Global tragedies continue to have devastating impact on the populace, particularly women and children. One of the consequences is that immigrant, refugee, and racialized women of Saskatchewan have experienced a number of traumatic events. Yet, women presenting symptoms of Post Traumatic Stress Disorder (PTSD) encounter mental health service providers with little or no experience working with immigrant, refugee and racialized clients. Many immigrant, refugee and racialized women fail to access the health care system for varying reasons, including language barriers and cultural differences between health providers and clients that create structural and systemic problems.

Purpose Of The Research
The initial project "PTSD: The Lived Experiences of Immigrant, Refugee, and Visible Minority Women in Saskatchewan," proposed a number of recommendations as ways of providing quality care to immigrant, refugee, and racialized women with PTSD symptoms. The ultimate objective of this current study, Women and PTSD: Moving Research to Policy was to develop policy statements and a communication strategy to improve and increase accessibility to services for immigrant, refugee, and racialized women in Saskatchewan who present symptoms of PTSD.

Method
Focus groups were held in Moose Jaw, Regina, Saskatoon, and Yorkton. A total of 36 individuals participated in these groups. The participants were representative of the sample of the PTSD study completed in 2000The groups included representatives of health departments and multicultural organizations, health professionals and immigrant, refugee and racialized women.

Issues Identified
Participants identified several key issues that impacted on the lives of immigrant, refugee and racialized women who were at risk of suffering, or who reported symptoms of PTSD. These included the need to improve accessibility and utilization of mental health services, the need to empower clients, the need to address the issue of the links between racism and mental health, the need to normalize traumatic responses, the need to enhance the relationship between health providers and service users. The study also identified a need to enhance awareness of use/misuse of medication (both on the part of medical profession, and on the part of users), and the issue of language as a barrier in health care.

Conclusions
The study described a number of policies and actions that will guide the work of Immigrant, Refugee and Visible Minority Women of Saskatchewan (IRVMWS) during the next several years. The following actions are those in which IRVMWS will play a lead role IRVMWS is also committed to collaboration with other organizations to provide advice and guidance on developing proposals and effective mechanisms for carrying out the recommendations to governments and other agencies.

IRVMWS recognizes the importance of considering the influence of PTSD in counseling and support services for newcomers, and will ensure that its programs and services address the needs of women with PTSD. The organization will strive to ensure that all front line workers and volunteers participate in training to assist them with identifying and working with individuals with symptoms of PTSD

IRVMWS will serve as a catalyst to set up a multidisciplinary coordinating team on PTSD, and will serve as interim chair while developing terms of reference.

IRVMWS will take the lead in promoting culturally specific policies and programs to recognize the importance of past traumatic experiences to the integration of immigrant, refugee and racialized women. This leadership will involve collaborating with other agencies that serve immigrant, refugee and racialized populations:

IRVMWS will work with ESL educators to integrate training and awareness of PTSD and trauma into all ESL curricula and programs. IRVMWS will do this through workshops and presentations to ESL educators.

IRVMWS will produce pamphlets in different languages to be accessed by immigrant, refugee and racialized women.

Recommendations To Governments And Other Agencies
The responsibility of ensuring full integration of immigrants, refugee, and racialized individuals and groups lies with all levels of governments - municipal, provincial and federal. The following are the recommendations for action by governments and other agencies for the policy issues identified through the research.

1. Multidisciplinary Coordinating Team

1.1 That governments and agencies participate in a Multidisciplinary Coordinating Team on PTSD.

1.2 That funding agencies and organizations include a statement of support for the Multidisciplinary Coordinating Team within their funding strategy.

1.3 That the Multidisciplinary Coordinating Team on PTSD will develop a broad-based media campaign to raise the awareness and knowledge of PTSD, following the suggestions found in this report.

1.4 That the Multidisciplinary Coordinating Team on PTSD develop a strategy to provide ongoing specialized training related to Post Traumatic Stress Disorder to a broad range of service providers, following the suggestions found in this report.

2. Improved Public Understanding

2.1 That Saskatchewan Health include a statement of commitment to informing the public about PTSD within their health promotion strategy.

2.2 That Saskatchewan Health collaborate with the Multidisciplinary Coordinating Team to enhance awareness of PTSD through information, education and communication.

2.3 That all levels of government enact and implement policies, programs and statutes that would specifically recognize PTSD as an important factor mitigating against the full integration of immigrant, refugee, and racialized women.

3. Curriculum for ESL and Other Students

3.1 That material on PTSD be developed and included in the ESL curriculum.

3.2 That the Saskatchewan Department of Learning collaborate with the Multidisciplinary Coordinating Team to develop curriculum material on PTSD for students in K-12 schools, public libraries, SIAST and universities.

3.3 That policies to collaborate with the Multidisciplinary Coordinating Team to develop curriculum focusing on PTSD be established and implemented by: the Saskatchewan Department of Learning; the University of Saskatchewan Colleges of Nursing and Medicine; the Faculties of Psychology at the University of Saskatchewan and the University of Regina; and, the Saskatchewan Institute of Applied Science and Technology Nursing Education Program.

4. Training for Service Providers

4.1 That training on how to deal effectively with the growing cultural diversity in Canadian society be provided to all health care professionals and other social services providers including police, immigration officers, resettlement officers, ESL instructors and educators.

4.2 In particular professionals and service providers should be made aware of the traumatic experiences of newcomers, immigrant, refugee, and racialized women. Professionals and service providers must receive appropriate training to enable them to appreciate the different manifestations of traumatic experiences in the day-to-day activities of survivors and their families.

4.3 Governments and service delivery organizations need to develop culturally and individually specific responses to clients presenting symptoms of trauma.

5. Service Delivery

5.1 That all levels of government make counseling newcomers an integral part of their resettlement programs, and attempts be made to identify PTSD in the process of counseling.

5.2 That Saskatchewan Health and other health authorities institute policies addressing more appropriate and accessible intake and service delivery for persons with PTSD.

5.3 That options be created for delivery of services related to PTSD, including mental health services, in locations other than in traditional or mainstream centers.

5.4 That government establish and fund women's health clinics within multi-purpose centres.

5.5 That health care providers and other first line workers, ESL instructors, resettlement officers, schools, immigration officers, police and other professionals collaborate in identifying the symptoms of PTSD, its effects and the likelihood of recurrence following similar traumatic situations.

5.6 Service provider organizations are encouraged to use resource material on PTSD in a variety of situations, including therapy groups, shelter programs, immigration programs and employment training programs.

6. Physician Care

6.1 That steps be taken to enhance physician billing methods so that they support the provision of good quality care and not quantitative health care.

6.2 That the Government of Saskatchewan provide additional incentives to physicians dealing with immigrant, refugee and racialized groups and other less privileged persons or groups as a way to encourage physicians to spend quality time with such clients.

7. Recognition of Foreign Credentials

7.1 That all levels of government recognize the foreign qualifications of immigrant, refugee and racialized individuals, and that this recognition occur as part of the resettlement process.

7.2 That governments and educational institutions continue to work towards the full implementation of Prior Learning Assessment, as quickly as possible.

7.3 That governments work towards improving the proportion and contribution of immigrant, refugee and racialized people to all departments, including the health sector.

7.4 That governments and health care organizations develop strategies for upgrading and training immigrant, refugee and racialized individuals who have worked for many years in health care.

8. ESL Training

8.1 That the costs of providing English as a Second Language (ESL) for newcomers be the responsibility of all levels of government.

8.2 That additional funds be allocated to second-language classes such as ESL.

8.3 That ESL training be provided to all Canadian residents (including immigrants, Canadian born individuals whose parents are immigrants, racialized groups and Aboriginal people) not only refugees, who lack the language skills necessary to become functional in the society.

8.4 That the ESL program become more flexible in terms of maximum hours of learning.

8.5 That all levels of government be encouraged to work with employers to provide tax rebates to motivate the introduction of language instruction in the workplace, including ESL or French language instruction.

9. Violence and Family Breakdown

9.1 That governments and agencies develop more culturally sensitive programs to support immigrant, refugee and racialized women and their families who are victims of family violence.

9.2 That the federal government examine its immigration policy and its implementation to ensure that there are mechanisms other than deportation for immigrant and refugee women whose sponsorship arrangements break down, and that this policy be well communicated to immigrant and refugee women.

9.3 That alternatives to deportation be established for immigrants and refugees charged or convicted with family violence.

9.4 That Citizenship and Immigration Canada and other levels of government establish follow-up mechanisms to ensure the protection of immigrant, refugee, and racialized women who are survivors of violence.

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