Center for Victims of Torture, conflict, conflict zones, conflict-affected countries, health and human rights, humanitarian care, IRCT, Johns Hopkins University, mental health, psychosocial support, refugee health, refugee mental health, torture rehabilitation, torture survivor rehabilitation, torture survivors, US Agency for International Development, USAID, war and conflict
Veronica Laveta, CVT International Services Clinical Advisor, and Jennifer Esala, Monitoring and Evaluation Advisor, recently traveled to Washington, DC for a U.S. Agency for International Development (USAID) Victims of Torture meeting organized by Johns Hopkins University. USAID’s Victims of Torture Program works primarily with nongovernmental organizations overseas to assist the treatment and rehabilitation of individuals, families, and community members who suffer from the physical and psychological effects of torture and trauma.
Participants at the meeting included researchers, practitioners, donors, and UN and International Rehabilitation Council for Torture Victims representatives. The meeting was designed to give feedback to USAID about recommended services and methods, identify gaps in the research, and recommend strategies for advocating for sustainable mental health services in low resource contexts. Veronica and Jennifer presented on CVT’s model of group counseling and the practice-based evidence CVT has gathered over the past 15 years working internationally. Here, Veronica shares some insights and observations from the meeting.
The presentations on the first morning set the stage for many multi-layered discussions the next day and a half that generated common themes. Although certainly many in the room had conducted randomized control trials for particular interventions, the group agreed that no one treatment was the panacea that should be recommended everywhere. In fact, multiple trials of the same interventions showed that even a small change in context (southern Iraq vs. northern Iraq) could yield much different results. In depth “ground up” needs assessment, engagement with local organizations, and context specific design of services and interventions are required rather than a “one size fits all” approach.
One theme that emerged was, although there may be some differences in specific techniques that have been tested, there seems to be an overall general consensus about the elements of treatment that tend to be effective. These elements include psychoeducation, narrative approaches, and cognitive behavioral therapy. How a particular service or intervention is designed would depend on the context. For instance, interventions in a context of continuous threat such as southern Iraq or South Africa would need to be different than in other contexts that were perhaps more stable or relatively safe. During the discussion, I was able to bring in my experience with the Centre for the Study of Violence and Reconciliation in South Africa helping design a context-specific clinical model of intervention.
Building on this general consensus, the group discussed the importance of problem-solving the challenges of implementation and sustainability given all the barriers and dilemmas that occur in the field. Many participants mentioned the limitation of single interventions trials rather than stepped care models that integrate multiple interventions and take more of a “whole community” approach. A “whole community” approach is essentially addressing the survivor’s physical and mental health, their social well-being, and their ability to function on a daily basis rather than focusing on one symptom or set of issues.
Among the small group discussions, the research group created a vision to develop a best stepped care model/best implementation approach in “50 villages” and to test its effectiveness on a wide variety of indicators. The approach would look for improvement well beyond individual symptoms. For instance, it seeks a reduction in overall community violence, an increase in functionality and productivity, and improved economic conditions that can occur when a full range of mental health services are provided.
Such a large scale research project that is tested over a long period of time could provide the evidence to finally persuade governments to invest in mental health services. Many in the group were unsure worldwide governments will value mental health services unless they see the cost benefit in terms of social stability, reduced violence, and other social and economic indicators.
Along with other practitioners, I emphasized the need for strong supervision models as key to quality services, care for the practitioners, and for successful implementation and sustainability.
Organizational health was another theme deemed critical for successful programs. The group came up with the idea of creating “best practice” case studies of organizations where clinical, monitoring and evaluation, and organizational leaders worked well together for the benefit of torture survivors.
I am pleased that all the meeting’s participants – well-known names in the torture treatment field – joined together to share their expertise and to work collaboratively. I was particularly proud that several approached me to express their admiration for CVT’s work.
I happily noted that many of the recommendations that emerged from the discussions reflect CVT’s core values and approach to torture treatment. It was truly a pleasure to learn from other colleagues in the field and collectively shape a vision for continuing to improve treatment for torture survivors.