Tuesday, May 12, 2015

"Looking through the Diamond": Clinical Dimensions

And now for part two! Today's dimension - clinical.

Clinical Dimensions of Aftercare

This dimension is one that I personally find very important. Some organizations that I have encountered conflate the social dimension (covered on Thursday) with the clinical one. Often this is due to lack of funds, and certainly not the fault of the organizations in many cases. However, it is important to understand that social and clinical needs for survivors of sexual exploitation are extremely different. While the social aspect is probably what will result in the most long-term recovery, none of this can happen at all if there are pressing medical or psychological issues going on.

While the need may seem straightforward, addressing it can be very difficult for these organizations that are often lacking resources. In many of the countries, there is a scarcity of professionals trained in a clinical setting with an understanding of trauma and the particular case of sexual exploitation. This means that it often takes creative solutions to address this. In some countries, I have seen organizations work like "consultant couunselors," providing services to other organizations at a more affordable rate than hiring a full-time professsional would cost. I have also seen organizations begin to empower and equip the professionals already in a country with specific training on trauma and other pertinent topics. I'm excited today to share some great examples of these types of creative solutions.

Example from Thailand: ZOE International

This organization understands the need for quality care to be delivered to survivors of sexual exploitation – especially those who are still children. ZOE provides many services for rescued victims of exploitation – one of which is a short- and long-term residential program for minor trafficking survivors, who do not have safe places to live. The facility houses over 70 children, ages 0-17. All of these children belong to a smaller family unit within the program, with a house parent to provide constant support. Many organizations would stop at that for emotional support, but ZOE goes a step further to ensure that the children residing at the home receive the best care possible.

Having a quality program like this is extremely important in the country of Thailand, where the government appears to be making efforts to increase their prevention and intervention efforts. If this proves successful, there will be an incredible need for clinical programs ready to work with survivors.

Within ZOE’s staff, there is a particular team of social workers, a psychologist, and translators that focus exclusively on clinical case management for all of the children in their care. This team delivers the weekly and biannual assessments for each child, which includes a widely-used and validated tool called the "Strengths Difficulties Questionnaire." This tool has been translated into Thai, meaning that very little is lost in translation. With a third of the children, the social workers, psychologist, and translators meet regularly to progress through an adapted trauma-focused cognitive behavioral therapy program.

Before the addition of the clinical team into the program at ZOE, counseling sessions were very informal and infrequent. Now, the team is able to strategically assess children’s progress and actually prevent future problems. In this way, the house parents are less burdened with conflicts and crises that stem from the symptoms of trauma. Furthermore, this team has been able to train the house parents in order to better equip them to respond to the unique needs of these children. ZOE has done an incredible job integrating a clinical team into their already existing operations. Find out more about the organization here!

Other Organizations

Tamar, India: is an organization established in India to support many of the freedom businesses that provide alternative jobs to women from a major red light district. This organization has social workers and counselors on staff that are available to help the women with any non-work related problems that they face. In this way, the staff in the freedom businesses can focus on the mission of their own organization - providing jobs. At the same time, the survivors still have access to the kind of psychological support that is needed along the road to recovery. Tamar already incorporates group therapy into their programs, and the organization is looking to add innovative options, like dance or art therapy. To learn more about how this works, check out this article.

Ghandi Memorial Hospital, Ethiopia: has a clinic particularly prepared to assess and treat victims of violent sexual abuse. The need for this kind of specialization is much more important than most people would think. Victims often visit a hospital very soon after the abuse, meaning they are incredibly traumatized and in need of compassionate attention. Traditional hospitals in many countries simply do not have staff experienced enough in these kinds of cases in order to provide this. The Ghandi Memorial Hospital in Ethiopia is a great example of an institution that has created a separate clinic just for this particular case type. I hope the ongoing efforts to establish sexual abuse clinics in many other hospitals in the country proves successful.

Higher Ground, Nepal: is taking on an exciting new project in the clinical dimension of aftercare. The organization’s focus overall is on empowering women who have been rescued by providing economic opportunity. However, a team has been formed within the organization to provide quality care for the survivors in the program and in other organization’s programs. A psychiatrist in the United States is supervising the further specialized education and training of two local care providers. Simultaneously with their studies, these psychologists are providing contract counseling to clients throughout the city. By charging a below market rate, the organizations providing for the other needs of these survivors are able to also provide quality counseling without beginning a project of their own in the clinical dimension. Find out more about Higher Ground here.


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