International Capacity Building Project Building capacity of torture treatment centers Pamela Kriege Santoso The Center for Victims of Torture October 31, 2007

Goal of the ICB Project Work with torture treatment centers to strengthen their capacities:  Clinical  Organizational  Technological  Advocacy So better positioned to be sustainable and provide effective services

Context: Role of Torture Treatment Centers Almost 200 torture treatment centers worldwide Small, isolated, lacking social support Specialized programs can contribute to building of knowledge of torture treatment

Context: Role of Torture Treatment Centers Unique role as healers for treatment and advocacy Design interventions that are appropriate for local and regional circumstances

Torture Treatment and Rehabilitation Partner Centers Guatemala City, Guatemala Psychosocial monitoring during mass grave exhumations, and staff development in technology use and mental health methodology Lima, Peru Clinical and technological skills training and direct services Cape Town, South Africa Organizational development, advocacy and lobbying, program management training Windhoek, Namibia Rehabilitation services and mobile clinic in northern regions and staff development training Kigali, Rwanda Rehabilitation services, torture prevention efforts, staff development training Nairobi, Kenya Forensic work and monitoring of prison detainees Addis Ababa, Ethiopia Rehabilitation services and anti-torture education training Ramallah, Palestine New offices in north and south of West Bank, and evaluation of internal and external services Pristine, Kosovo Rehabilitation services, advocacy, and training of professionals and students, CBT training for staff Kampala, Uganda Technology acquisition, public awareness raising efforts, staff development trainings, legal services to torture survivors Phnom Penh, Cambodia Trauma Healing Initiative (THI) – Building clinical and public education capacity among a network of torture treatment resources Dhaka, Bangladesh Community outreach programs, torture prevention training for health and law enforcement professionals, and advocacy work New Delhi, India Rehabilitation services and training of health, law, and human rights professionals Islamabad, Pakistan Rehabilitation and monitoring of torture cases in local prisons, training workshops Sofia, Bulgaria Rehabilitation services to torture survivors from Turkish minority and establishment of mobile units in Varna and Isperih Bucharest, Romania Financial management training leading to update of internal financial management system Kono, Sierra Leone CVT provides direct counseling services and trains local psychosocial counselors Khartoum, Sudan Yaounde, Cameroon

Key Project Activities Organizational assessments Operational sub-grants ($25,000/year) Technology sub-grants ($15,000) In-country technical assistance from local or international consultants ($12,000) Workshops Staff exchanges Database and website development Monitoring and ongoing follow-up coaching

Centro de Atencion Psicosocial (CAPS), Peru “The unique aspect of this project is that it helps us identify our institutional needs, while respecting our own goals and timeframe for the institution.”

Examples of Service Delivery enhancement Salaries for clinicians / new staff Community assessments New programs (for children, refugees, prisoners) Mobile clinics Training of other professionals Supervision Training on counseling skills, techniques Workshops Exchanges with other centers

Evaluation: Organizational Matrix Functional Areas: A. Governance B. Organizational Operations and Management Systems C. Human Resources D. Financial Resources E. Service Delivery F. Information Technology G. External Relations Ratings: Emerging Developing Consolidating Sustaining

E. Service Delivery The quality of service delivery is the strongest indicator of the success and effectiveness of an organization. A viable organization not only provides quality services to meet community needs but also is able to provide this level of excellence over time. Two principle activities/outcomes that need to be considered are: Direct Services to clients and Public Education.

EmergingDevelopingConsolidatingSustaining SECTORAL EXPERTISE Organization has limited track record in sector and area of service delivery but some good ideas about how to meet needs of target community/constituenci es. It has little operational experience however and no specialization in the sector. Improved targeting and redefined service/technical assistance package. Growing expertise in technical area and ability to access additional expertise in that area when required. Client base well defined and well reached. Efficient delivery of appropriate services. Fee for service and other cost recovery mechanisms being built in to service delivery process. Organization being recognized as having significant expertise in technical area and being invited to contribute to these areas. Organization is able to adapt program and other service delivery capacities to changing needs of constituency and to deliver services to additional communities/ constituencies. Full recognition as experts in technical area and given consultative status in those sectors by government and other multi-sectoral organizations. IMPACT ASSESSMENT Organization does not systematically monitor or evaluate program/project achievements against projected or planned activities. It does not measure overall impact and has not determined impact indicators or established baseline measures of indicators. Individual projects evaluated to determine if projected activities took place as planned and if specific project objectives were achieved. These objectives may or may not be measurable. The Organization is aware of the issue of program sustainability and is exploring how to measure impact. There are no overall impact indicators selected and no baseline data available or accessed to provide basis of comparison. Measurable indicators of success and impact have been determined. Studies are conducted or accessed which provide baseline measures. This information is regularly re-measured.

Development of a Clinical Matrix for Torture Treatment Services Clinical Program Management Clinical Processes  Accessibility / physical premises  Client intake  Clinical records  Clinical Training and Experience  Staff Clinical Supervision  Staff Self-Care  Staff performance evaluation  Client Services Overall Program Impact / Evaluation Developing Healthcare Pathways for Constituents Individual Client Outcome Measures

2.2 Client Intake EmergingDevelopingConsolidatingSustaining 2a) Target group not well defined and/or not clear to others. 2a) Target group clearly delineated and specified externally. 2b) Initial client screening process conducted by non-clinician or inexperienced clinician. 2b) Initial client screening process conducted by experienced clinician. 2c) Limited client education about principles of information and treatment confidentiality. 2c) Extensive client education about principles of information and treatment confidentiality.

Strengths of this model Centers already exist – no start-up Locally run Partners actively involved in developing training and technical assistance plan Can learn from other centers in project Strengthens worldwide movement Holistic approach: not just focused on Clinical Training

Challenges of this model Treatment centers not always where there is need Source of funding may limit partners Lack of trained mental health professionals in many developing countries; university and other training Takes time and funding to improve clinical skills Interest in new techniques while needing basic skills Loss of staff to higher paying Intl. NGOs Hard for CVT to measure impact on beneficiaries Partners ultimately in control of decisions Risk of dependency on CVT funds

Lessons Learned Strong personal relationships are key Basic counseling skills still needed Must continue to support fundraising and project management skills

Partners worldwide doing great work, under difficult circumstances, with little support