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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)
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.
• 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
PSCs serve as interpreters and cultural brokers and help to adapt counseling models to local
settings
Key Activity 1 – Training the PSCs
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
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 Populations- Beneficiaries
• 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 population- more 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
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 integrate respective skills/interests
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
And its very expensive!
Over the 3 programs in Sierra Leone, DRC and Liberia
2,227 clients received direct counseling in 200610,714 clients since 1999
1 expatriate clinician required to supervise 12-15 PSCs
88 PSCs and 6 expatriate clinicians currentlyOver 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
ISP ScopeSierra Leone Kono district communitiesAdmin office in Freetown
Liberia Lofa County Bong County Monrovia
Dem. Republic of CongoKatanga district (Pweto and Lubumbashi)
Pweto
Four to five communities for each site in each country
• Must build skills of entire staff, not just PSCs, to ensure long-term sustainability
Sustainability
• Requires clear justification to donors of need for development of national staff as mental heath paraprofessionals and of time it requires
• Requires a resource rich and/or diversified donor base to meet the costs
• 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
Effectiveness
• 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
Evaluation
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
• Support is crucial
Tired clinicians
• 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)
Ethical Considerations