Family Therapists in Prenatal & Postnatal Care - Family Therapy Magazine

Family Therapists in Prenatal & Postnatal Care - Family Therapy Magazine

Home September / October 2022 Volume 21, No. 5
PERSPECTIVES
Family Therapists in Prenatal & Postnatal Care
Debbie Manigat, DMFT
 
The journey of becoming a masterful family therapist is lifelong. It is a discovery of clinical refinement as we explore new relational therapy theories, infuse systemic thinking in other fields like maternal health, and find new tools to better serve families. Each time that we meet with families, parents or children, we gain priceless insights.
With a therapeutic lens emerging in infant mental health (IMH) and family therapy, therapists can cultivate a conscious approach to treatment experiences with families in the prenatal and postnatal period. By centering on the transformation that occurs in attachment relationships, IMH and family therapy fosters a systemic mindset on prevention, cultural responsiveness, palliative care, integrated maternity care, and child development.
Leading with IMH means recognizing culture, optimal growth, social/emotional, behavioral, and cognitive development of the infant in the context of the unfolding relationship between the infant and care-giving system. In doing so, therapists have the opportunity to learn from multiple narratives and generations. For instance, during this time, important social and school readiness milestones such as successful self-regulation, executive functioning, healthy lifestyles, and so many other instrumental developmental life skills are all growing (Zeanah, 2019). IMH reveals that an undesired behavior from a child may be the symptom of a deeper, trauma-related matter, which teaches us as professionals to not target “what is wrong” or the presenting concern in isolation. IMH paired with family therapy teaches us to intentionally approach the interview with a trauma-informed grounding to assess what may or may not have happened in the family life cycle as well as consider past generational trauma. On a fundamental level, this shift in lens and service directly affects the positive social and emotional development of the parent-child relationship.
Additionally, an IMH lens also prepares family therapists to focus on the parallel process and be attentive that they cannot successfully help a family alone. For prenatal care, therapists should collaborative with OBGYNs, midwives, doulas, nutritionists, social workers, and/or delivery nurse practitioners. For postnatal care, therapists should be mindful to work with neonatal nurses, intensive care unit nurses, lactation consultants, pediatricians, social workers, chaplains and/ or hospice as applicable. Especially in times of miscarriage or infant loss, clinicians need to cooperate with medical professionals and the family system in care of their grieving process.
Considering this, an IMH lens requires proper training and professional development. Programs involving parent effectiveness training, infant care and development, training of supplemental caregivers, and training of infant specialists all legitimately fall under the rubric of IMH (Fitzgerald & Barton, 2000).
IMH training needs and professional development recommendations
The demand for trained therapists with an IMH specialization or endorsement is rising. The growth of the IMH field and IMH subject matter experts is also a direct result of the training and education available. Changing the provider paradigm across systems, along with corresponding changes in policies, procedures, protocols, and professional practice, requires combining resources and overcoming the challenges of working across institutions and systems (Lester & Sparrow, 2010). We need to follow the collective wisdom of Dr. T. Berry Brazelton, Dr. Nadine Burke Harris, Dr. Renee Boynton-Jarrett, Dr. Joia Adele Crear-Perry and many other IMH leaders in looking for strengths and passion within these systems, just as we do with parents and children (Lester & Sparrow, 2010). National organizations like “Zero to Three,” “Brazelton Touchpoints Center,” and “Alliance for the Advancement of Infant Mental Health” have training and professional development opportunities for members and providers seeking to learn more about IMH. Due to funding from the Alliance for Innovation on Maternal Health and U.S. the Maternal and Child Health Bureau, each state also has an opportunity to learn more about infant mortality and create programs or trainings to address disparities in care.
The American College of Obstetricians and Gynecologists is also leading the way in partnership with numerous national and state leaders including the Association of Maternal & Child Health Programs (AMCHP) to work with states and health systems to implement maternal safety bundles through data-driven quality improvement. In collaboration with the Council on Patient Safety in Women’s Health Care, “AIM – Maternal Health” has developed bundles to address hemorrhage, hypertension in pregnancy, prevention of maternal venous thromboembolism and support of vaginal births (Alliance for Innovation on Maternal Health, n.d.).
The AIM – Maternal Health team has a new bundle in the development stage: Reduction of Peripartum Racial Disparities. This bundle is unique because it does not focus on a specific outcome or direct cause of maternal mortality and morbidity; rather, it concentrates on addressing health equity across the care continuum and opportunities presented during the care processes to close disparities in maternal health outcomes (Alliance for Innovation on Maternal Health, n.d). This work group is led by Dr. Elizabeth Howell from the Mount Sinai School of Medicine and Dr. William Grobman from Northwestern University Feinberg School of Medicine. It includes representative membership from the American Association of Family Practitioners, American College of Nurse Midwives, Association of Women’s Health, Obstetric and Neonatal Nurses, Society for Obstetric Anesthesia and Perinatology, Society for Maternal/Fetal Medicine and AMCHP. This bundle will focus on strategies that include establishing systems to accurately document patients’ self-identified race, ethnicity and preferred language; using patient-centered strategies; ensuring staff education on racial and ethnic disparities in maternal health outcomes, shared decision-making and implicit bias; and building a culture of equity at the facility-level to complement a culture of safety. This is an area where AAMFTneeds to be a voice, have opportunities to learn from other disciplines, as well as have their professional membership contributing to the research.
As the field continues to evolve and more clinicians shift their focus to IMH, there are several goals for training needs:
Define and promote a core set of principles pertaining to the understanding of infant development in context that is relevant to the training needs of all practitioners who work with young children (Zeanah, 2019).
Develop and refine training experiences that differentially develop the knowledge and skills appropriate to the degree to which professionals should be involved with an infant’s state of being, based on their discipline of origin (Zeanah, 2019).
Provide supervision/consultation that promotes professional development in the context of a supportive relationship (Zeanah, 2019).
Stereotyping and implicit bias contribute to racial and ethnic disparities in health. Taken with this work, it gives warrant for hospitals and other care organizations to invest in efforts to reduce such biases and explore their connection to institutional racism (Greenwood, Hardeman, Huang, & Sojourner 2020).
Basic education about neuroscience and how brain development is involved in mental health (Patterson & Vakili, 2014).
Review of research that explains how sensitive developmental periods, particularly early in life, are affected by environmental factors (Patterson & Vakili, 2014).
Education about how relational interventions may be able to shape the brain to promote healing (Patterson & Vakili, 2014).
Form professional social work organizations and actively participate in coalition building with other professions (Alzate, 2009).
Reach out to policy makers and educate them (Alzate, 2009).
Create alliances with like-minded organizations and agencies that provide services, conduct research, lobby, or educate about issues that directly and indirectly affect the exercise of sexual and reproductive rights (Alzate, 2009).
This is an area where AAMFT needs to be a voice, have opportunities to learn from other disciplines, as well as have their professional membership contributing to the research.
IMH training design in family therapy
From state to county organizations and universities, there are numerous trainings on topics such as trauma-informed care, adverse childhood experiences (ACEs), implicit bias, cultural humility, reflective practice, attachment, resilience, and many others across disciplines. Trainings that are identified as industry standard to support expanding the foundation of family therapy in IMH include DC: 0-5, Child-Parent Psychotherapy, Circle of Security, Brazelton Touchpoints, Attachment and Biobehavioral Catch-Up, FirstPlay, The Growing Brain (Zero to Three), Play Therapy, and Trauma-Focused Cognitive Behavioral Therapy, among many others. Lester and Sparrow (2010) provide essential elements of IMH training design which include IMH and developmental theory, relationship-based centering, time for reflection, cultural responsiveness, transference of learning, and the reality of anxiety of working with infants or families with young children in training. In support of trainees’ needs, best practice is to begin from within. Trainees can reflect on their own family, nurturing or schooling memories in the 0-5 age range, as well as workplace experiences overtime. This helps build the trainee capacity for reflective practice in recognizing what it feels like to be listened to and acknowledged (i.e., a parent with concerns of pregnancy complications, grief, or expectations of baby), as well as builds a relationship between the trainers to trainees, as well as trainees with fellow trainees in the learning space. Next, a structure where trainees can practice careful observation is crucial whether through role plays, live encounters, or homework, as observation is a critical skill and IMH endorsement competency is a best practice (Lester & Sparrow, 2010). A dynamic professional development journey in IMH can be curated with the previously mentioned components that includes the theories of family therapy.
To address the gap of IMH training in family therapy and bring awareness to birth equity and maternal mental health, the Kirkpatrick (2019) model is an industry option for designing or evaluating any type of training. The training purpose of knowledge and skill attainment must be verifiable by incorporating existing formative or summative evaluation tools. Let’s lay the foundation here by defining goals of the training, selecting vendor/content/tools, and designing evaluation plan/tools (Kirkpatrick, 2019). Questions to consider include:
What overall problem is the training supposed to solve?
What outcome would mean success?
Are there key company metrics you are hoping to improve with this initiative?
Next, Kirkpatrick notes (2019) execution plans include assessing how you will conduct the training, implement support and reinforcement, monitor and adjust for the transference of learning. Questions to consider at this phase include:
What performance issue are you trying to address?
What should people actually do on the job after training?
What support/tools/resources do people need in order to be successful?
Lastly, determine how you will demonstrate value by compiling data, reporting progress and validating the results of the training (Kirkpatrick, 2019). Questions to consider in training finalizations are:
What do people need to know to be able to perform well on the job?
What practice is required for people to perform the necessary skills?
To what degree are you interested in hearing about participant reactions to the training?
Is there any other data you wish to receive about the training program itself?
Kirkpatrick (2019) also recommends using a blended evaluation plan that focuses on support for trainees and accountability of training provider. Support entails reinforcing what is learned through follow-up modules, on-the-job training, self-directed learning opportunities, refreshers, job aids, reminders, and job modeling. Another form of support is encouraging through coaching and mentoring or setting rewards through pay for performance and recognition (Kirkpatrick, 2019). Accountability or monitoring can look like a pre or post survey, review of trainees’ work after training, assessing key performance indicators, interviews with trainees or supervisors, observing clinical practice and/or self-monitoring/report (Kirkpatrick, 2019). Ongoing monitoring and time to adjust family therapy trainings in IMH should be allotted because plan modifications are not failures or mistakes; they are good training practice (Kirkpatrick, 2019).
Currently, there are no evidence-based maternal mental health or IMH integrated family therapy trainings. Stone (2012) noticed the lack of IMH practitioners inversely limits the expert help available for young children, their families, and primary service providers when a very young child exhibits mental health concerns. We can be that change. Family therapists with an IMH lens can provide consultation to programs serving families with young children in how to support the caregiver-child relationship, promote social-emotional growth, and manage challenging behaviors (Stone, 2012). To get equipped and learn more about how family therapists may be transformative in reproductive care and address birth disparities, download the free “ Birth Equity in Family Therapy Toolkit ” (sponsored by the AAMFT Minority Fellowship Program).
This article is offered free by AAMFT. If you are interested in accessing members-only content, join today!
Debbie Manigat, DMFT, LMFT, embodies a spirit of empowerment as a healthcare disparity change agent in the field of family therapy. She is a proud graduate of Howard University (Bachelor of Arts) where she majored in Communications and minored in African American Studies. For her Master of Science degree in Counselor Education, she attended Palm Beach Atlantic University and completed dual tracks in Mental Health and Marriage & Family Therapy with an emphasis on soul care. For her Doctor of Marriage & Family Therapy, Manigat attended Nova Southeastern University (NSU) where her research was on integrated reproductive care, Narrative Therapy, Existential and Satir therapies. At NSU, she was a 2019-2021 AAMFT MFP Doctoral Fellow and she is currently an AAMFT Professional member. Her clinical and leadership practice focuses on infant mental health, cultural humility, and holistic wellness. She is passionate about researching, writing, and presenting on healing generational trauma, epigenetics, suicide prevention, positive/ adverse childhood experiences, and birth equity. She is a certified Brazelton Touchpoints Site Network Coordinator, Lean Six Sigma Yellow Belt, and Lean SIX SIGMA DMAIC at a local children’s services council. Additionally, she is trained in Infant Mental Health Level 1 & 2, Reflective Practice & Supervision, Family Play Therapy, Gottman Therapy, Trauma-Focused CBT, Mindfulness-Based Stress Reduction, EMDR and suicide prevention.
REFERENCES
Alliance for Innovation on Maternal Health. (n.d.). Retrieved from https://safehealthcareforeverywoman.org/aim
Alzate, M. (2009). The role of sexual and reproductive rights in social work practice. Affilia: Journal of Women & Social Work, 24(2), 108-119.
Fitzgerald, H. E., & Barton, L. R. (2000). Infant mental health: Origins and emergence of an interdisciplinary field. In J. D. Osofsky & H. E. Fitzgerald (Eds.), WAIMH handbook of infant mental health, Vol.1: Historical, cultural, and international perspectives on infant mental health. New York: John Wiley & Sons, Inc
Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician-patient racial concordance and disparities in birthing mortality for newborns. PNAS Proceedings of the National Academy of Sciences of the United States of America, 117(35), 21194-21200.
Kirkpatrick, W. (2019, May 20). [Conference Presentation]. How to evaluate nearly any type of training. ATD 2019 Conference, Washington, DC, United States.
Lester, B. M., & Sparrow, J. (2010). Nurturing children and families: Building on the legacy of T. Berry Brazelton. Wiley & Sons.
Patterson, J. E., & Vakili, S. (2014). Relationships, environment, and the brain: How emerging research is changing what we know about the impact of families on human development. Family Process, 53(1), 22-32. doi:http://dx.doi.org.ezproxylocal.library.nova.edu/10.1111/famp.12057
Stone, H. A. (2012). Training infant mental Health Therapists: Characteristics Related to Outcomes [published doctoral thesis]. University of Illinois at Chicago. UMI Number: 3542759Zeanah, C. H. (2019). (Ed.). Handbook of infant mental health. (4th edition). New York, NY: Guilford.
 
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The AAMFT Blog
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TREATNET Family and the United Nations: Family Therapy with Adolescents at Risk of Substance Abuse and Contact with the Criminal Justice System
In 2018, we (LLC and MP) met in person for the first time in the lobby outside a large conference room at the United Nations Office in Vienna. Although we had collaborated previously (Palit & Levin, 2016; Charlés & Samarasinghe, 2016), we had never met face-to-face. In Vienna, we were invited participants in a United Nations Office on Drugs and Crime (UNODC) technical consultation: “Elements of Family-based Treatments for Adolescents with Drug Use Disorders: Creating Societies Resilient to Drugs and Crime. ” This consultation meeting included 25 experts across the fields of family therapy, staff from the UNODC PTRS unit, and the World Health Organization, and subject matter experts in substance use disorders and countering violent extremism. The meeting was convened for a memorable week in Vienna, with participants from over 13 countries. The goal of the meeting was “to identify key elements of effective approaches to the treatment of adolescents with drug use disorders and to provide guidance for the development of a UN training package on family therapy.” A key aspect of the “effective approaches” and “guidance” asked of us as a group of technical experts was that we had to consider FT adaptation and implementation in low and middle income countries. The challenge is clear; while research studies in many contexts illustrate how systemic family therapy practices are part of the evidence base, Busse et al. (2021) noted that:
…almost all these studies were conducted in high-income countries and almost all of them were conducted within a research context in university setting. As such, the findings might not be generalisable to studies conducted in LMICs …. Furthermore, adolescents with SUDs and their families in LMICs do not have or very little access to effective treatment such as family-based therapy. To address this accessibility gap as well as to increase quality and diversity of treatment options for adolescents with drug and other SUDs, the Treatnet Family (TF) was developed by the United Nations Office on Drugs and Crime (UNODC; 2020). (p. 2)
That package that was begun in 2018 in Vienna is now called Treatnet Family (see below for an example of some of the concepts addressed in the package). Treatnet Family has been a part of feasibility studies, has been implemented in many countries and regions, and involved hundreds of practitioners across the globe. The package is openly accessible at no cost, and as of this writing, has been translated into four languages, with more on the way. We need more multilateral efforts and collaborations like this one, and family therapy as an established field needs to hear much more and much more often about the ways practice must be adapted to meet country contexts across the globe.
A recent publication by Busse et al. (2021) described Treatnet Family (TF) as:
containing elements of evidence-based family therapy which has been developed specifically for adolescents with SUDs and their families in low resource settings. TF focuses on family interactions and uses elements of family therapy to interrupt ineffective communication within the family. It contains the key components of family therapy, such as:
positive reframing (i.e., positive labeling of a negative behavior without necessarily accepting it as fine. It involves emphasizing the possible positive intent behind a seemingly negative behavior),
positive relational reframing (i.e., positive labeling of a negative behavior in relationship to the family without necessarily accepting it as okay. Even when the behavior is self-destructive, the intent behind it can be understood and appreciated, yet not necessarily condoned).
perspective taking (i.e., developing empathy and the ability to take another person’s viewpoint into account).
relational questions (i.e., to support perspective taking, relational questions are asked [e.g., “When Narendra gets into trouble, who feels most sorry for him?”] in order to encourage perspective taking and relational thinking).
going with resistance (i.e., helping family members feel heard and understood, which reduces defensiveness and makes more productive conversations possible).
TF has six sessions, with each session lasting between 90 and 120 minutes. Each session is to be attended by the adolescent with SUDs and his/her family members because the primary focus of the sessions is on the relationships among family members. The practitioner’s role is to interrupt problematic cycles, ineffective communication, and harmful behaviors family members currently use to meet their emotional and interpersonal needs. As change in family interaction can influence each family member’s behavior, family members are encouraged to be part of the solution.” (p. 2)
For more on Treatnet Family: https://www.unodc.org/documents/southeasterneurope/UNODC_Treatnet_Family_brochure_190320.pdf
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Definitions
The following are definitions for terms commonly used pertaining to becoming licensed in other states or practicing in other states. The definitions below represent how these terms are used in this article and may not represent how these terms are defined by others:
Portability: Portability or license portability is the general ability to take an individual’s qualifications for a license in one state and apply them for licensure in another state. The term “portability” is used to describe the various methods to allow a licensee in one state to be able to legally provide services to clients in other states, including through model laws, reciprocity, endorsement, or compacts.
Model Laws: Model laws, also referred to as model portability laws, are laws included as provisions within existing state licensure statutes that allow out-of-state licensees to obtain a license in a state in an expedited fashion without having to meet all of the requirements that an associate clinician applying for initial licensure would have to meet. Most MFT state licensure laws contact such model laws allowing an MFT licensed in another state to obtain licensure if they meet certain requirements or have been licensed for several years. Model laws are far more common than licensure compacts. Unlike compacts, the language in model laws can differ from state to state.
Endorsement: Endorsement generally describes laws that allow a state board to recognize or endorse a person’s license granted in another state, allowing that person to become licensed in the endorsing state. The terms “portability” and “endorsement” are commonly used interchangeably.
Reciprocity: Licensure reciprocity is when a state honors and recognizes licensees from certain other states through mutual agreements in other states. However, in the healthcare field, these agreements, which must be approved by officials in each state, are not found in most states pertaining to mental health licensure as states are reluctant to grant reciprocity.
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Afghan Family Evacuees: “Not just here for themselves”
I (LLC) interviewed Alexandra “Xan” Weber, International Institute for New England’s (IINE) Senior Vice President for Advancement. IINE was founded in 1918, and is a non-profit social service organization that serves refugees and immigrants through resettlement, education, livelihood/career advancement and support for the journey toward citizenship. Responsible for resource development, advocacy, and strategic initiatives, Xan oversees the organization’s fundraising, institutional partnerships, advocacy initiatives, and strategic planning. She began her career at IINE in 2008 as IINE’s Director of Community Services, managing the Boston site’s refugee resettlement program, various victim services projects, and behavioral health services. IINE is an affiliate of the United States Committee for Refugees and Immigrants, and one of the nine national networks contracted with the U.S. Department of State to resettle Afghan evacuees. In 12 weeks, IINE resettled over 450 Afghan evacuees throughout New England.
Laurie: What are the most important things that clinicians need to know about this group? 
Xan: In my presentations to the community, I often list everything that refugees usually go through—statelessness and forced migration, violence, war. This population faced an additional challenge—evacuation, an additional trauma. At IINE, we’re not used to receiving evacuated populations who have had no time to prepare and process their resettlement. Afghan evacuees did not prepare for resettlement and I think that that in itself has created another layer of suffering. We are meeting many Afghans who do not have a sense of refugee identity. Evacuees made a life or death decision to evacuate—a lot to process in just a short amount of time. And we’ve heard the actual evacuation itself was horrible and traumatic. People rushing the airports and tarmacs and getting trampled, getting pulled over barbed wire fencing to reach an airplane, some people making it onboard and others not and families separated.
Afghan evacuees were air evac’ed from Afghanistan to a third country, and this step added to the complexity of their resettlement process. From overseas bases, evacuees were flown to Dulles Airport in Virginia and then dispersed to military bases in the U.S. A shuffling between U.S. bases in multiple countries is not the typical refugee experience, and when they arrived at U.S. bases, most lacked processing documentation. Lack of documentation impacted evacuees’ sense of security—they did not enter the country with traditional refugee documentation, work authorization, etc. The U.S. government didn’t really know who they were and they had to go through months of processing on U.S. bases to generate critical documents. On the U.S. military bases, families struggled. Even if they had shelter, heat, and food that they could eat, for some there was so much dust in the air, their children had asthma attacks. 
Laurie: Can you say a bit more about the term used for the evacuees? “Humanitarian parole”?
Xan: Most Afghan evacuees were offered Humanitarian Parole by the U.S., and they entered as parolees. Humanitarian Parole is a rare authorization—it’s an opportunity offered to people ineligible for admission to the U.S. to enter temporarily due to a compelling emergency. This designation is outside of refugee processing, and it doesn’t confer the same benefits. Afghans who have humanitarian parole have been authorized to stay in the U.S. for two years, and within that time, they have to adjust their legal status or they will become unlawfully present. Afghan evacuee status presents, therefore, an additional significant concern—without a broad status adjustment of the 100,000 Afghans who are here now, every single one of them will need an attorney to adjust their legal status in the U.S. The adjustment process is extraordinarily time consuming and expensive.  
Laurie: How would you say your organization looks at mental health and psychosocial support needs of the families you serve, in particular the Afghan families? 
Xan: I think it’s our mission to consider clients’ health, mental health, and well-being. The logistical support offered by resettlement is not enough. Refugees by definition have been through persecution, for many physical and emotional violence, and upon resettlement need time to adjust. Ideally, IINE would have clinically-trained case workers who could enhance client health, even providing practical and logistical support alone. We don’t have many clinically-trained case workers on staff, but we are lucky because we work with amazing community health center partners, and over the summer we moved offices in Lowell and are now co-located with the Lowell Community Health Center. In considering our move, we asked ourselves, what’s the most important support that our clients need that we don’t provide? We don’t provide healthcare [at IINE]. In combining skill sets with partners, we can achieve holistic support.
Laurie: What have you seen that’s on the minds of these families? What’s the thing that they’re telling you or telling your caseworkers?
Xan: I’ve worked with a few Afghan families myself, and our staff have shared lots of different stories about their experiences resettling Afghan evacuees. Honestly, I think our staff, on the whole, are very challenged by many of the Afghan families that they’ve met. The evacuees’ expectations are so high, and many seem so dissatisfied with what we can offer through the resettlement program. The U.S. resettlement program is one-size-fits all: every refugee receives the same services and support, right down to the the number of forks, spoons, and knives per family…it’s very, very proscribed. 
At IINE, we’ve been doing this a long time—we try to assess each family’s needs and we give as much individualized support as we can. Because of an incredible outpouring of support from community members and funders, the Afghan evacuee population is receiving about five times the amount of funding and resources than any other resettling refugee population. But many evacuees are upset because they expect to resettle into a middle-class American life, and the U.S. refugee program doesn’t provide resources to begin life in the U.S. at that economic level.  Most families we have met are completely focused on their children, and they are here for their children. They’re also really focused on working; they want to get a job. They want to know where their paperwork is. They want to know where the grocery store is. They want to know how to get work authorization. They want to know where things are, they want to do things. They want a bank account, they want to finally move into the driver’s seat in their life after having a huge, disruptive time of feeling out of control. 
After the evacuation experience, it hard to know how so many function so well. Most are simultaneously experiencing deep grief, because most of their family is still in Afghanistan. 
Laurie: Have you noticed things that have worked that have been helpful to reduce the worry for the families you work with, or that caseworkers work with?
Xan: I think when evacuees get their questions answered, that’s the most helpful, moving away from complete uncertainty about everything and toward control. Even if it’s just receiving a food card to go and buy their own groceries. These are practical things that I think have helped people start making their decisions, and feeling more in control. 
Laurie: You mention the deep grief for families, who are separated from each other, with many still in Afghanistan. Can you say more about what is happening regarding reuniting families?
Xan: Most evacuees left most of their family in Afghanistan when they were evacuated. We refer evacuees to our attorneys to explore legal reunification options. But we haven’t had success in helping Afghan families in country to get out. An IINE case worker is an Afghan refugee whose family resettled in Canada, and she and her husband were admitted to the U.S. Her entire family fled Afghanistan through Pakistan, and just barely escaped. They recently  joined her sister in Canada. The CTV W5 Channel broadcasting station did an entire video series on her—with graphic footage of the Afghan evacuation. Watching it, I realized it is hard to put into context what people endured. People had to decide who in their family was going to try to evacuate and who would be left behind.
But those who fled have not left their connections behind. Many Afghans are motivated to resettle and work because they want to be able to send money home, to those now struggling in an Afghanistan on the verge of famine. I was just talking to someone who worked in Afghanistan for years, and he said all of the money wire channels are still open, and people can still send money through Western Union to family in Afghanistan. At the end of the day, what you learn as a resettlement provider is that those offered a chance to resettle in a new country and rebuild their lives are not just here for themselves. They try desperately to share even the most basic, modest support they are given with others still in hell.
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Afghan Family Evacuees: “Not just here for themselves.”
I (LLC) interviewed Alexandra “Xan” Weber, International Institute for New England’s (IINE) Senior Vice President for Advancement. IINE was founded in 1918, and is a non-profit social service organization that serves refugees and immigrants through resettlement, education, livelihood/career advancement and support for the journey toward citizenship. Responsible for resource development, advocacy, and strategic initiatives, Xan oversees the organization’s fundraising, institutional partnerships, advocacy initiatives, and strategic planning. She began her career at IINE in 2008 as IINE’s Director of Community Services, managing the Boston site’s refugee resettlement program, various victim services projects, and behavioral health services. IINE is an affiliate of the United States Committee for Refugees and Immigrants, and one of the nine national networks contracted with the U.S. Department of State to resettle Afghan evacuees. In 12 weeks, IINE resettled over 450 Afghan evacuees throughout New England.
Laurie: What are the most important things that clinicians need to know about this group?
Xan: In my presentations to the community, I often list everything that refugees usually go through—statelessness and forced migration, violence, war. This population faced an additional challenge—evacuation, an additional trauma. At IINE, we’re not used to receiving evacuated populations who have had no time to prepare and process their resettlement. Afghan evacuees did not prepare for resettlement and I think that that in itself has created another layer of suffering. We are meeting many Afghans who do not have a sense of refugee identity. Evacuees made a life or death decision to evacuate—a lot to process in just a short amount of time. And we’ve heard the actual evacuation itself was horrible and traumatic. People rushing the airports and tarmacs and getting trampled, getting pulled over barbed wire fencing to reach an airplane, some people making it onboard and others not and families separated.
Afghan evacuees were air evac’ed from Afghanistan to a third country, and this step added to the complexity of their resettlement process. From overseas bases, evacuees were flown to Dulles Airport in Virginia and then dispersed to military bases in the U.S. A shuffling between U.S. bases in multiple countries is not the typical refugee experience, and when they arrived at U.S. bases, most lacked processing documentation. Lack of documentation impacted evacuees’ sense of
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