1. Center for Victims of Torture International Services Program

2. 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)

3. 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)

4. CVT ISP Key Activities I. PSC Training 2. Client Care 3. Community Outreach

5. 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.

6. 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

7. 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

8. 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

9. Counseling hut and PSCs

10. 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.

11. 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.

12. 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

13. 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

14. CVT ISP Strengths/Challenges

15. 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

16. 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!

17. 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

18. Sierra Leone Kono district communities Admin office in Freetown Liberia Lofa County Bong County Monrovia Dem. Republic of Congo Katanga district (Pweto and Lubumbashi) Pweto Four to five communities for each site in each country

19. 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

20. 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

21. 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

22. 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

23. 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

24. Thank you