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From the Midwest to the Middle East: A Regional Center for Trauma Rehabilitation and Training

CVT will help heal the effects of torture and war trauma, train local organizations, develop a regional workforce, and empower refugees.

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Explain your project idea in two sentences.

A regional training center for trauma rehabilitation specialists in the Middle East will strengthen the professional work force and bring peace to people who have experienced torture and war trauma.

What is your organization name? Explain your organization in one sentence.

The Center for Victims of Torture heals the wounds of torture on individuals, families & communities

Is this project idea new for you or your organization? If no, how much have you already executed on?

We did focus groups and a survey and formed a national Sustainability Task Force that made recommendations and created a road map. We consulted the Ministry of Health, professional groups, universities, WHO, hospitals, peer and local NGOs. A regional training center was the clear preferred path.

What is the problem you aim to solve with this idea? How would you define this problem as urgent and a priority in your target community?

There is a severe shortage of professionals in the Middle East with specialized rehabilitation training to help rebuild the lives and restore hope of individuals, families, and communities affected by war trauma and torture—people unable to work, care for children, or attend school as a result.

What is the timeline for your project idea? What are the key steps for implementation in the next 1-3 years?

CVT is actively working on partnerships and seeking funds to advance the idea; for instance we have submitted a proposal to USAID’s American Schools and Hospitals Abroad program for equipment and supplies (projectors, online learning management systems, etc). If approved, the project would begin in earnest in October 2017 and is projected to take two years. CVT already provides training through strategic partnerships throughout the region; this grant would help consolidate this collaboration.

Describe the individual or team that will implement this idea (if a partnership, please explain breakdown of responsibility).

The team includes an international services program manager, country directors and representatives, clinical advisors for mental health and physical therapy, and M&E, new business development, and finance officers. It also consults extensively with internal and external users and partners.

What do you need the most support with in this project idea?

  • Business Development/Partnerships

What is your primary goal over the next 6 weeks of Refinement?

  • Iterate or improve on my product/service

How do you currently measure (or plan to measure) results for this project?

We’ll gather statistics on trainees disaggregated by gender, nationality, profession, and experience level to compare to baselines. We will measure professional development of individual trainees through pre- and post-training evaluations and mentor and participant feedback. CVT will seek input from participants on a regular basis and incorporate their suggestions as appropriate. We’ll also measure uptake of our proposed training innovations, such as an app version of our group therapy model.

How has your project proposal changed due to your user research during the Beneficiary Feedback Phase?

We’ve been collecting feedback for several years from many sources: clients who have participated in CVT’s rehabilitative services; staff and other trainees; and partner organizations who both receive training and are co-collaborators. As such, we’ve already incorporated many suggestions into the project design. We’d be happy to share quotes/surveys/other products from our user input process.

(Optional) What are some of your still unanswered questions or concerns about this idea?

See the answer in the answer box below, "During this Improve Phase, please use the space below to add any additional information to your proposal" for our thoughts on what still needs to be learned to make this challenge idea take root and succeed.

During this Improve Phase, please use the space below to add any additional information to your proposal.

CVT has a vision, but it is not ours alone. It has been inspired by others we come into contact with through our work in many places, in different contexts, both past and present. We share it with our clients, our teams, our partners from Kirkuk to Gaziantep to Beirut, host societies hoping to aid neighbors in need, and displaced persons seeking to have an impact on what’s left of their communities. In submitting this application, we hope to also share it with you – as reviewers, as experts, as stakeholders and as members of a global community. We hope this summary addresses the questions raised for final submission, which center on the themes of feasibility, viability, learning, innovation and engagement with target communities as empowered participants rather than as vulnerable recipients.

We start by telling a story: not about what we will do but what has been done. CVT’s first international work was in Sub-Saharan Africa. Some of the Liberian war and torture survivors who CVT trained as they sought refuge Guinean camps are now professional rehabilitation specialists back in their home country, providing services in the wake of a devastating Ebola crisis. One CVT partner from South Africa is now advising the Gambian Minister of Justice on truth and reconciliation in the aftermath of widespread torture and human rights atrocities. Times and conditions change, but the demand for these services does not abate. The transfer and exchange of knowledge, skills, tools and resources proposed herein provides a bridge to future response and resilience, as we’ve seen in Liberia and Gambia. As unfortunate as it is, services like those CVT provides seem to be direly needed well into the future, and we want to be part of a sustainable solution. CVT has a unique model that can empower local professionals, the communities they aim to heal and the partners who reach where we cannot. The narrative that our clients, our staff, our partners share of CVT’s impact is the one we hope to sustainably realize on an even greater scale in the Middle East. From healing to capacity-building at the individual, family, community, country and regional level, CVT is dedicated to taking the next step forward: bridge-building.

The bridges proposed in this challenge are diverse: technology, requiring innovation, will connect clients and professionals in the region to share their experiences, knowledge, resources and their needs; partnerships, requiring collaboration, will connect individuals and organizations with different experiences to find mutual opportunities; group support, requiring empathy/outreach, will connect clients to professionals, parents to children, and survivors to communities; referrals, requiring relationships/cooperation, will connect organizations to clients to meet their comprehensive needs. In this vision, CVT would serve as the bridge, but it would be far from the only builder.

The project is designed with the understanding that responding to and planning beyond any one crisis requires a trauma-informed approach that acknowledges the impact of war atrocities, torture and other gross human rights violations on individuals, families, communities, countries and beyond. It will draw upon CVT expertise for specialized trauma rehabilitation, capacity-building and networking. The partner organizations CVT plans to engage have areas of expertise and/or interest that together can address the profound, complex, and long-term effects of trauma whilst building a regional local workforce to continue this task well into the future. This project is scalable and can expand to more countries/partners. Its approach is iterative, meaning it welcomes feedback to inform/refine implementation. Its tools are innovative, meaning they introduce a unique combination of resources and ideas to accomplish something not achieved to date in this context. Finally, its strategy is sustainable, meaning it recognizes that trauma resulting from war and oppression requires a local solution built upon regional networks of support. After 10 years in the region, CVT has the infrastructure to get that process started and the experience measuring its own impact through a critical lens to ensure results are relevant, reflective and robust.

CVT will target 5 partner organizations in at least 3 countries. It will hire a program engineer to adapt CVT’s clinical tools to electronic use and to work with partners to customize exchange platforms that can cross borders and reach providers and survivors operating in hard-to-access areas based on the unique contexts. Finally, it will engage a program consultant to evaluate a cross-subsidizing model that can be applied to trauma rehabilitation work to ensure that services are sustainable, adaptable, and affordable. This is an area where CVT has many ideas, and an active interest in thinking through the models to promote organizational development, survivor empowerment and professional capacity-building.

Note that you may also edit any of your previous answers within the proposal. Here is a great place to note any big final changes or iterations you have made to your proposal below:

Please note that in re-envisioning our idea for this latest round of answers and submission, we re-read all the materials with the expert reviewers’ comments as well as the storytelling and other criteria, and we reassessed the first sets of on-line feedback. This in turn informed the updates reflected in the revised documents we’re submitting now. We also shifted some of the language to strengthen the regional and innovation aspect and to take the focus off Jordan a bit more, given it is a “hub” in a regional effort and not necessarily the focus of the effort. In responding to the latest feedback, we have made changes to narrative sections throughout the submission, including: re-conceptualizing the original submitted application; adjusting some answers to the first set of online questions; and providing an answer to the expert feedback questions. We included the answer to the expert feedback questions in two places: in the reply box in the comment section, since this is where the questions were posted; and in the "additional information to your proposal" answer box, as this is an important piece that needs to be a part of the proposal itself – and not only a reaction to feedback.

We would also like to let the whole BridgeBuilder community know how much we have appreciated this unique and inspiring process! The different genres of feedback, the multi-layered review system, the focus on program idea and vision versus money….and we could go on. What a breath of fresh air! And we’ve had such a creative and thoughtful experience. We have learned so much throughout this process, and no matter what happens with our Middle East regional training center challenge idea we’re proposing here, we’re already thinking about other programming that we’d love to put in front of the BridgeBuilder community, should you decide to repeat this challenge in the future. Thank you for this inspiring opportunity!

Conflicts in Syria, Iraq, Afghanistan, South Sudan, Israel/Palestine, and Yemen have created the world’s largest refugee crisis since the end of World War II.

Jordan, a long-standing oasis of stability in the Middle East, officially hosts over 656,000 Syrian refugees and nearly 62,000 Iraqi refugees. It is believed there are many more who are not officially registered. This is in addition to more than two million Palestinian refugees whom Jordan has hosted for decades, and new, recent influxes of people fleeing Yemen, Somalia, and South Sudan.

Since 2008, Jordan has provided a base for the Center for Victims of Torture’s (CVT) operations in the region where refugees—often reluctant to seek help from US organizations—have found safety, trust, and renewed hope. CVT’s Jordanian staff report feeling empowered and inspired by continued US support for their work and the many supportive Americans and other western professionals they work alongside at CVT. They also express a desire to contribute to peace and stability across their borders, and to support their peers in other countries.

A large percentage of refugees fleeing war and systematic oppression are survivors of torture. In the US, it is estimated that up to 44% of refugees are torture survivors. There is no reason to believe this percent is lower in Jordan, although there is no official estimate.

Even if they have not been tortured, all refugees have experienced the loss of their homelands and many have witnessed atrocities such as the bombing of their homes, schools, and hospitals. Many have survived gross human rights abuses and violations of international humanitarian law.

CVT fills a niche role. Over 30 years, CVT clients have told us that it is the psychological effects of torture from which it is most difficult to recover—a common act is to force people to watch or listen to family members being tortured. Common after effects are flashbacks, intrusive memories, inability to sleep or concentrate, and crippling anxiety and depression. Mental and physical trauma rehabilitation is a specialized field that requires in-depth training and practice.

Although a number of organizations provide for the basic needs of refugees such as food and shelter, there is very little available to address the profoundly destabilizing effects of war trauma and torture. The decrease in functioning resulting from trauma is magnified under the hardships of life as a refugee and the lack of hope for returning home. Torture and war trauma can lead to disabling conditions that interfere with the most basic functions of daily life, and the ongoing, violent nature of the conflict back home can further impede healing. Those suffering from traumatic experiences can become immobilized by their symptoms, unable to contribute to their family’s well-being (or for children, to attend school) or function within their communities. This also manifests in high rates of suicide, child abuse, and domestic violence among refugees as well as negative coping mechanisms, including child labor, prostitution, and risky attempts to reach safety that leave migrants vulnerable to human trafficking and slavery.

From the most recent program period, the demographics of CVT clients in Jordan were as follows: 43% were men and 57% were women. Twenty-six percent were children. Sixty-five percent were Syrian, 27% Iraqi, and eight percent were Sudanese, Yemeni, or Somali. The demographics of our workforce in Jordan are as follows: 92% of CVT’s counselors, 66% of its social workers, and 70% of its physiotherapists are women. All are Jordanian, due to government restrictions on refugees working.

Given the chronic nature of the refugee situation in Jordan, it is time to sustainably formalize trauma rehabilitation training and embed it into the Jordanian higher-education system. While a Jordanian “owned” training center is the long-term aim, CVT will be addressing urgent needs while moving toward this goal. CVT has always provided in-depth training to its own staff, who then apply what they have learned by co-facilitating mental health and physical therapy groups alongside experienced professionals, and eventually facilitate the groups themselves.

Given the lack of trauma rehabilitation services and professional training in Syria, Iraq, and elsewhere—and the stability and support found in Jordan—it makes sense to physically locate a regional training center in Amman, in partnership with local and regional universities and other organizations with a similar vision. CVT will explore innovative technology platforms to reach professionals, partners, and survivors in remote or dangerous areas in the region, or those for whom cost or other considerations make travel to Amman impractical.

How this project will contribute to Building Bridges of Peace and Prosperity:

It is no surprise that individuals who have witnessed atrocities against their families, communities, and nation often feel angry and resentful. Sometimes it is depression or deep feelings of shame that are most difficult to cope with. This often leads to the breakdown of family relationships, and is a main contributing factor to the strikingly high incidence of domestic abuse among refugees in Jordan. This project will help individuals to heal, enabling them to think positively about the future. When hope is restored, people are able to focus on rebuilding their lives. Additionally, CVT clients report that through its group-based model, social and community cohesion – often severed in times of war, violence, and oppression – is improved. Empathizing with others from different religions, sects, ethnicities, politics, and countries, can help restore some of the damaged trust and ties that serve to rebuild communities wherever refugees return or resettle.

As for Prosperity, CVT’s organizational goal is to help survivors “rebuild productive lives of dignity.” When survivors’ symptoms improve—when they are able to get a good night’s sleep, manage their thoughts and emotions, and flashbacks recede, they are able to focus in school, manage a household, hold a job, or otherwise be productive.

The second way this project would contribute to prosperity is by developing knowledge and skills of trauma rehabilitation professionals. This project will also support training of administrative employees who are the backbone of any organization, such as human resources and finance professionals.

 Women play a critical role in delivering these services, particularly in the Middle East where cultural considerations may prohibit men from engaging in services for rape survivors. While only 16% of Jordanian women are active in the workforce, 92% of CVT’s counselors, 66% of its social workers, and 70% of its physiotherapists are women. Promoting the professional development of women can have ripple effects. Research by micro lending and other organizations has shown that when women prosper, families and communities prosper.

Explain your idea

Alongside strategic partners, CVT will create a regional training center where mental health, social work, physical therapists and other professionals will learn theory and apply their skills to treat victims of war trauma, torture and other gross human rights violations. CVT staff and other professionals in the region will receive in-depth, long-term, continuous and high-quality training, as well as ongoing supervision, from experts, enabling them to cultivate skills that will be valuable throughout their careers. This could include psychologists, social workers, and physical therapists working in private or public health systems.

Curricula will be developed with CVT’s expert clinical advisors and partner organizations (whom we’re not ready to list as roles/responsibilities are still being negotiated). We will negotiate how CVT-awarded credentials will mesh with established training programs in participants’ respective countries to ensure relevance (i.e.: would a CVT certificate in trauma counseling count toward a master’s degree in psychology in Kurdistan?) We will also build the skills of organizational leaders and admin staff to operate effective, efficient, sustainable organizations.

The program will be based in Amman, with the potential for sub-centers in partner facilities throughout the region. Due to the great need for training and the value of face-to-face training, CVT will endeavor to bring professionals from Syria, Turkey, Iraq and elsewhere to Amman when funding/logistics make this feasible. However, restrictions on certain nationalities and security conditions in some target areas may present challenges. For this and other practical reasons, CVT will develop innovative technological platforms to deliver training and supervision remotely. CVT has been exploring telemedicine and training for about a year. We are aware that there are many options (SMS, chatbots, Skype, online courses) and we would seek to partner with an expert to advise on the best options.

This project will strive to develop a large cadre of professionals who will be “trainers of trainers.” That is, they will be able to directly provide rehabilitative care and train other organizations and professionals, thus expanding the benefit exponentially.

One benefit of working in the Middle East, compared with CVT programs in Africa, is that Jordanians, Syrians and other people from the region have more access to higher education, so many may have some training in general psychology, social work or physical therapy. In complex emergencies, required services are often provided by international staff, unfamiliar with local language and context, and reliant on foreign funding appeals. However, formal qualifications include little practical training or trauma specialization appropriate to meet the needs of the region’s volatility. CVT’s training offers unique opportunities absent from national education systems and crucial for successful rehabilitation.

Who Benefits?

Two groups of people will benefit: 1) Torture and war trauma survivors; and 2) mental health, physical therapy, administrative and social work professionals. Note that these categories are not mutually exclusive; in some cases CVT is able to support the affected population to build skills among displaced and war-affected communities, supporting long-term sustainability.

Clients will benefit from reductions in mental health/physical symptoms and by improvements in their ability to function. In the most recent report period, 100% of clients demonstrated improvement in at least one area of psychological symptoms or behavioral problems between intake and 6-month follow-up assessment. Trauma rehabilitation professionals from the region will benefit from developing skills that will make them more effective in their work and more employable. The increase in skills at the local, country and regional level will help strengthen communities in conflict, post-conflict and development contexts.

How is your idea unique?

There are many organizations providing medical care, food, shelter, education and other services to refugees in Jordan. There are also some services that address their mental health needs; however, CVT is unique in the in-depth, specialized interdisciplinary care we provide. CVT is the only organization in Jordan grounded in decades of rehabilitative care for torture survivors. CVT is also a known advocate against the use of torture by the US Government. This lends us credibility and helps us gain trust with local professionals, government officials and clients. CVT also has an adaptable approach to providing services in many contexts, which is flexible/effective in meeting client and partner needs. There is really no other organization in Jordan providing specialized rehabilitative care to torture and trauma survivors the way CVT does, or providing the same level of supervised training. Regional exchanges focus on networking, rather than integrated/collective capacity-building.

Idea Proposal Stage

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Tell us more about you

CVT is a nonprofit organization founded in Minnesota in 1985 as the first rehabilitation center for torture survivors in the US and remains the largest organization of its kind in the world. The full scope of CVT’s work includes:
• rehabilitation for survivors of torture and war trauma in the US, Africa, and the Middle East;
• technical assistance and training for human rights activists and over 110 smaller torture rehabilitation programs in the US and other countries; and
• nonpartisan policy advocacy to end the use of torture and advance human rights.

CVT’s approach to mental health trauma is based on the three-stage Trauma Therapy Model developed by Dr. Judith Herman, professor of clinical psychiatry at Harvard University Medical School. The three stages are: 1) safety and stabilization; 2) remembrance and mourning; and 3) reconnection and integration. Counseling sessions focus initially on emotional stabilization, then exploration of trauma memories, and finally reclaiming of dignity and reconnecting with community. This counseling model uses various evidence-informed approaches including cognitive, behavioral, narrative, and exposure therapies.

Because torture affects both the mind and body, sometimes survivors become mentally disconnected from their own bodies. Therefore, CVT also incorporates physical therapy into some of its programs, including in Jordan. Finally, CVT adds social work services to help survivors get the services they need to meet practical needs such as for housing, childcare, and legal aid.

CVT employs 300 full-time and 40 part-time staff. Of these, 93 are based in US.

CVT has received over three dozen awards for quality programming and financial stewardship. CVT was awarded the National Crime Victim Services Award presented by the US Department of Justice and the American Psychological Association’s International Humanitarian Award. CVT has received a 4-star rating (the highest) five years in a row from Charity Navigator, a designation achieved by only 97% of the nearly 8,000 rated charities.

In Jordan CVT collaborates with dozens of other organizations such as Jesuit Refugee Society, International Medical Corps, CARE, Handicap International, the UN, and local Jordanian organizations. We have partners throughout the region. We would appreciate introductions to program engineers or other specialists who could help us evaluate and implement distance training and supervision platforms.

The project will be led by CVT staff in the US and Jordan in collaboration with strategic national and regional partner organizations. CVT is in the process of negotiating partnerships with Jordanian and other partners.

Expertise in sector

  • 7+ years

Organization Filing Status

  • Yes, we are a registered non-profit.

13 comments

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Photo of Dipanwita Das
Team

Thank you, Kate Rushton 
Hi Anne, Your idea sounds fantastic and thanks to you for your work in this crucial area. In the realm of training, I noticed that you have mentioned the importance of face-to-face training and certifications as well as technological training interventions. I had a couple of questions about that. 1. In the user map, you have talked about an online training platform, do you have any more information on how you are thinking that through? Are you planning on a custom solution or planning to use an existing LMS or platform? 2. In the certification model, do you have ongoing conversations with universities etc? 3. How are you using the training to build community? 4. What's the feedback model you are thinking about using to evaluate the impact of the training?
For the Future of Higher Ed Challenge that we participated in, we submitted Impact College (http://impact.college/) which provides a training deployment platform + instructional design + animation, etc services to social impact orgs with training as a part of their programs. That's the context in which I am asking you these questions. Again, great work, this is such a critical field. Thank you, D

Photo of Amy J!
Team

Hello!  My name is Amy-Jo.  I work with Anne.  Thank you for your interest in CVT's Jordan initiatives! Our Jordan program staff are currently working on several different deadlines, and we'll get back to you with answers to your questions early next week.  Thanks, again!

Photo of Amy J!
Team

Hello, this is Amy-Jo again.  I apologize for the delay in getting back to you.  Here are answers to your questions:

1. In the user map, you have talked about an online training platform, do you have any more information on how you are thinking that through? Are you planning on a custom solution or planning to use an existing LMS or platform?

ANSWER: We have a few options. First, our “Partners in Trauma Healing Project, ” a separate project, currently has an online platform that can be customized for this purpose, which would be a lower-cost option but would still require some design and programming. Other organizations we’ve worked with have bespoke platforms developed from the ground-up or from some basic model, but they can be difficult to work with on slower connections. It therefore makes sense to us to start out with customizing what we have, at least for field testing, so we get a sense of the operational requirements if we need to upgrade or go in a different direction.

2. In the certification model, do you have ongoing conversations with universities etc?

ANSWER:  We do have ongoing conversations with universities in the United States and in the Middle East. We’d like to have at least one university partnership in each location (city) where we work or have partners. In Jordan, CVT’s lectures and some training does align with local curriculum requirements, and participation is accredited for degree or certificate programs. However, we would like to work with Accrediting bodies, professional associations, universities, and relevant ministries to make this systematic. Currently we have ad-hoc collaborations with about 3-5 universities in Jordan, an MOU with one university in Jordan, and ongoing work with a few in Iraq. When we take into account our partners and their university connections, the list gets much longer! We strive to have a model in the Middle East similar to our programming in Uganda, where the CVT training course yields a certificate that is approved and issued by Makarere University. Most US university collaborations relate to research, but provide great ‘bridges’ to sister schools or university collaborations elsewhere. This is something our Program Manager has experience in (university networks across or within regions, accreditation and curriculum development).

3. How are you using the training to build community?

ANSWER: Training often happens in silos, or it can be a blanket approach based on whatever the organizations have access to. Customized training allows clinicians and organizations to get closer to the needs of each population they work with in order to better respond to their needs. For instance, in Halabja, Iraq, the needs are very different than in Al-Qosh, not so far away. Our partners in Iraq are starting to see beneficiary populations that are new to them and have new needs, but who our partners in southeast Turkey have built up quite a knowledge base serving. We aim to connect these organizations and ensure that experiences are shared throughout a common community of service providers who can provide support to one another (and learn from each other), whilst also connecting service providers with new beneficiary communities that they can also engage with, learn from, and hopefully support.

4. What's the feedback model you are thinking about using to evaluate the impact of the training?

ANSWER:  We have a variety of options, ranging from simple pre/post tests to more nuanced surveys that indicate how helpful or useful the training was. When we share information, we also want to see, with evidence, that it has had an impact on practice. With longer term partnerships, we look at quality outcomes over time, rather than information transferred in a one-session event. If you have more questions about this – and some of the ideas and options we would hope to develop to address this important point you’ve raised – we would be happy to connect you to our Research Department.

Thank you so much for your thoughtful questions and for your interest in this important work!

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