How To Provide For PSS In Emergency Situations For Refugees And Torture Survivors By: Jackson Nzusyo Mutavi 2015 Psychosocial Support Forum Date: 1-3 September 2015 Venue: Elephant Hills Hotel, Victoria Falls, Zimbabwe

Acknowledgement: Centre for Victims of Torture CVT Staff and CVT clients Bureau of Population, Refugees, and Migration (BPRM) United Nations Voluntary Fund for Victims of Torture (UNVFVT) 2

Center for Victims of Torture: psychological care for torture survivors in Africa, Middle East and US; in Dadaab (camp Ifo =83,873) since 2011 In Nairobi since 2013 Who we are and where we work

Objectives 1. Why are psychosocial measures important? a) What do intake measures give clinicians in terms of planning treatment? b) What do follow up measures give clinicians in terms of treatment? c) What do follow up measures give programs in terms of impact data? 2. Training (and retraining) PSCs to use the measures? 3. What measures does CVT use? And Why? 4. Using reliability checks to fine tune PSC training on assessment? 5. How we analyze at aggregate level? 6. Results 4

What do intake measures give clinicians in terms of planning treatment? 1. To build the foundation for the therapeutic relationship. 2. Providing information about counselling, the counsellors, the counselling model, and CVT. 3. Obtain explicit, written consent for treatment. 4. To test the early expectations of both client and counselor. 5. To identify and prioritize the client’s goals for therapy. 6. Treatment planning: The information gathered in 4. and 5. provides the foundation for good treatment planning. 7. To track progress: It sometimes happens that clients (and sometimes counsellors too) find it difficult to track therapeutic progress being made. 8. To document mental health needs for other service providers: It sometimes happens that it is helpful to provide other service providers with detailed information about a particular client’s emotional and social health. 5

What do follow up measures give clinicians in terms of treatment? Current symptoms and functioning are assessed through clinical interview and formal measures in order to; – determine who is most appropriate and in need of the clinical services and to assess safety concerns; – help the clinical staff know the individual psychological and functional challenges each person is facing to make the clinical process most effective; – establish a baseline for assessment of progress and outcome; – identify need for referral to other services. 6

Training (and retraining) PSCs to use the measures. To assess client satisfaction and comfort with the group treatment experience; To discuss perceived progress with symptom and functioning challenges identified at intake; to discuss client’s participation, to strengthen commitment to the remaining sessions and to follow up on safety concerns. 7

Components of the assessment The CVT assessment is made up of six main sections. These are: – Section A – Client’s Demographic Information. – Section B – History. – Section C – Social Support. – Section D – Client Specific Problems. – Section E – Health Problems. – Section F – Problem Rating Scales. These are somatic complaints, anxiety, depression, post-traumatic stress and ability to functioning. 8

What measures does CVT use? And Why? Formal assessment is conducted using measures to assess: – PTSD – Anxiety – Depression – Functioning Current symptoms and functioning are assessed through clinical interview and formal measures in order to; – determine who is most appropriate and in need of the clinical services and to assess safety concerns; – help the clinical staff know the individual psychological and functional challenges each person is facing to make the clinical process most effective; – establish a baseline for assessment of progress and outcome; – identify need for referral to other services. 9

Safety &Stabilization, Remembrance & Mourning and Reconnection. 10

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Using reliability checks to fine tune PSC training on assessment? Measures’ Scores many of them were reliable for CVT Clients Except Physical symptoms. N=1239 ReliabilityDescription 1.0Perfect.90Excellent.80Good.70Acceptable.60Substandard.50Poor Below.50Very Poor Note. Boldfaced reliabilities indicate levels of acceptable reliability Measure/ScaleReliability ( α ) Physical.704 Anxiety.849 Depression.832 Post Traumatic Stress.880 Behavioral Functioning.807

What do follow up measures give programs in terms of impact data? 13 Clients Depression Post-Traumatic Stress SomaticAnxiety Behavioral Functioning Difficulties N (both intakes and follow-up) % Showing Decreas e Cohen’ s d % Showing Decreas e Cohen’ s d % Showing Decreas e Cohen’ s d % Showing Decreas e Cohen’ s d % Showing Decreas e Cohen’ s d % % % % %0.76 Intake compared to 6-month follow-up or 41% (508) clients who attended all sessions and could be identified for follow-up (Hopkins Symptom Checklist, PTSD Checklist)

Improvement on Client symptoms 14 N=508. All decreases in this graph are significant at the p=0.01 level.

Results VariableRepeated measure T-test P-valueES Depression < PTSD < Somatic < Anxiety < Behavioral Functioning Difficulties < Counseling intervention may improve torture victims’ wellbeing - at least for regular attendees Intake compared to 6-month follow-up or 41% (508) clients who attended all sessions and could be identified for follow-up (Hopkins Symptom Checklist, PTSD Checklist)

Conclusion A short-term group intervention by lay counselors can have significant benefits. 16

Thank you for listening! Comments or questions?