Transcript Center for Victims of Torture in Guinea, West Africa

Center for Victims of Torture
International Services Program
CVT International Services Program
Description
• Countries with large population of highly
traumatized refugees/returnees Liberia, Sierra
Leone, Dem. Rep. Congo
• Qualified expatriate Clinicians provide
intensive hands on training to national
staff - Psychosocial Counselors (PSCs)
Current CVT International Services
Programs (ISP)
Sierra Leone
Kono district communities
Liberia
• Monrovia
• Lofa County
• Bong County
Dem. Republic of Congo
• Communities in Katanga
district (Pweto and Lubumbashi)
CVT ISP Key Activities
I. PSC Training
2. Client Care
3. Community Outreach
Key Activity 1 – Training the PSCs
CVT Clinicians recruit and train Psychosocial Counselors
(PSCs) from the refugee community.
The PSCs start an intensive training program that continues
throughout their career with CVT.
Key Activity 1 – Training the PSCs
PSCs serve as interpreters and cultural brokers
and help to adapt counseling models to local
settings
• Initial two-week training
• Pre- and post-testing
• First, PSC observes Clinician lead
session
• PSC co-leads, then leads
• Clinician observes and provides
feedback to PSC
• Ongoing monthly focused 1-3
day workshops
Key Activity 2 –Client Care
Elements of direct mental health services
• Client identification
• Intake assessment
• Group or individual treatment planning
• Counseling sessions
• Follow-up client assessments
• Home and family visits
• Referrals to other agencies
Key Activity 2 – Client Care
Small Group Counseling
– Sessions provide psychoeducation and opportunity for trauma
processing
– Sessions average 8-10 weeks, 1.5 hours per week
– Groups average 6-12 members
– PSCs participate initially as interpreters, then learn how to facilitate
groups on their own
Individual Counseling
– For clients unable to attend group sessions due to extremity of
symptoms or with a great need to address problems 1:1
– Carried out by expatriate Clinicians until PSCs ready to counsel on
their own
Counseling hut and PSCs
Key Activity 3 - Community
Sensitizations
• Raise awareness of
the prevalence and
effects of torture
• Help community
members know what
CVT does to help
survivors
• Help identify potential
clients.
Key Activity 3 – Community
Psychosocial Activities
• Provide activities such as
games, drama, arts and crafts,
and sports activities provided
regularly
• Engage the community in the
healing process, promoting
positive extra-curricular activities
for clients.
• Help identify new clients.
Target PopulationsBeneficiaries
• Survivors of torture and their families in
refugee settings or communities of return
• National Staff trained to serve as PSCs
• Staff at other agencies and community
leaders
Model Selection/Context
Indigenous capacity in mental health service provision
is non-existent or destroyed
Torture extremely prevalent among target populationmore than 50%
Availability of partner agencies nearby to provide basic
needs, security
Need to have enough staff to address high risk of
vicarious trauma for both expats and local staff
CVT ISP Strengths/Challenges
Strengths of ISP
Hands-on, immediate, continuous clinical supervision and
training, allows for long-term professional and documentable
skills building
Easier to document improvement in clients
Easier to adapt western therapy models to indigenous culture
Potential to integrate learning back at CVT headquarters
Immediate post-conflict response and treatment but have to
balance with security issues
PSCs heal from their own trauma through their work at CVT Relationships with families and others are improved
Challenges of ISP
Challenge to find qualified expatriate Clinicians and
And its very
integrate respective skills/interests
expensive!
Full program means covering all security, financial
accountability, human resources, personnel
management remotely
Building capacity of national staff to be more independent
providers requires 4-5 years minimum
Consistency required in services and training when much is
uncertain (funding, political conditions, logistics)
Community acceptance of mental health mission difficult
with high material needs of beneficiaries
ISP Scope
Over the 3 programs in Sierra Leone, DRC and Liberia
2,227 clients received direct counseling in 2006
10,714 clients since 1999
1 expatriate clinician required to supervise 12-15 PSCs
88 PSCs and 6 expatriate clinicians currently
Over 250 PSCs trained since 1999
26,671 community members participated in sensitization in
2006
1,951 NGO partners, health care, teachers and community
leaders trained in 2006
ISP Scope
Sierra Leone
Kono district
communities
Admin office in
Freetown
Pweto
Liberia
Lofa
Dem. Republic of
County
Congo
Bong
Katanga district
County
(Pweto and
Monrovia
Lubumbashi)
Four to five communities for each site in each country
Sustainability
• Must build skills of entire staff, not just PSCs, to
ensure long-term sustainability
• Requires a resource rich and/or diversified
donor base to meet the costs
• Requires clear justification to donors of need for
development of national staff as mental heath
paraprofessionals and of time it requires
Effectiveness
• Better ability to document improvement in
clients through long-term follow up
• Widely accepted in communities of
operation after initial skepticism
• Good response to services from
communities and partner agencies
Evaluation
• Clients-- at 3-month intervals,
symptoms; social support;
behavioral functioning
• PSCs--internal trainings and
performance
• External training of partners,
health care, teachers, religious
and community leaders
• Clinicians--performance
Lessons Learned
•
•
•
•
Need to make sure there are enough resources
Good field management essential
Good financial management essential
Orientation to CVT organizational culture
important
• Not stretch staff too thinly
– Concentrate staff in minimal number of sites
• Communities of return more challenging than
refugee camps Tired clinicians
• Support is crucial
Ethical Considerations
• How to address the issue of ongoing
clinical supervision
• What can we offer our staff in terms of a
“leave behind” piece?
• How to practice as a Human Rights
organization
• Standards of practice (confidentiality, etc)
Thank you