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Social Health Care  (SHC)
Training and Treatment Program

A comprehensive, integrated, interdisciplinary, and sustainable
humanitarian assistance service
aimed at healing the trauma of war and violence,
and equipping the members of
traumatized and displaced communities in regions of conflict
with the skills, resources, and hope needed
for restoring mental health, balance, dignity, and self-determination.

   Features of the Social Health Care Training and
          Treatment Program:

1) A comprehensive, integrated, interdisciplinary, and permanent health care service providing immediate, critically needed crisis intervention, coping skills, and trauma recovery treatment to thousands of refugees currently within the borders of Jordan, Lebanon, and Turkey that is locally based, culturally appropriate, expandable, and sustainable.

2) An on-going professional and interdisciplinary trauma treatment training program providing practical skills to hundreds of local university students, professionals, and NGO staff equipping a steadily growing expert pool of service providers with increasing local capacity and empowerment for healing and recovery within their society. The program is based on a "training of trainers" model to also create a growing local pool of experts who progressively take on the role of conducting the training into the future.

3) A strategic and long term investment in advancing and developing the future local human service system.

4) A major investment in the local academic system through providing universities with previously absent locally-based official internships and practicums for their mental health related academic programs that allow students to remain in their home country for their certified professional practical training, rather than being required to seek these on their own and outside the country; and in doing so ensure that future generations of young human service professionals remain to serve their home society.

5) A substantial and growing vocational benefit to trainees and the local economy and generating secure jobs, through creating skilled professional positions, secure jobs in the social health care field, and an expanding job market for those vital services within the society as an increasing number of recipients are introduced to and benefit from the available services.

6) An assessment, evaluation, and monitoring system that is comprehensive, valid, and culturally sensitive.

7) An innovative, adaptable, and continually developing treatment and training model that can be replicated in other regions of conflict where there is immediate, massive need, limited resources, and where the human service infrastructure is overwhelmed due to being either underdeveloped or profoundly undermined as a result of war and violence.

8) Research and Analysis of the dynamics of unresolved communal trauma and it's transfer into future generations, implications for relationships within and between communities past, present, and future, as well as the development of new culturally appropriate, practical models and methods for healing trauma on the large group, societal level.

The SHC training and treatment service is directly based on Common Bond Institute's long established comprehensive Catastrophic Trauma Recovery (CTR) training and treatment model. The CTR model is an intensive integrated and interdisciplinary system intended to quickly build local capacity and empowerment within service communities themselves through instilling local professionals and relief workers assisting refugees and victims of violence in regions of conflict with the effective skills needed for social healing and recovery, and investing in the development of the local human service infrastructure.

  Services

1) Direct Social/Mental Health Services:
Providing a comprehensive, progressive range of critically needed crisis intervention, coping skills training, trauma recovery, and rehabilitation services to the massive and increasing number of individuals and families suffering from psychological and emotional trauma in the region due to war and violence, and who currently go untreated. The program is designed to address immediate and long term treatment needs, build close working relationships to support local practitioners and aid organizations, conduct public education regarding psychosocial services, and provide training in self-help skills to victim populations and their community to instill self-empowerment and promote mutual support. An added benefit is the invaluable investment in the future health service system for the region through building a permanent and growing local pool of skilled mental health workers and the capacity for providing extensive professional health care services to victims of trauma where huge portions of the population have been impacted.

• A detailed description of the treatment model and specific direct services can be viewed at:  Catastrophic Trauma Recovery (CTR)
• A detailed description of the progressive levels of treatment and process for entry into the service system can be viewed at:  Service Delivery Model

2) Professional Training:
A comprehensive and intensive curriculum providing multiple areas and levels of expert training and proficiency in practical mental health and crisis intervention skills to hundreds of students, current professionals, paraprofessionals, and volunteer relief workers that immediately enable them to function as a broad and expanding pool of skilled service providers in refugees camps and their society in general.
By intent, members of refugee communities are sought out to include within the pool of trainees - to model self-empowerment and to provide them with the effective skills needed to assist in both healing their societies and training others to do so when they eventually return to their countries.
Training is also offered to local humanitarian NGO's who's staff are in need of specialized experience in practical treatment and assessment skills.

Interdisciplinary Team: Training includes and integrates several mental health related disciplines, and is fundamentally committed to a strong interdisciplinary team model that includes psychology, psychiatry, social work, occupational therapy, physiotherapy, special education, and psychiatric nursing. The interdisciplinary team forms the center of all treatment planning, implementation, and supervision. On-going training, direct clinical case consultation, guidance, and mentoring is provided on a permanent basis by Common Bond Institute's international expert pool of practitioners.

Training of Trainers: Creating a core group of selected local trainees and professionals with advanced abilities who form a highly skilled, interdisciplinary mentor pool for eventually joining the expert training team to conduct on-going locally-based training groups.

A description of the Professional Training model and levels of professional and paraprofessional training available can be viewed at:  
Professional Training

3) Formal Internship, Vocational Experience, and Job Creation:
Working closely with academic departments within local universities and colleges, supporting and augmenting their terminal degree programs by providing the formal practical training, field experience, and internship components for graduate students in mental health related disciplines that is currently missing within their formal curriculums. Current department degrees include: psychology, psychiatry, social work, occupational therapy, physiotherapy, special education, and psychiatric nursing.

Training provides professional certification of training, experience, and proficiency that allows a significantly increased number of graduate students to meet national standards and requirements for licensing to practice. The intent is to produce a growing number of deeply needed local practitioners in these services, and to grow and develop an effective human service infrastructure that is increasingly better capable of meeting the needs of their society in the future. At the same time, it promotes the creation of skilled professional positions in the social health care field and a growing job market for those vital services within the society that can help provide stable vocational employment and a benefit to the economy in general.

Internships and practicums are supervised by expert professionals and certified with endorsements by accredited US universities and professional training institutes. The end goal is to create a local mentor pool of qualified practitioners who will eventually become the official field instructors and supervisors into the future, and to establish formal membership relationships with our international network of professional associations in each discipline for on-going support and cooperation.

4) Assessment, Evaluation, and Monitoring:

• Needs Assessment for Recipient Communities
  Utilizing effective, standardized, and culturally adapted assessment and evaluation tools, identifying the type and amount of needs within communities.
  
  
• On-going Service Monitoring and Reporting
  Ensuring accountability, quality control, uniformity, responsiveness, and internal integrity through regular monitoring.
  
  
• Program and Service Delivery Evaluation
  Regular evaluations conducted by assessment teams to determine overall effectiveness and success toward meeting program goals and mission, need for further improvement and development, and opportunities for creative innovation and expanding on the overall mission.
  
  
• Program Development
  Continual focus on program visioning and practical development for further applications and scaling in support of the overall human service infrastructure, as well as replicating in other societies exhibiting similar critical needs and systemic challenges.

  5) Research and Analysis:
  Collaborating with two major research and development initiatives organized by Common Bond Institute that study communal trauma and it's transfer into future generations, as well as the development of new models and methodologies for healing trauma on the large group, societal level:
  1) The Global Network for the Study of Transgenerational Trauma - a professional network of permanent working study groups researching the dynamics of unresolved communal trauma, it's inheritance into future generations, and implications for violent relationships within and between communities
  2) Annual International Conference on Transgenerational Trauma: Communal Wounds and Victim Identities - an annual meeting place for Network members to share knowledge, explore critical issues and applications, and explore the development of new models and methodologies for treating communal trauma.

  Need

Service Recipients:
Individuals and families in refugees camps within Jordan, Lebanon, and Turkey, as well as residents of these countries who are in need of assistance, but who have limited or no access at all to the very limited existing services.

Immediate Need:
On the ground needs assessments reveal a critical level of serious, debilitating post-traumatic stress disorder (PTSD) symptoms pervasive throughout the entire refugee population in the region. Due to continuing and growing level of violence, traumatic experiences, and extreme deprivation in daily life, including violence done to them and viewing the violence and death of others - many of who are family members and neighbors, victims are re-traumatized on a regular basis. This is particularly devastating for children who have less ability and psychological resources to cope with this heightened level of danger, stress, and loss.

Long Term Need:
Profound psychological and emotional injuries may be the most enduring effects of war and violence, yet historically, they are the least addressed in terms of rebuilding a community or society, and preventing future violence within and between communities. Large-scale recovery efforts commonly focus on more visible needs such as food, shelter, clothing, physical health, security, and economic aid. However, the effects of deep psychological trauma on individuals, their families, and ultimately their communities is typically overlooked or minimized, and seldom truly resolved. This invariably leads to it becoming imbedded as part of the psyche of a society that extends the wounds into future generations where it is too often played out in further violence and the creation of new victims. In this way the cycle of violence and the cycle of trauma directly contribute to each other. The pervasive presence of such a large segment of traumatized members in all areas of these societies poses perhaps the most formidable barrier to recovery and peace. Without these urgently needed services it is expected the trauma of violent physical and emotional abuse, loss of loved ones and neighbors, loss of homes and community, and dramatic decline in basic daily life, will continue. It is imperative to not only the present but to the future that victims on all sides are assisted in healing and recovering from their tragic experiences. True healing and recovery can then better lead to lasting peace.

Whether in the Middle East, Europe, Caucuses, Balkans, Africa, or elsewhere, in modern times or the past, regardless of the original motivation of conflict, unresolved communal psychological wounds, often inherited from one generation to the other, are one of the most powerful fuels of war and violence. The chronicle of hostilities and conflict throughout our human story is heavily woven with narratives of revenge, retribution, and righting past wrongs, with often competing narratives on both sides of the same conflicts. No society or age is immune to these toxic dynamics, as is painfully evidenced by just the wars and bloodshed over the last century. Efforts at maintaining peace and avoiding war are seriously handicapped if they do not directly address such current and historical wounds to create the means for preventing future traumas by preventing unresolved communal wounds from bleeding into subsequent generations.

Treating large civilian populations, experiencing catastrophic psychological trauma pervasive at all levels of a society due to war and violence, poses unique challenges not typically focused on in the therapeutic literature or conventional clinical practice, where the historical application is with individuals or small groups. When the society is one where human services are seriously underdeveloped or absent, and where the integrity of the existing social support system itself is critically compromised by a catastrophic situation, this challenge can be overwhelming. Although needs assessments conducted in the region over the years by various international aid organizations have consistently identified this critical, pervasive, and relatively unmet need, and although NGO coordinating agencies and relief organizations confirm this as a present and growing condition, there has been far too little provided in the way of adequate direct treatment services or local training in trauma treatment.

This lack of action has been primarily due to the lack of workable models and methodologies in the field of mental health for undertaking such an immense, long-term task of treating at the large and societal level, and particularly where the local human service infrastructure is significantly lacking. What is required are concerted efforts at developing new models oriented toward treating large populations in societies where trauma has become systemic and available resources are extremely limited, to both heal the current trauma and prevent it's transfer into future generations where it can erupt at any given flashpoint within and between communities.

Local capacity building: These approaches must incorporate an integrated and multi-level flow of services and supports designed to respond to both immediate and long-term effects of trauma. A key feature is that the capacity to provide and quickly expand these services on an ongoing basis is designed to be instilled within the local community itself by tapping into the available skills and human resources within it. The deep symbolism of a community healing itself is vital to regaining the sense of empowerment, value, dignity, and balance with the world that is threatened and undermined by the trauma experience. It is noteworthy that these qualities within a community also support compassion and tolerance toward others that can help defuse impulses toward revenge and retribution. It is imperative that any model also be sensitive and appropriate to the cultural context of both the trauma experience and treatment. Thus, in addition to adaptations of highly effective mental health treatment methods, it is important to enlist traditional healing aspects of the society, including its cultural and spiritual resources.

 Current State Of Existing Services

In general, there is a seriously limited amount of mental health service, expertise, or resources in the region. What little does exist in neighboring countries hosting refugees and in Syria is completely overwhelmed, with only a small percent of the population capable of paying significant fees to access them, while the critical need for such services is continually and rapidly growing by the tens of thousands as a massive stream of new refugees enters these countries each day to swell the millions languishing in camps spread across the region. Mental health services of any kind from aid organizations is extremely limited and stretched, or in most cases nonexistent, with the emphasis and efforts of national and international relief organizations to date primarily directed toward addressing the basics of food, shelter, clothing, and security, or simply assessing the need for services.

The fields of practical clinical psychology, psychiatry, psychotherapy, and related services are also profoundly limited.

At universities, departments of Psychology, Psychiatry, Clinical Social Work, Rehabilitation Therapy, Special Education, and Psychiatric Nursing lack practical training and experience in treatment and assessment skills, or such departments are nonexistent, requiring graduate students to seek access to training programs outside the country - that are only limitedly available and unaffordable to most - to acquire necessary skills before being able to function as practitioners within their society. To compound things further, due to the very poor local job market, those who acquire specialty training outside of Jordan, Lebanon, and Turkey too often do not return so that their skills can benefit their society, resulting in a continual talent drain that further diminishes local capacity.

As a result entire communities made up of millions are in a state of profound need, deprivation, and crisis, with a serious deficiency or complete lack of effective services to meet their needs.

 Further Details on SHC Services:
         Main SHC Program Page
         Professional Training
         Catastrophic Trauma Recovery (CTR) training and treatment model
         Service Delivery Model
         International Coalition and Network
         Assessment, Evaluation, and Monitoring
         Research and Analysis

* Please address all Program Questions and Inquiries to
Common Bond Institute

Underlying Concepts