Torture survivors who recently arrived in the United States and those who have been in the country longer-term may receive services. All individuals who request services must complete an initial assessment visit to establish eligibility for services and to assess their specific needs. To request services for yourself or to refer a potential participant to the center, contact the Operations Manager, Izabela Lundberg (at 303-321-3221 x203 or ilundberg@rmscdenver.org).

Healthcare
The Healthcare program at RMSC is a joint project with the University of Colorado Health Sciences Center School of Nursing (UCHSC-SON). The Director of Healthcare Services is a graduate-prepared public health nurse and a member of the clinical faculty of the school. Students from the undergraduate and graduate nursing programs provide direct services to participants at RMSC and in the community. With over four years of experience, the program has proven that this pioneering approach can assist participants in building healthy lives and futures.

Clinical Needs Survivors of torture and their families have multiple health care needs but they have rarely received any health care since they fled persecution. They suffer from the physical scars left by torture, as well as the physical complaints that are characteristic of post-traumatic stress disorder, such as insomnia, severe headaches, gastrointestinal complaints and chronic pain. The survivors and their families need care for neglected medical problems, screening for infectious diseases, preventive care, and health education. In order to access health care, they face the formidable barriers of language, cost and an unfamiliar system.

Clinical Services All participants are seen by a registered nurse for a comprehensive assessment of their health status and needs. The nursing staff then follows up on clinical concerns directly or provides referrals to care in the community, such as physicians, dentists, optometrists and audiologists. The nurses act as case managers for all services and provide health education for the participants and their families.

Community Services The nurses provide education for health care professionals and community groups on the health care needs of RMSC participants. RMSC recently established a collaboration and training program with The Caritas Clinic at Exempla Health Care St Joseph Hospital to provide specialized medical care to our participants.

Mental Health
The goal of mental health services is to address emotional, cognitive, psychosocial, and somatic consequences of torture and/or war trauma; and to support strengths and empower participants to build new futures in the community. Mental Health services include assessment, treatment, psychiatric evaluation (as needed), and medication management (as needed).

Group Focus The western model of mental health treatment is unfamiliar to most participants at RMSC, and individual psychotherapy may not be the best approach to healing in this cross-cultural context. The RMSC mental health program emphasizes group work because many RMSC participants come from communal cultures, where belonging to a community was central to learning skills, establishing a sense of identity, observing models for behavior, nurturing growth, and healing from emotional pain. Building trust and engagement in community is critical to torture survivors. Groups at RMSC encourage participants to become mentors, teachers, and supporters of each other's integration into a new culture, and emphasize commonalities within the human experience while respecting participants' diverse cultural backgrounds.

Individual Treatment The group program is supplemented by individual treatment for participants who present with issues better addressed by one to one mental health interventions. Individual treatment is goal directed and solution focused.

Psychosocial Services
Most participants at RMSC come to this country with limited resources, often related to the conditions under which they left their countries of origin. Asylum seekers, who petition to stay in the United States after they arrive, are not eligible for services provided to refugees—individuals and families who arrive with immediate eligibility for a range of community services. Housing, food, transportation, basic necessities, and financial backing are scarce or non-existent for many asylum seekers. Because many have escaped with nothing more than their lives, some participants have left families in their home countries; many do not speak English; and the American system of accessing resources is foreign to them. Participants typically come to RMSC with high needs and few resources.

Meeting Basic Needs Although participants may present with significant psychosocial and emotional concerns, these issues cannot be adequately addressed until basic needs are met. Psychosocial Service caseworkers assess each participant's needs and resources. In consultation with the multidisciplinary team, recommendations are made to address some participant needs. Based on the assessment of individual needs, a participant may receive food cards for basic or supplemental groceries and bus passes for transportation to services and community resources. Although RMSC does not provide financial assistance for housing, the caseworkers may assist by identifying resources for low-cost housing options. Caseworkers also teach participants how to locate and utilize community resources to meet basic needs.

Goals and Reassessment Caseworkers help participants identify goals and find resources. English language classes, introduction to work groups, networking in expatriate communities, gathering information about schools, and learning about parenting and safety represent some goals. Each participant receiving RMSC psychosocial Services is reassessed on a regular basis to determine progress toward goals and changing needs for services. When participants are granted asylum, they are typically referred to agencies mandated to serve asylees and refugees.

Legal Services
Over 85% of RMSC's participants are asylum-seekers who are in need of legal representation as they apply for asylum, withholding of removal and Convention Against Torture relief. Asylum law is an extremely complex area of the law. Unfortunately, asylum-seekers in our community often fall prey to non-lawyers who charge high fees and harm asylum-seeker's ability to gain asylum. RMSC is one of only three non-profit agencies in Colorado that provides free legal representation to asylum-seekers who cannot afford private attorneys.

Representation The Legal Department, through its Director and a growing corps of volunteer attorneys, provides representation at all levels of the asylum application process, including the filing of applications for employment authorization and asylum, and representation before the Department of Homeland Security, in immigration court proceedings, and before the Board of Immigration Appeals and the U.S. Circuit Court of Appeals for the 10th Circuit.

Outreach and Advocacy The Legal Director also conducts extensive outreach on a national and local level to educate and train attorneys, law students, non-profit staff, government officials and the public regarding issues affecting asylum-seekers and torture survivors. RMSC, through its Legal Director, advocates for changes to existing law that would ensure the asylum-seekers and refugees are protected and not returned to countries where they are likely to be tortured.

Interpreter/Translation Bank (ITB)
RMSC has a comprehensive ITB formed to serve torture survivors and their families from all over the world. Currently the ITB has more than 50 active professionally trained interpreters /translators who are providing quality services in more than 35 languages in legal, health and psychosocial settings. The ITB is always looking for talented bilingual individuals interested in providing such services. This position is paid and utilized as needed on a contractual basis. For any inquiries please contact Izabela Lundberg at 303-321-3221 ext. 203 or ilundberg@rmscdenver.org.

Culture Broker Program (CBP)
Through our CBP, experienced interpreters may receive further training and join our emerging core of culture brokers (CBs). CBs are outreached-oriented members of refugee communities who communicate across cultures in our health systems, schools, courts, and between refugee communities and the "mainstream." The CBP is a fee-based opportunity for providers of services in Denver and surroundings to access informative and critically needed cultural information about RMSC participants they are working with, and for participants to have their cultural concerns clearly represented. For any inquiries please contact Izabela Lundberg at 303-321-3221 ext. 203 or ilundberg@rmscdenver.org.

Volunteer Program
RMSC volunteers contribute their skills, experience, and ongoing support to enhance the agency's efforts to provide meaningful and comprehensive services. Volunteer opportunities focus on five major areas of activities, including: special event planning; group support; participant support activities; resource development and research, and office and administrative support. Please contact Pam Nelson at 303-321-3221, ext. 213, or at pnelson@rmscdenver.org for further information.