Toolkit: Empowering Service Providers to Support Refugee Mental Health with Trauma-Informed Care

Empowering Service Providers to Support Refugee Mental Health with Trauma-Informed Care

This toolkit is designed for service providers who work with refugees and refugee claimants, offering a practical guide to providing trauma-informed care and settlement support. The toolkit is rooted in principles of human rights, social justice, and Canada’s commitments under International Humanitarian Law, and focuses on supporting the mental health of forced migrants.

This toolkit provides a structured framework to better understand the refugee experience, apply trauma-informed care principles, and incorporate self-care strategies for both service providers and clients. It also contains essential tools, resources, and strategies to improve your work and foster a compassionate, effective response to refugee needs.

 

This toolkit has been developed, curated and written by VAST, in partnership with the BC Refugee Hub, as part of the BC Safe Haven Resource Network, led by AMSSA, funded by the Province of British Columbia.

Part 1: Supporting Refugee Mental Health & Trauma Informed Practice

Refugees face unique challenges across three stages:

  1. Pre-Migration: Exposure to violence, persecution, and instability.
  2. Migration: Journey marked by danger, uncertainty, and loss.
  3. Resettlement: Adjusting to a new environment while processing trauma.

Important Considerations:

  • Stress vs. Distress: Recognizing the difference between normal stress and harmful, pervasive distress is crucial in supporting refugees.
  • Pre-existing Resources: Building on survivors' strengths, skills, and knowledge and wisdom developed from their past experiences is key to effective support.

Understanding the connection between chronic distress and trauma is essential. When distress stems from systemic violence, such as torture inflicted by institutions meant to protect, support must go beyond symptom management to include trauma-informed care and the right to rehabilitation. Recognizing this helps us better respond to the complex realities many survivors carry with them.

Manual: International Rehabilitation Council for Torture Victims (IRCT) - Global Standards on Rehabilitation of Torture Victims

Training: The Centre for Addiction and Mental Health (CAMH) - Immigrant and Refugee Mental Health Main Course

Training: Canadian Centre for Victims of Torture (CCVT) - National Trauma-Informed Care Training Project

Research Article: Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized.

Research Article: Moving from compassion fatigue to compassion resilience Part 4: Signs and consequences of compassion fatigue

Quick Read: Compassion fatigue: Signs, symptoms, and how to cope

Quick Read: The Zone of Fabulousness: Resisting vicarious trauma with justice doing

Video: Alternative ways to look at Vicarious Trauma & Worker Burnout: The Zone of Fabulousness

Quick Read: Understanding Refugee Trauma and Recovery: A Guide

Quick Read: The National Child Traumatic Stress Network

Quick Read: Refugee Mental Health: What You Need To Know

Research Article: Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

Manual: Fraser Valley Refugee Response Team (RRT) Information Sheet: Supporting Refugee Clients Who Have Experienced Trauma

Research Article: Applying Trauma-Informed Practices to the Care of Refugee and Immigrant Youth: 10 Clinical Pearls

Manual: Pacific Immigrant Resource Society - Community Based Training Guide: A Trauma-Informed Approach

 

Part 2: Torture Definition and Prevalence

Canada signed and ratified the United Nations Convention Against Torture (UNCAT) in 1987, agreeing to prevent torture locally and globally, and support the rehabilitation of survivors. According to UNCAT, torture involves intentionally inflicting severe physical or psychological pain on someone for purposes such as punishment, intimidation, obtaining information, or discrimination. Necessarily, torture refers to violence done by an institution that should be supporting or protecting a person, including police, military, healthcare, and education systems; and the violence is done based on some aspect of the individual’s identity. Most people may not be aware, but local and global data indicate that approximately 35% of all refugees and refugee claimants are identifiable as survivors of torture.

VAST has received continuous support from the United Nations Voluntary Fund for Victims of Torture since 1993, longer than any other rehabilitation centre globally. We strongly believe in every survivor's right to rehabilitation, as outlined in international standards, including the Istanbul Protocol which defines how we can document the physical and psychological impacts. VAST is also a member of the International Rehabilitation Council for Torture Victims (IRCT), a global network focused on survivor rehabilitation and the prevention of torture.

Additional resources:

Quick Read: The Centre for Victims of Torture - Effects of Torture

Manual: The Centre for Victims of Torture Manual for Group Counseling

Policy: Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

Policy: Implementing The Right to Rehabilitation

Policy: Istanbul Protocol

The Hakomi Principles guide VAST’s trauma-informed care approach:

  • Non-Violence: Creating a respectful, compassionate environment.
  • Mind-Body Integration: Understanding the deep connection between physical sensations, emotions, and unconscious patterns.
  • Unity: Emphasizing the interconnectedness of the human experience.
  • Organicity: Trusting in the innate wisdom and self-healing capacity within each person.
  • Mindfulness: Using present-moment awareness to explore and transform core beliefs.

Judith Herman’s Stages of Trauma Recovery are crucial for understanding refugee healing:

1. Safety and Stabilization: Ensuring safety and stabilizing the emotional state.

Recognizing the Stage:

  • The client exhibits signs of feeling unsafe, both internally (e.g., emotional dysregulation) and externally (e.g., unstable living conditions, basic needs unmet).​
  • They may struggle with basic self-care, experience sleep disturbances, or have difficulty managing strong emotions.

Support Strategies:

  • Establish a Safe Environment: Ensure the client feels physically and emotionally secure. This can include consistency, transparency, and clear expectations and boundaries.​ Also consider Maslow’s Hierarchy of Needs, clients basic needs must first be met - See ‘Additional Resources’ below.
  • Develop Coping Skills: Introduce techniques such as mindfulness, deep breathing exercises, or grounding methods to help manage overwhelming emotions. See Section 4: Trauma-Informed Group Techniques for tools.

2. Remembrance and Mourning: Processing traumatic memories and grief.

Recognizing the Stage:

  • Client begins to express a desire to discuss traumatic experiences or shows signs of reflecting on past events.​
  • They may exhibit grief, sadness, or a need to make sense of their experiences.

Support Strategies:

  • Facilitate Therapeutic Expression: Provide opportunities for the client to narrate their trauma in a controlled, supportive setting, ensuring they don't become overwhelmed or re-traumatized.
  • Encourage Creative Outlets: Utilize art, music, or writing therapies to help clients process emotions nonverbally, which can be less triggering. See Part 5: Expressive Art Therapy below.

3. Reconnection: Rebuilding relationships and understanding of self in a new context.

Recognizing the Stage:

  • Client shows interest in rebuilding relationships, engaging with the community, or pursuing personal goals.​
  • They exhibit increased confidence and a desire to establish a new sense of self.

Support Strategies:

  • Encourage Community Engagement: Support involvement in local groups or activities that align with their interests.​
  • Assist in Skill Development: Assist in identifying and pursuing educational or vocational opportunities to build autonomy and self-efficacy.

Additional resources:

Research Article: The Stages of Change: When are Trauma Patients Truly Ready to Change?

Research Article: Recovery from psychological trauma

Quick Read: 3 Stages of Recovery from Trauma & PTSD in Therapy

4. VAST Vulnerability Screening Tool

VAST utilizes and shares its Vulnerability Assessment Tool to identify the urgent needs of refugees and prioritize their care. The tool involves a semi-structured interview and can be a good precursor to later using such standardized psychological measurements tools such as:

  • Hopkins Symptom Checklist (HSCL)
  • Harvard Trauma Questionnaire (HTQ)

Additional resources:

Tool: VAST - Vulnerability Screening Tool

 

 

Part 3: Trauma Informed Group Model

Trauma-informed group support recognizes the profound impact of trauma on individuals. It creates a space where survivors can safely process their emotions and experiences. The core principles of trauma-informed group support include:

  • Safety: Ensuring a predictable and non-judgmental environment where participants feel secure.
  • Empowerment: Allowing participants to have control over their healing journey by making choices about their participation.
  • Collaboration: Building trust through shared experiences and mutual support.

This approach reduces isolation, enhances emotional regulation, and fosters collective healing.

Additional resources:

Manual: VAST Landing and Settling: A Group Therapy Program for Refugees in British Columbia

Research Article: Inclusion, exclusion, and group psychotherapy: The importance of a trauma-informed approach

Research Article: Trauma-Informed Groups: Recommendations for Group Work Practice

Quick Read: Group Therapy for Trauma: Is It Effective?

Support groups can be a powerful space for connection, healing, and empowerment, especially when created with intention, cultural sensitivity, and trauma-informed practices. While this guide provides an overall structure for non-clinical support groups, it's important to note that facilitators should have experience working in the field and be skilled in using culturally responsive, invitational language. These groups should not be used as substitutes for clinical therapy but can offer meaningful peer-based support and community-building.:

If you are designing or facilitating support groups, consider the following general stages of group development. Each stage plays a key role in building safety, cohesion, and group effectiveness:

1. Forming: at this stage the group is just coming together. Members are often quiet and cautious.

Example: A support group for refugee women meets for the first time. Participants observe quietly, unsure if it’s safe to share.

Tip: Set clear norms and agreements. Establish safety, clarify the group’s purpose, and allow space for trust to build.

2. Storming: Differences or tensions emerge as members begin to engage more openly.

Example: One participant speaks frequently while another withdraws. A group member challenges a guideline.

Tip: Normalize conflict as part of growth. Model respectful dialogue and support the group in navigating differences.

3. Norming: Trust begins to build; participants feel more comfortable, and roles are better understood.

Example: Group members begin to check in on each other and support quieter voices.

Tip: Reinforce shared agreements. Use rituals (like opening circles) to deepen connection.

4. Performing: the group is cohesive and focused. Participants share more deeply and support one another.

Example: A trauma support group co-creates coping strategies and shares personal experiences.

Tip: Support participant leadership and autonomy. Facilitate gently while allowing peer dynamics to lead up members actively work toward their goals.

5. Adjourning: The group ends. Members reflect, say goodbye, and process the transition.

Example: In the final session, members express gratitude, share reflections, and plan to stay connected.

Tip: Provide space for closure and emotional reflection. Acknowledge the end and offer follow-up options or referrals.

If you're part of a clinical team, consider exploring the warming, middle, and ending stages in more detail, especially when working with trauma survivors. You can find further guidance with multiple resources listed below or you can reach out to VAST for inquiries. 

Additional resources:

Video: Stages of Group Therapy & Support Groups: Group Development Phases for Counseling and Therapy Groups

Quick Read: Tuckman’s Stages of Group Development

Academic Article: Leading Teams #2: Stages of Group Development

Trauma-informed groups must adhere to specific principles:

Choice and Autonomy: Participants decide their level of involvement.

Examples:

  • During a grounding activity, the facilitator says: “If you’d like to, you can close your eyes or just soften your gaze. Do what feels safest for you.”
  • In a storytelling circle, participants are reminded: “You’re always welcome to pass or share only what you’re comfortable with. There’s no pressure to speak.”

Inclusivity and Accessibility: Practices that honor diverse cultural and individual needs.

Examples:

  • Before the group begins, facilitators ask about dietary needs, cultural practices, or religious observances to ensure the space is welcoming and responsive.
  • The group offers multiple ways to participate verbally, through drawing, writing, using objects or symbols, or through an interpreter when needed.

Invitational Language: Avoiding pressure and allowing participants to engage at their own pace.

Examples:

  • Instead of saying “Now everyone needs to share,” the facilitator says: “You’re invited to share a word, a gesture, or simply listen, whatever feels right for you today.”
  • When introducing a group exercise: “This is something you’re welcome to try. If it doesn’t feel like the right fit, feel free to sit it out or observe.”

Collaboration: Groups are co-created spaces where participants feel valued and heard.

Examples:

  • On the first day, the group co-develops community agreements (e.g., confidentiality, listening with respect) together.
  • A participant suggests adding music to the opening routine, and the group tries it out, reinforcing shared ownership.

Additional resources:

Research Article: Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women

Book: Trauma-Informed Principles in Group Therapy, Psychodrama, and Organizations

Quick Read: Understanding Trauma-Informed Facilitation

Manual: BC Ministry of Education - Compassionate Learning Communities, Supporting a Trauma Informed Practice - Facilitator Guide

Quick Read: Guidelines for Planning and Facilitating Trauma- and Violence-Informed Meetings

Quick Read: Toolkit for Trauma- Informed Training Facilitation

 

Part 4. Trauma-Informed Group Techniques

Key techniques used in trauma-informed group support include:

  • Grounding Exercises: Focus on physical sensations, such as the "5-4-3-2-1" exercise, which helps bring participants into the present moment.
  • Mindfulness and Breathing: Techniques like box breathing to calm the nervous system and foster presence.
  • Movement: Gentle yoga or body awareness activities to release tension and improve self-regulation.

Below are more details about each of these techniques:

  1. 5-4-3-2-1 Grounding Technique: A simple, sensory-based grounding tool that helps reduce anxiety and overwhelm by bringing attention to the present moment. By focusing on 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, and 1 you can taste, this exercise gently redirects the mind away from distressing thoughts and helps reestablish a sense of safety and control.
  2. Box Breathing (Square Breathing): A calming breathing technique that regulates the nervous system and reduces physical symptoms of stress. By inhaling for 4 counts, holding for 4, exhaling for 4, and holding again for 4, this rhythmic practice slows the heart rate, eases tension, and supports emotional regulation. It is especially helpful during moments of fear or anxiety.
  3. Body Awareness Scan: A gentle mindfulness practice that supports reconnection with the body, a key aspect of trauma recovery. By guiding attention slowly through different areas of the body (e.g., feet, legs, arms, chest), participants become more attuned to bodily sensations, which helps them notice where they hold tension and where they feel calm, fostering grounding and emotional safety.

Additional resources:

Quick Read: Practicing Mindfulness in Groups: 8 Activities and Exercises

Quick Read: Trauma-Informed Mindfulness: A Guide

Research Article: Single vs. Group Mindfulness Meditation: Effects on Personality, Religiousness/Spirituality, and Mindfulness Skills

Research Article: Mindfulness-based treatments for post-traumatic stress disorder: a review of the treatment literature and neurobiological evidence

Research Article: The Role of Mindfulness and Embodiment in Group-Based Trauma Treatment

Manual: VAST - Group Therapy Manual

The trauma-focused group model offers several benefits:

  • Emotional Regulation: Techniques such as breathing exercises help stabilize emotions.
  • Community Building: Group support fosters connections with others who understand shared experiences.
  • Empowerment: Focuses on participants' strengths and agency, helping them regain a sense of control.
  • Accessibility: Groups offer a welcoming entry point for those hesitant about one-on-one counseling, and for organizations who may not have the funding resources to be able to offer individual supports
  • Mutuality: Being able to see ourselves in and through others is very helpful, and being able to see others at a different stage of the spectrum of healing, recovery, and progress, is beneficial to all, including to those who are able to shift to being in a position of helping others.

Additional resources:

Book: Theory and Practice of Group Counseling, 8th Ed.

Book Chapter: Group Work With Immigrants and Refugees

Quick Read: Group therapy is as effective as individual therapy, and more efficient. Here’s how to do it successfully

Quick Read: The Value of Support Groups

Quick Read: What is the impact of peer support groups on refugees’ mental health?

Research Article: Peer Support Groups: Evaluating a Culturally Grounded, Strengths-Based Approach for Work With Refugees

Research Article: Group Therapy for Refugees and Torture Survivors: Treatment Model Innovations

Powerpoint: Group Work: A Social Work Approach with Refugees

 

Part 5: Expressive Arts Therapy

Expressive Arts Therapy integrates creative practices such as visual art, music, movement, and writing to support individuals in processing trauma. It offers a non-verbal outlet for expressing emotions and experiences, which can be especially helpful for those who struggle to articulate their feelings verbally. This approach supports emotional release, self-regulation, and healing in a safe, imaginative space.

While Expressive Arts Therapy can be used in both clinical and non-clinical settings, this section focuses on how it can enhance non-clinical, community-based services. It can be a powerful tool for frontline staff, peer facilitators, and organizations working with trauma-impacted populations particularly in contexts where language barriers exist, or when working with children and youth, who may respond more readily to non-verbal forms of communication.

Appropriate settings might include:

  • Non-clinical support groups (e.g., for newcomers, youth, or survivors of violence)
  • Wellness workshops or drop-in creative sessions
  • Peer-led or community spaces focused on identity, belonging, or healing
  • Youth programs where play and creativity are central to engagement

You don’t need to be a therapist to integrate expressive arts into your work but it’s essential to use trauma-informed practices: invite, never force; offer structure and choice; and remain attentive to how creative work may surface complex emotions. Expressive arts can help participants feel seen, grounded, and connected without relying solely on words.

  • Holistic Engagement: Involves the mind, body, and emotions in the healing process.
  • Non-Judgmental Environment: Encourages self-expression without the need for artistic skill or judgment.
  • Process Over Product: The focus is on the experience of creating, not the final product.
  • Mindfulness: The act of creation helps individuals be present in the moment, reducing distress.
  • Empowerment: Participants have control over their creative choices, fostering a sense of autonomy.

Additional resources:

Video: What is Expressive Arts Therapy? An Introduction by Cathy A. Malchiodi, PhD

Research Article: Introduction to the Use of Expressive Arts in Counseling

Quick Read: 6 Benefits of Expressive Arts Therapy

  • Emotional Expression: Helps individuals express feelings that are too difficult to verbalize.
  • Healing Through Creation: Art offers a safe space for exploring trauma and healing without revisiting painful memories verbally.
  • Restoration of Control: Provides individuals with the tools to reconnect with their sense of self and regain control over their healing process.
  • Cultural Sensitivity: Creative expression is adaptable to diverse cultural contexts and can honor individuals' backgrounds.

Additional resources:

Video: Four Functions of Expressive Arts Therapy in Trauma Recovery by Cathy A. Malchiodi, PhD

Research Article: Effectiveness of trauma-focused art therapy (TFAT) for psychological trauma

Quick Read: What Is Trauma-Informed Expressive Arts Therapy?

Quick Read: Expressive Arts Therapy Is a Culturally Relevant Practice

  • Visual Art: Drawing, painting, and sculpting are common methods to represent emotions and release tension.
  • Music and Sound: Playing instruments or listening to music helps facilitate emotional regulation and expression.
  • Dance and Movement: Expressive movement allows the body to release stored trauma, promoting relaxation and healing.
  • Writing: Journaling or creative writing provides a channel for reflecting on and processing trauma.

Additional resources:

Research Article: The Connection Between Art, Healing, and Public Health: A Review of Current Literature

Video: Expressive Arts Therapy and Trauma: Movement, Sound, Image, Performance with Cathy Malchiodi, PhD

Quick Read: Expressive Arts Therapy: 15 Creative Activities and Techniques

 

Part 6: Organizational Assessment

Organizational assessments for trauma-informed and culturally appropriate practices are critical for ensuring that service providers are meeting the needs of refugees and other vulnerable populations. Assessments are most effective when integrated into regular review cycles and key transition points such as the launch of new programs, staff onboarding periods, or strategic planning phases.

Below is a brief overview of when each assessment type might be most useful and how often it can be conducted.

  • Self-Assessment: Ideal as a starting point for organizations new to trauma-informed practices, or as an annual check-in for ongoing efforts. Helps staff reflect on current awareness, safety measures, and the healing environment. Best used during strategic planning or after significant staff changes.
  • Reception/Frontline Service Assessment: Can be used bi-annually or annually to evaluate the client experience at initial points of contact. Especially helpful when onboarding new frontline staff or updating intake procedures, to ensure interactions are welcoming, safe, and culturally responsive.
  • Program Evaluation: Reviews the effectiveness of specific programs in meeting client needs and implementing trauma-informed care principles, best conducted at midpoint and endpoint of program cycles.
  • Managerial Assessment: Evaluates the organization’s management structure and practices, including leadership’s commitment to trauma-informed care and organizational support for staff, useful as part of performance reviews, leadership training, or organizational development efforts. Recommended annually or bi-annually.
  • Overall Organizational Assessment: A comprehensive evaluation of all aspects of the organization, ensuring alignment with trauma-informed and culturally sensitive practices at all levels. Should be conducted every 1–2 years, or before major transitions (e.g., restructuring, expansion, or accreditation).

Contact VAST if you are interested in obtaining support to conduct any of the below assessments.

Manual: Trauma-Informed Practice Guide (Ministry of Children and Family Development)

Toolkit: Canadian Centre for Diversity and Inclusion: Creating a diversity, equity, and inclusion strategy

Manual: National Association of Social Workers - Standards and Indicators for Cultural Competence in Social Work Practice

Manual: National Culturally and Linguistically Appropriate Services (CLAS) Standards

Manual: National Center for Child Traumatic Stress - Trauma-Informed Organizational Assessment

Quick Read: What is Culturally-Sensitive Trauma-Informed Care?

Research Article: Trauma-Informed Organizations

 

Part 7: De-escalation Techniques and Communication Strategies

De-escalation is a crucial process in conflict resolution, especially when working with individuals who may be experiencing trauma, stress, or emotional overwhelm. The goal is to reduce emotional intensity and regain control of the situation to prevent escalation into violence or further distress. A trauma-informed de-escalation approach involves understanding the person’s emotional state, maintaining calmness, and fostering a sense of safety.

At VAST, de-escalation is approached through both immediate crisis intervention and proactive communication techniques. This includes recognizing signs of emotional overwhelm, responding with empathy, and adapting to each individual’s cultural and emotional context. These strategies are particularly important in non-clinical support settings where service providers may be the first point of contact for individuals in distress.

Below are evidence-based strategies that combine communication skills, nervous system awareness, and trauma-informed values:

Observe and attune to emotional and physical cues
Pay close attention to tone, body language, and facial expressions. Look for signs like long silences, fidgeting, withdrawn eye contact, rapid breathing, or shakiness.
 → Respond with presence, not pressure. Adjust your tone and pace to match the person’s energy and comfort level.

Use reflective language
Repeat or rephrase the person’s words in a calm, non-judgmental tone to show you're listening and trying to understand.
 → “It sounds like you’ve been holding a lot.”
 → “What I hear you saying is…”

Use invitational not directive language
Avoid commands or rigid phrasing. Instead, offer choice and autonomy.
 → “Would it be okay if we paused here?”
 → “You’re welcome to take a break if that feels helpful.”

Name the emotion gently
If appropriate, name what you observe in a supportive way. This can help someone feel seen and less alone in their experience.
 → “This seems really overwhelming right now.”
 → “I can tell this is bringing up a lot.”

Regulate your own nervous system
You can’t co-regulate if you’re dysregulated. Before responding, take a breath. Slow your own tone and pace.
 → Practice brief grounding techniques: feel your feet on the floor, relax your shoulders, breathe slowly through your nose.

Use non-threatening non-verbal communication
Keep your body posture open, avoid sudden movements, and maintain a calm facial expression.
 → Sit or stand at eye level if possible. Don’t hover or crowd.

Offer silence and space
Silence can feel uncomfortable, but it allows time for emotional processing. Don’t fill the space—let the person lead.
 → Wait without pressure. Trust that silence can be part of healing.

Avoid over explaining or offering too much information
In heightened emotional states, people may not be able to process complex details. Less is more.
 → Keep responses short and supportive. Save logistics or next steps for when they’re calm.

Set respectful boundaries
If safety or focus is at risk, set clear, non-punitive limits.
 → “Let’s take a pause now so we can both feel grounded.”
 → “I want to continue this conversation, but we may need to come back to it when things feel more settled.”

Respect cultural context and language
Avoid idioms, jargon, or mental health terms that may not translate across languages or cultures.
 → Ask open-ended questions like: “How would you describe what you’re feeling in your own words?”

De-escalation is most effective when practiced with self-awareness, cultural humility, and compassion. It’s not about “fixing” the situation but about holding space for someone’s emotions, reducing harm, and supporting a return to safety.

Toolkit: CPI’s Top 10 De-Escalation Tips

Toolkit: De-escalation and responding to challenging situations

Quick Read: Collaborative communication during escalated situations

Video: Calming & De-escalation Strategies

Quick Read: The DBT STOP Skill

Course: Nonviolent Crisis Intervention Training

 

Additional Support

The Provincial Refugee Mental Health Information and Support Line

VAST offers a free, non-crisis support line for professionals supporting refugees and refugee claimants in BC. Services include consultation, resources, and referrals.

📞 778-653-8278
📞 Toll-Free: 1-888-619-8636
🕘 Mon–Fri, 9 AM–5 PM