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Psychosocial Support Outside the Box



Another Conference on Trauma?

Will children be well-served by a global symposium on the devastation wrought by trauma and conflicts around the world on children’s emotional well-being”? There’s going to be one this week, in the Hague. I confess skepticism. Typically the results of such gatherings are minimal. A nice time is had by all. A task force and several new committees are established. Reports are written. Consultants are recruited for assessments and advice. More meetings are organized. Funding is pursued for all the above. By the time any actual programs or research take place, much financial and institutional capital is already consumed, directed to situations and purposes long past the hour of prime benefit.

When you add up all the airline tickets, all the $275 per diems for hotels and food, all the organizing costs, all the salaries of participants, you could fund a fat handful of projects delivering real results to real people or conduct desperately needed research generating hard data about impact.

Yes, people need to get together and talk, but hardly about “what works and doesn’t work”. The data is here, at our fingertips. You don’t even need to be a researcher to find it - a simple search on Google Scholar yields enough guidance to develop well-informed interventions for communities in need.

The problem is not that we don’t know what to do to support communities and experiencing trauma, it’s that we simply aren’t doing the things known to be effective on a scale big enough to make a difference.

There are many reasons for this. Some, like fierce competition for resources to address human suffering, are unavoidable. But some, like lack of coordination and cooperation among key actors in this sector, are inexcusable.

A gap that merits attention

Practitioners and academics in this field are poorly connected. I learned this the hard way in recent years, with one foot in the academic world as a PhD student and the other in the world of practice as a trainer and consultant to projects run by the UN and other international NGO agencies.

On the one hand, academic research has made tremendous progress in studying needs of communities exposed to trauma. But in the field, it seems that many people are still in the 80’s and 90’s, practicing outdated methods and in some cases causing more harm than good. On the other hand, field organizations have also made encouraging progress in the attention they are giving to delivery of psychosocial services. Few academics have kept up with the proliferation of experience that has resulted and the evolving challenges now emerging.

Getting access to field data is hard for academics

Rather than talkshop exchanges of ideas and anecdotes, our field desperately needs bona fide research measuring the effectiveness of the many different approaches being employed. Academics excel at this, but they need access to field data to do their work. As a researcher eager to learn about what actually works and doesn’t work, several years ago I nearly gave up on access to the practitioner world for data gathering. I approached one organization after another with a request to conduct carefully designed, Internal Review Board-approved PhD research in a field setting.

Only after many declines over a two year period, was I able to gain the permission of one organization to proceed with research. Success came in part because I was also a practitioner - the organization I worked with would benefit from receiving free consultation and training and access to cutting edge approaches in trauma therapy and training methods.

Practitioners face their own strugglesPractitioners face unforgiving realities of survival. Raising money is a constant challenge, and when grants do come through, there is never enough money and time to do things as well as desired. Organizations say wonderful things - with all good intentions - about community empowerment, contextualized design, monitoring and evaluating, and applying recent advances in the field. But they take shortcuts to survive. Programs are typically hastily designed according to somebody’s boilerplate notions of what worked elsewhere, often with minimal involvement of local resource people, organizations, and communities. Evaluation, if it is done at all, rarely yields enough reliable data to convincingly assess the effectiveness of approaches used.

Virtually nobody in the practitioner world has time to both do well the things they intend to do and yet stay ahead of funder cycles. As a researcher, I found organizations and staff eager to learn from the results of the research I was doing, but few resources were available from the organizations to assist. I could see that when my particular research project ended, very little would continue the learning I had sought to do.

Start with prevention

Given the limited resources available for trauma response, it is urgent to allocate resources carefully, in ways most likely to bring maximal results. Community resiliency building and prevention should be a top priority in places prone to conflict and natural disaster. See my blog on this of two weeks ago. Prevention programs can’t substitute for response programs, but they can substantially reduce the costs of psychosocial responses required after trauma has taken place. They lay the groundwork and prepare communities in ways that reduce the psychological damage of trauma.

Think outside the box

Despite the need, individual/group therapy as we know it in the Western world is simply not an option for most populations exposed to trauma due to cost and lack of trained professionals. We must figure out alternatives.

First, we need to develop interventions that are short term, cost effective and carefully documented for effectiveness in reducing trauma symptoms and increasing post traumatic growth. Second, we need to make sure that such interventions are culturally sensitive, which means that these interventions need to be developed in consultation and partnership with people in beneficiary communities.

There is much to be learned about how to do this. But I am optimistic that it can be done. In my 2013 pilot research I was able to demonstrate effectiveness in reducing secondary traumatic stress symptoms following 6 sessions with individuals. My current goal is to achieve that kind of results in a delivery format scalable to groups and communities.

Modest investment in research would go a long way.

Generating good data remains one of the biggest deficits and most important opportunities for our field. One obvious strategy would be to strengthen collaboration between PhD programs and agencies in the field.

In the course of my PhD program, I conducted two field studies in two countries. This produced data of value to a large global network and and also expanded intervention and training resources for organizations in both countries, at little or no cost to them. I was lucky in that I lived close to situations in need of trauma response and had the personal resources to support study and research.

But in fact not a lot would be needed to greatly expand the access of PhD students to situations where they could do important field research and generate the kind of data needed to provide empirical guidance to practitioners and other researchers. Students from strong doctoral programs bring substantial training in relevant skills and careful oversight from Internal Review Boards populated by experts in how to conduct field research in ways that protect the integrity of participants. Providing them access to field situations, encouragement of field practitioners who recognize the importance of research, and modest financial assistance for the logistics involved in delivering interventions designed to meet research protocols would go a long way.

In my cohort of doctoral students at Lesley University were twelve students. Such a program could produce a number of empirical field studies every year with a modest investment of time and money to facilitate it.

Occasionally summits surprise even skeptics and become catalytic events that change many things for the good, for years. I hope the Hague gathering turns out like that. And I hope that those attending remember that an investment of less than half of what it will cost could facilitate a lot of doctoral research projects generating hard data crucial to truly advancing this work.

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