Trauma Healing Initiative: Cambodia Building a culturally appropriate healing network

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Trauma Healing Initiative Cambodia Building a
culturally appropriate healing
network

• Carol White
• The Center for Victims of Torture
• Oct. 31, 2007

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Project charge

• To address the high levels of trauma in Cambodia

Poverty Domestic violence Community violence
and exploitation Depression, alcohol abuse,
PTSD
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What model to choose?

• Direct services with a training component?
• Training community mental health workers?
• Professional education?
• Support a torture treatment/human rights
  organization?

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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

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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

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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
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The model we chose
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Trauma Healing Initiative Strategy

• Training of trainers
• 2. Community outreach education strategies
• Training the Network
• Network model development

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Steps in the planning phase
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Our first challengeSetting the stage

• Is it feasible?
• How can we position the project to get the
  broadest support?
• Who should lead the effort in Cambodia?

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Feasibility assessment

• Met with 20 organizations
• 30 key informants
• Explained project concept

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(No Transcript)
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Get National Program for Mental Health congruence
blessing

• Dr. Ka Sunbaunet, Director
• 20-year mental health plan
• Interest in participating
• Congruent with plan

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Assess relevance to upcoming Khmer Rouge trials
(ECCC)

• Royal Government of Cambodia task force

• Helen Jarvis, special advisor

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Choose implementing partner

• TPO Cambodia
• MOU/subgrant
• scope of work
• Hire coordinator

And the partner chooses us.
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Bring potential core group agency leaders
together for the call
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Our next challengeEngaging partners in the
project

• Engage individual clinicians
• Get buy-in from agencies
• Build knowledge trust in CVT and among
  individuals

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Engagement tactics

• International training events
• Start regular meetings to share cases and decide
  training topics
• Help review project plan
• Social time

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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
• Childrens mental health
• Community mental health/training/trauma treatment
• Khmer Rouge anti-impunity and documentation
• Cambodian returnees from the U.S.

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Progress in the implementing phase
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The next challenge How to train the Core Group
of Clinicians
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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

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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

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Examples of collaboration among partners

• Department of psychology
• National Program for Mental Health
• NGO requests for assistance
• 5 requests for service enhancement subgrants

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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

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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.

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Overall challenges with this model of
capacity-building

• Low control vs. buy-in and low cost
• Potential for high impact sustainabilitybut
• 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 ?

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Opportunities
a brighter future for Cambodia !
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Summary
International Services International Capacity Building Trauma Healing Initiative
Context The model chosen must fit the country context culture, resources, potential for local control broader impact The model chosen must fit the country context culture, resources, potential for local control broader impact 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 High Low Low-medium
Culturally appropriate Direct long term supervision makes adaptation of western therapy models to indigenous culture easier Run by local professionals Professional core group is consulted, but lack of direct services makes ?ing this difficult
Cost High Low Low
Evaluation High control direct services makes evaluation easier Self report consultant monitoring Classroom evaluation some work observation
Local buy-in Indigenous staff of CVT One institution Implementing 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