHC), BuildaBridge continued to provide high-quality, culturally specific art therapy and therapeutic art-making groups in the community context to the Bhutanese and Burmese refugee populations living in South Philadelphia. The BuildaBridge ClassroomSM, a trauma-informed, hope-infused, child-centered replicable model that includes a restorative justice approach for working with youth served as the foundation of the art therapy groups. Consistent with that foundation, the groups accomplished two goals: 1) Assisted refugee children in working towards mental health goals set by art therapists based on children’s identified behavioral problems and 2) Taught children key life lessons through art-making in one or more of the BuildaBridge ClassroomSM Model outcome areas (Artistic, Social, Academic & Character Development). Woven throughout each group, therapists used art and art-making as a metaphor for additional life skills and lessons. It is these elements that assisted refugees in identifying adjustment strategies based on the strengths of their communities in promoting success, strength, recovery and resiliency in a new culture.

Additionally, BuildaBridge assisted the PRMHC in evaluating the successes of the past two years through a collaborative-wide survey that resulted in the development of a strategic plan for Years 3 and 4. Based on the past few years of programming, BuildaBridge led a presentation at Nationalities Services Center’s Cultural Awareness and the Immigrant Community Conference on “How Art-making can facilitate the development of an immigrant’s identity” and provided input for the PRMHC’s presentations at over ten conferences. Outreach to the incoming Congolese refugee populations resulted in two focus groups held with this population which included art-making experiences. Art therapy groups for the Congolese will begin began in July 2014 and will continue into Year 4.

Artists Christine Byma (L) and Julia Crawford (R) engage with Bhutanese children during a visual art activity

Philadelphia Refugee Mental Health Collaborative BuildaBridge International report of Year 3

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BuildaBridge Personnel Year 1 Year 2 Year 3 Total number of artists engaged: 17

Creative Arts Therapists 5 6 5 Seven artists have been involved at least two or more years of the refugee project

o Three artists involved for 2 years o Four artists involved for all 3 years

Assistant teaching instructors 5 3 2

Total number of Artists 10 9 7

BuildaBridge Outputs 16 Burmese groups 43 Burmese individuals (Chin and Karen ethnicities)

- 41 children plus 2 Case Aides

Five attended at least 10 or more of the groups

Eight attended at least 6 or more of the groups

12 Bhutanese groups 15 Bhutanese individuals – 14 children plus 1 Case Aide • Two had perfect attendance • Nine attended at least 7 or more of the groups

Congolese focus groups 18 Congolese individuals

Total number of refugees 76

PRMHC Goals and Outcomes The goals and outcomes for refugee art therapy groups are detailed extensions of three of the PRMHC’s original goals:

Building ethnic community capacity to recognize and address behavioral health needs in their communities

Development of culturally appropriate supportive groups for new arrivals to deal with resettlement and forced migration stresses in non-traditional settings

Increasing understanding of the adaptive strategies of new refugee populations

Art therapists identified Year 3 goals for their respective groups based on the previous year’s goals and

assessments documenting children’s progress, in addition to their observations of children during the first two groups of Year 3.

Art therapists Natalie Hoffmann (R) and Bethany Stiltner (L) lead Burmese children in a visual art activity

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Bhutanese Year 3 Goals 1. Help each child to express their thoughts, ideas, and emotions non-verbally through the creative process of movement and visual arts and verbally through language. 2. Create a sense of group cohesion and community; encourage bonding among children. 3. Identify significant emotional and/or mental health concerns that require recommendation to additional mental health services. 4. Increase impulse control; specifically (a) during transitions that require moving through space, (b) waiting for a turn to participate, (c) gently touching others when invited, and (d) calmly choosing art supplies. 5. Encourage utilization of various art-making (such as movement, drawing, painting, and storytelling) for self-expression and growth both in session and in other areas of the child’s life. Bhutanese Group Accomplishments Metaphors 1. 30% of children understood the metaphor: Just as we can imprint our artwork with patterns, we leave

an imprint in the world around us 2. 90% of children understood the metaphor: Just as some art materials create…

…impermanent pieces, some things in life change constantly …semi-permanent pieces, some things in life last a while and then change …permanent pieces (unless broken), some things in life last longer than we do (artifacts)

Outcomes in Skill and Knowledge Areas Academic 1. 90% of children exhibited increased knowledge

and understanding of the life cycle of the Monarch Butterfly as evidenced by:

The story lines of the dances choreographed, verbal responses and explanations to questions, and visual artwork created.

2. 50% of children learned the vocabulary words: impermanent, semi-permanent and artifact as evidenced by:

Verbal responses describing the definitions of each word.

Children's use of these words to describe their art work.

Social 1. 80% of children exhibited understanding and application of the following social skills: collaboration,

turn-taking, respect, personal space, sharing space, sharing materials, sharing ideas, listening to others and welcoming others (hospitality) as evidenced by:

Children's conduct throughout all sessions.

Children's explanation to new comers of the expectations. Spiritual/Character Development 1. 90% of children exhibited an increased awe at the world and a hopeful future orientation during art-

making related to the life cycle and imprint of butterflies and evidenced by:

A Bhutanese child displays the cocoon they created out of paper mache and the contents inside of it, illustrating the

life cycle of the butterfly

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Deep interest in looking more closely at pictures of the life cycle process and asking questions that dig further into the details of the process.

2. 80% of children demonstrated an understanding of their own imprint (purpose) in the world as evidenced by:

Children's verbal responses and explanation of what they currently do to help others and what they hope to do in the future to help others or make the world a wonderful place.

Artistic 1. 90% of children learned how to create sculptures out of four materials – leaves, mud, sculpey and

modeling clay as evidenced by:

The completion of art works in each of the materials (authentic assessment). 2. 80% of children demonstrated their understanding and application of choreographing narrative dances

using beginning, middle, end, original movement, props and a collaborative creative process as evidenced by:

The completion and performance of self-choreographed dances that utilized all of these elements (authentic assessment).

Burmese Year 3 Goals 1. For all BuildaBridge personnel and students to learn each others’ names 2. To establish a sense of safety and group cohesion through BuildaBridge’s structured art and movement activities where children can express themselves. 3. To use maps as a theme and structure to accomplish goal two, as well as to give children an opportunity to express their thoughts and feelings about their experiences as refugees and as children

Burmese Group Accomplishments Metaphors 1. 90% of children understood the metaphor: Recycling – Just like when we take discarded objects that had one purpose, and recycle them and give them a new purpose, in life we can find new meanings, purposes, and identities for ourselves, and art can help us do this. 2. 80% of children understood the metaphor: Working together - Just like when we make art, sometimes our art piece will turn out better, and we will have more fun if you work together and ask for help. In life sometimes we can achieve things by working with other people that we could never have achieved by working with ourselves. Understanding of these metaphors was evidenced by:

Children's ability to discuss the metaphor at the end of group when their artwork was completed.

Natalie Hoffmann working with Burmese children on an art-making experience

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Outcomes in Skill and Knowledge Areas Academic knowledge/skills: 1. 70% of children learned the vocabulary words: recycle, patience, collage, butterfly, dragonfly and

transformation as evidenced by:

Children's ability to raise hands and share definitions of words

Children's ability to demonstrate understanding of words through their actions (i.e. "B. can you take a deep breath and show me what patience looks like while you are folding your paper? I know that you are feeling frustrated." B. takes breath and more calmly works on her project without stating that she cannot do it.)

2. 90% of children were able to verbally express how they feel without prompting from therapist (building

emotion knowledge vocabulary) by the end of the term as evidenced by:

Children played the movement emotion game at the beginning of group and spontaneously offered their name, feeling, and simple movement

Social skills: 1. 100% of children exhibited understanding and application of the following social skills: collaboration,

turn-taking, respect, personal space, sharing space, sharing materials, sharing ideas, listening to others, communication, welcoming others (hospitality) as evidenced by:

Children did not verbally protest when asked to work together. They were able to stand/sit side by side in close proximity while working together on various projects without getting angry or frustrated. They were able to work on the same paper together at times. They were also able to take turns tracing one another's bodies on large pieces of paper and respected one another's boundaries.

Children acknowledged and welcomed outside guests (BuildaBridge staff) into their group.

Children listened to one another and took turns while sharing their artwork at the end of group.

“Upon entry, with the teachers yet to arrive, they scurried around readying the classroom with mats and nametags, searching for the BuildaBridge Classroom Motto and Rules, knowing they needed to go up on the wall. They were proudly displaying their initiative and graciously inviting me to help them set up what was very clearly their space. They owned it and the rituals and expectations of the class and they owned them all together. I was in good hands, welcomed and guided by a community of young children who knew where they belonged and relished in that belonging as an important, evolving part of their lives in a place far from home.” – Community Relations Assistant, Julie Rosen, on her experience visiting the Burmese children’s group

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2. 100% of children increased their frustration tolerance-not giving up when something is hard, or when

you can do something right the first time as evidenced by:

Children verbally expressed frustration at various art tasks without acting out or stopping work. Children were able to ask for and accept help from adults. Children responded well when praised by adults for their efforts.

3. 90% of children learned the names of every BuildaBridge staff member and those of all the other children by the end of the term as evidenced by:

Children’s conscious effort to state the names of others when asking others questions or making a statement to that person.

Spiritual/Character development: 1. 90% of children spoke a blessing to at least one of their peers during the closing rituals:

During the ending ritual, children were eager to raise their hands, point to a peer's artwork that they liked, and state why they liked it.

Children wrote thank you cards to their peers and staff during final group. 2. 90% of children exhibited understanding that working on something with the help of others can make

us stronger as evidenced by:

Children verbally stating during discussion that they like working together with other people because it helps them achieve bigger and better things.

3. 60% of children exhibited understanding that we can create new meaning for ourselves (purpose) as evidenced by:

Children's ability to relate the recycle metaphor to their lives by talking about how people can also change themselves into something new or different.

Artistic skills: 1. 100% of children increased fine motor skills as evidenced by:

Children’s ability to fold paper in specific ways after practicing or after initial inability 2. 100% of children demostrated rhythmic competence as evidenced by:

Children moving their bodies and bobbing their heads to the rhythm when prompted by a peer’s playing of an instrument

Children's ability to play a similar beat on their own instrument in response to their peer's musical playing

Artwork created by a Burmese child Artists Natalie Hoffmann and Liz Green discuss the

children’s artwork

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Individual Stories S. S. is a 10-year old Bhutanese refugee girl who has been attending groups since they started in August 2011 with almost near perfect attendance. In the almost three years of her attending groups, S. has made significant progress in all of the BuildaBridge outcome areas (social, character development, artistic and academic). As an illustration of the development of her social skills, S. has improved relations with her younger brother with whom she is often competitive. This has been an ongoing growth area the therapists have been addressing. During the past two years, S. tended not to participate as much in the movement experiences when other girls are not in attendance. During this third year of programming and as an illustration of her increased character development and artistic skills, S. now participates fully and with consistent rhythm even when she is the only girl in the group. With regard to the visual arts, S. would often rush to create as many pieces as possible. Therapists revealed this year that she is savoring the process of completing one, quality piece of art. One of the most significant ways S. has progressed in her development is the recognition and explanation of her past. On November 17, 2013, the art therapist noted in her assessment, “This session is the first group that S. has ever explicitly talked about the move from Nepal to Philadelphia. Her discussions of topics like these have deepened in thoughtfulness.” It is on this foundation that therapists continue to work with S. through art-making experiences, exploring her past, her traumas and her dreams for the future. R. R. is a 9-year old Bhutanese refugee boy who has been attending groups since September 2012 with almost near perfect attendance. He has set a leading example for the other children by his active participation, serious and thoughtful insights and creative individual expression. Therapists have worked with R. to develop further his leadership (character development and social outcome) skills by providing opportunities for him to demonstrate his artistic and academic skills. During one group, the therapist asked if anyone ever takes something bad and turns it into something good or new. R. responded by saying that he does that a lot and gave the example that if a toy car breaks, that if the wheel falls off, you can use the wheel for something else and you can still play with it. illustrating his understanding of the concept and his articulation of the concept to others. During another group, the therapist asked if the children ever go through changes the same way the Monarch butterfly does from a caterpillar to a butterfly. R. responded that “the world turns so everything is always changing, and that time never stops so we are all always moving forward.” The other children shared as well, building upon the main themes R. mentioned. In other assessments, the therapist noted that R. shows increased expression and playfulness in the opening song and welcoming rituals. Therapists continue their efforts to develop R.’s independent thinking and leadership skills.

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B. B. is a 9-year old Burmese refugee girl who has been attending BuildaBridge art groups regularly since September 2012. Art therapists have helped B. to develop her leadership skills and frustration tolerance over the past two years. As leader, in a Fall 2013 group, she offered to translate the BuildaBridge Motto and Rules for the newly arrived peers. Throughout the course of the year, B. often raises her hand first to provide answers to the questions, demonstrating to the therapists and others her eagerness to be engaged. By the Spring of 2014, B. was engaging her peers in responding to questions, asking for help to get others involved while at the same time, encouraging others to actively be engaged (social skills) Previously, she would copy her peer’s artwork and get upset when it didn’t look right (exactly like her peer’s). She became frustrated easily during art projects, said she was going to quit and she that doesn’t like doing things that are hard. Art therapists worked with B. individually to talk about why, and about how doing things that are hard, just like in life, can teach us skills and patience. During the next group, B. increased in her individual creative expression by turning a box into a turtle (turning something old into something new, finding meaning and renewed sense of purpose). She was proud of her individual creation, having not copied her peers, and proudly shared this. Highlights from the artists Natalie Hoffmann, Lead Creative Arts Therapist with the Burmese group Maps and art activities involving maps were used during the fall 2013 term to provide opportunity for self-expression around their experience as refugees. [During the map activity] the children all picked Thailand to draw, which is consistent with what the translator told us: that the children do not remember Burma, having been in refugee camps in Thailand for most of their lives. Sometimes when they draw air planes, it looks like they are representing their trip to America. Other times they look like cargo/supply planes; and still other times they draw them shooting or dropping bombs. The children appear to enjoy drawing about themselves and topics related to themselves (developmentally appropriate) such as their country of origin or their journey as a refugee. Family imagery is common, as are houses on stilts (from Thailand) and airplanes (as transportation and symbols of war). Children also created maps of Pennsylvania, which therapists used to teach children geography.

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Learning to share or give up something for someone else was a lesson therapists worked on during the fall 2013 term. As is developmentally appropriate, some of the children wanted to keep all of their tiles and it was hard for them to understand why they would give some away. Children were told that they could keep one tile for themselves, and were also invited to make tiles for the BuildaBridge Gala Fundraiser. This was hard for some children. The group leader talked about the idea of sharing, making a choice, and helping other people through their art. Instead of putting their art all together as they did last week, they individually and as a group were able to come together to give their art away. The children really progressed in terms of learning to share with and think of others, key social and life skills.

Julia Crawford, Lead Therapeutic Movement Instructor with the Bhutanese group Transitions between art-making experiences for the Bhutanese group have been challenging, as has been respecting others when they are speaking or sharing art. In order to develop children’s social skills in these areas, therapists created consistent methods for the transitions coupled with a team teaching approach for classroom restorative discipline. By the end of the year, the therapist noted that 80% of children now have a better understanding and practice of hospitality which includes: collaboration, turn-taking, respect, personal space, sharing space, sharing materials, sharing ideas, listening to and welcoming others.

The children as a whole group are also showing an increased ability in mirroring one another, indicating their increased ability for empathy. Their ability to modulate their volume and speed in singing and movement indicates increased self-control and awareness. Contributed movements continue to increase, indicating unique self-expression and expression of original thoughts.

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Links Project Website http://buildabridgerefugeeproject.blogspot.com Project Video http://vimeo.com/65112790 PRMHC website www.culturalcommunities.org

BuildaBridge International 205 W. Tulpehocken Street, Philadelphia, PA 19144

Phone: 215-842-0428 www.buildabridge.org