1. Trauma Healing Initiative: Cambodia Building a culturally appropriate healing network Carol White The Center for Victims of Torture Oct. 31, 2007

2. Project charge To address the high levels of trauma in Cambodia Poverty Domestic violence Community violence and exploitation Depression, alcohol abuse, PTSD

3. What model to choose? Direct services with a training component? Training community mental health workers? Professional education? Support a torture treatment/human rights organization?

4. Project Context Problems Currently one of the poorest countries 80% of population engaged in rural subsistence farming Trauma is a public health problem. –Older generation –New levels of violence Rampant government corruption, land-grabbing and use of violence and intimidation

5. Project Context Assets At peace for over 15 years Active civil society and many NGOs Rapid economic growth Strong family systems A budding mental health infrastructure

6. A culture of impunity No legitimate war crimes trials have been held since Pol Pot times No truth and reconciliation process Former Khmer Rouge and KR victims live side by side; many local officials are former khmer Rouge After 30 years a tribunal has now been authorized, to last 3 years and prosecute up to 6 top leaders, starting in 2007 Exhumed skulls from the “killing fields”

7. The model we chose

8. Trauma Healing Initiative Strategy 1.Training of trainers 2.Community outreach & education strategies 3.Training the Network 4.Network model development

9. Steps in the planning phase

10. Our first challenge: Setting the stage Is it feasible? How can we position the project to get the broadest support? Who should lead the effort in Cambodia?

11. Feasibility assessment Met with 20 organizations 30 key informants Explained project concept

13. Get National Program for Mental Health congruence & blessing Dr. Ka Sunbaunet, Director 20-year mental health plan Interest in participating Congruent with plan

14. Assess relevance to upcoming Khmer Rouge trials (ECCC) Royal Government of Cambodia task force Helen Jarvis, special advisor

15. Choose implementing partner TPO Cambodia –MOU/subgrant –scope of work –Hire coordinator And the partner chooses us.

16. Bring potential core group agency leaders together for the “call”

17. Our next challenge: Engaging partners in the project Engage individual clinicians Get buy-in from agencies Build knowledge & trust in CVT and among individuals

18. Engagement tactics International training events Start regular meetings to share cases and decide training topics Help review project plan Social time

19. A core group of clinicians begins to meet monthly from 9 organizations Trafficking victims Human rights/torture clients Extreme domestic violence/rape clients Government psychiatry University psychology department Children’s mental health Community mental health/training/trauma treatment Khmer Rouge anti-impunity and documentation Cambodian returnees from the U.S.

20. Progress in the implementing phase

21. The next challenge: How to train the Core Group of Clinicians

22. Expert trauma training consultant living in-country for one year In-depth training in psychotherapy(150 hours to date) Case consultation and observation Agency consults as requested Pilot curricula for future manualization

23. The next challenge: How to sustain and deepen the learning ? Create treatment and training manuals Continue expatriate consultancy as long as possible Incent organizational experimentation & service enhancement Encourage collaboration among partner agencies

24. Examples of collaboration among partners Department of psychology National Program for Mental Health NGO requests for assistance 5 requests for service enhancement subgrants

25. By the end of four years, THI hopes to have: Trauma treatment and training manuals Piloted public education strategies A core group of multi-disciplinary Cambodian clinicians who can train others Piloted innovations in ongoing clinical supervision and training A trauma clinic functioning in Phnom Penh that cares for torture survivors and serves as a training site

26. By the end of four years, THI plans to have: A functioning network of agencies and individuals in one urban and one rural area. Ongoing relationships between clinical providers serving torture/trauma survivors and human rights organizations A means of tracking and evaluating the level of impact the network is having on reaching and serving the target population.

27. Overall challenges with this model of capacity-building Low control vs. buy-in and low cost Potential for high impact & sustainability—but High risk for failure How can technology help in low resource/tech savvy environment? Is there a “tipping point” when local agents continue to collaborate and train on trauma treatment ?

28. Opportunities: a brighter future for Cambodia !

29. Summary International ServicesInternational Capacity Building Trauma Healing Initiative Context The model chosen must fit the country context: culture, resources, potential for local control & broader impact Scope Training & direct services: Local scale Training & OD: One indigenous institution with torture/human rights focus Training only: Potential for reaching many agencies & governmt health structure Control HighLowLow-medium Culturally appropriate Direct long term supervision makes adaptation of western therapy models to indigenous culture easier Run by local professionalsProfessional core group is consulted, but lack of direct services makes  ing this difficult Cost HighLow Evaluation High control & direct services makes evaluation easier Self report & consultant monitoring Classroom evaluation & some work observation Local buy-in Indigenous staff of CVTOne institutionImplementing partner, partner agencies, core group of clinicians Sustainability Hard, because of cost & INGO model Medium: Need to find other funders High potential: Depends on buy-in & appropriateness of training