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

Trauma Healing Initiative: Cambodia Building a culturally appropriate healing network. Carol White The Center for Victims of Torture Oct. 31, 2007. Project charge. To address the high levels of trauma in Cambodia. Poverty Domestic violence

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

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  1. Trauma Healing Initiative: CambodiaBuilding 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 • Training of trainers 2. Community outreach & education strategies • Training the Network • 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. Met with 20 organizations 30 key informants Explained project concept Feasibility assessment

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

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

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

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

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

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

  18. 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.

  19. Progress in the implementing phase

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

  21. 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

  22. 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

  23. Examplesof collaboration among partners • Department of psychology • National Program for Mental Health • NGO requests for assistance • 5 requests for service enhancement subgrants

  24. 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

  25. 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.

  26. 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 ?

  27. Opportunities: a brighter future for Cambodia !

  28. Summary

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