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Catastrophic Trauma Recovery (CTR) Model

Catastrophic Trauma Recovery (CTR) Model

An integrated, multi-modal, and interdiciplinary treatment and training approach for addressing large-scale, community-wide trauma and loss due to catastrophic occurrences in regions of conflict and war where skill and hard resources are scarce

Need

Profound psychological and emotional injuries may be the most enduring effects of war, yet historically, they are the least addressed in terms of rebuilding a society and preventing future violence. Large-scale recovery efforts commonly focus on more visible needs such as food, shelter, clothing, physical health, 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 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.

Transgenerational Trauma:

Whether in the Middle East, the Caucuses, the Balkans, 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 violent conflicts. 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 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 numerous needs assessments conducted in these regions over the years by the United Nations and international aid organizations have consistently identified this critical, pervasive, and relatively unmet need, and although NGO coordinating agencies, health and relief organizations, and local governmental authorities throughout these regions confirm this as a present and growing condition, there has been far too little provided in the way of adequate direct services or local training in trauma treatment.

 

This lack of action has been primarily due to the lack of new 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. What is required are concerted efforts at developing new models oriented toward treating large populations in societies where trauma has become systemic.

 

These approaches must incorporate an integrated 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 resources within it. 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 aspects of the society, including its cultural and spiritual resources.

Current State Of Existing Local Services

In general, there is a serious lack of adequate mental health service expertise or resources in these regions. The fields of clinical psychology, psychiatry, psychotherapy, and related services is either significantly limited or nearly absent. At many regional universities there are either no Departments of Psychology, Psychiatry, Clinical Social Work, etc., or the programs are seriously lacking in basic practical training in treatment and assessment skills.

Project Description and Purpose

In response to requests for such new models, Common Bond Institute developed the Catastrophic Trauma Recovery (CTR) model near the end of the Balkan Wars. (CBI’s CTR model is described in a chapter [“When Society Is The Victim”] contributed to Dr. Stanley Krippner’s 2003 book on “The Psychological Impact of War Trauma on Civilians”). The objective was to design a comprehensive, integrated, and interdisciplinary treatment and training program, culturally sensitive and particularly suited to regions experiencing violent turmoil where services are underdeveloped and/or the society’s infrastructure has broken down. The CTR Model offers a comprehensive progression of intensive practical training in crisis intervention and outreach, immediate symptom relief, trauma resolution, and support skills to large groups of local professionals, paraprofessionals, and relief workers currently working directly with victims of violence and natural disaster. On-going training and consultation occur with support from CBI, IHPA, and our network of participating professional training organizations to continually advance and support the development of a permanent and growing human service system within these communities.

 

The purpose is to increase the capacity of local services and relief workers in providing direct intervention and treatment to victims of trauma where huge portions of the population have been impacted by widespread violence or natural disaster. The project is designed to address both immediate and long term treatment needs and to establish close, ongoing relationships with and between local aid and service organizations for mutual support and increased effectivenes. An added benefit is the invaluable investment in the future health services of the region.

 

In addition, the project is linked to Global Network for the study of Transgenerational Trauma, a global interdisciplinary network of professional study groups from diverse cultures to examine and research the dynamics and implications of communal trauma and transgenerational trauma, to develop effective, culturally sensitive methods for healing, and to raise awareness and provide education regarding these to human service providers, key policy and decision makers, leaders in society, and the general public.


Interdisciplinary: An essential characteristic of any model that seeks to address such a need is that it be fundamentally interdisciplinary and team oriented. Ideally such a model would include team members representing: psychology, psychiatry, social work, counseling, special education, psychiatric nursing, medicine, occupational therapy, physical therapy, education, and other related fields as needed.

Specific Goals of this Training Are:

    • To create an extensive, permanent, and expanding pool of local health professionals and paraprofessionals equipped with practical skills to meet the immediate needs of the large portion of the population throughout these regions suffering from severe psychological trauma.
    • To teach and actively promote a strong interdiscipinary team model as the default model for human services in the region. Ideally such a model includes team members representing: psychology, psychiatry, social work, counseling, special education, medicine, psychiatric nursing, occupational therapy, physical therapy, education, and other related fields as needed.
    • To create a core group of selected local trainees and professionals with advanced abilities who form a highly skilled, interdisciplinary mentor pool for eventually conducting on-going locally based trainings and supervision, and in this way multiply the pace and breadth of the development of available services to the most people provided by the community itself.
    • To conduct short and long-term service needs assessments – adapting and developing effective assessment and evaluation tools that are standardized, valid, and culturally appropriate to the local culture.
    • To contribute to advancing and developing the infrastructure of the local human services system, and develop on-going links to a supportive and collaborative global network of professional training and treatment organizations. In this way to contribute to expanding the availability and quality of future human services within the community and region at large. An expected outcome is that the service system developed through the project, and the trainees themselves, will also contribute to steadily creating a growing local market for their professional employment.
    • To provide public education in self-help skills and resources to victim populations and their community, and to build capacity for community support of victims.
    • To link local universities and professional organizations and groups to the Global Network For The Study of Transgenerational Trauma – an interdisciplinary, multi-cultural network of professionals from diverse cultures researching and examining the dynamics and implications of communal trauma and transgenerational trauma, developing effective, culturally sensitive methods for healing, and promoting awareness and education regarding these to human service providers, key policy and decision makers, leaders in society, and the general public.
    • To contribute to the stability of local communities with large populations of victims, and so to regional stability as a whole.

CTR Integrated Treatment and Training Model

Equipping communities impacted by trauma and displacement with whole person, multimodal, and culturally adapted psycho-social skills and service templates to empower them in taking on the central role in their own recovery.


The CTR model is Based on a pyramid structure for establishing a broad base of self-help and peer support capabilities across the community in the immediate, while progressively building more in-depth local capacity for expertise in psychosocial treatment and recovery services in the long term.

    • Needs and Service Resource Assessment: for immediate and long term treatment needs of the target community. To include assessment of current human service resources, available skills, recommendations for establishing essential components and pilot demonstration projects, and collaborating with local stakeholders and outside resources to assist in their development.
    • Public Mental Health Education: Informing the public of mental health issues, symptoms, self-help practices, and treatments to promote understanding, reduce stigma, and increase sensitivity and acceptance.
    • Coping Capacity and Empowerment: Utilizing learned skills to decrease feeling helpless, overwhelmed, or out of control, and increase a sense of self-control, tolerance to stress, empowerment, and confidence.
    • Lay and Peer Support: Providing emotional support, guidance, and reassurance through shared skills such as Listening Ear and Compassionate Listening, particularly given the sheer size of the victim pool and scarcity of local mental health services.
      •  Community members providing emotional support and reassurance to family, neighbors, and other community members using learned skills.
      •  Survivor Support Groups: Ongoing facilitated peer groups offering support, safety, and acceptance to further augment and maintain coping skills and support trauma treatment.
    • Communal Healing and Resilience Building: Examples include employing traditional, spiritual, and newly created healing and empowering ritual and ceremony, building healing and recovery cultural narratives, and tapping into the community to develop an empowered, self-help identity through training a growing pool of skilled healers from within it.
    • Community Intervention, Mediation, Conflict Resolution, and
    • Victim Advocacy: to nurture community acceptance and build capacity for support of victims, particularly victims of rape and sexual abuse who often face a second trauma of blame and rejection. Representatives of like cultural and religious traditions from other regions are enlisted as liaisons to interface with local counterparts to assist in encouraging and modeling support within the community. Sensitivity training programs are introduced into the community, and an orientation to the culture and local religions is provided to project trainers to ensure sensitivity in applying training within this context.
    • Socio-Economic-Educational Stabilization and Empowerment
    • Trauma-informed Local Community Service Providers (medical providers, clergy, spiritual leaders, teachers, law enforcement, etc.) equipped with basic psychosocial orientation and intervention skills to more effectively engage with and support individuals exhibiting emotional, behavioral, and physical trauma symptoms, and assess for referral to more in-depth treatment.
    • Crisis Intervention, Emotional Stabilization, and Community
    • Outreach: provided by trained professionals and paraprofessionals
    • Trauma therapy and Assessment: Availability of a broad spectrum of interdisciplinary therapeutic methods and approaches for both short term and long term in-depth treatment, adapted to the local culture, for treating psycho-emotional trauma and other mental health issues.
    • Medication for immediate short term symptom relief.
    • Support And Sustaining Of Local Services And Service Providers:
      • Training Of Trainers
      • Development and Promotion of a Local Pool of Expert Trainers and Mentors.
        • Self-Care and Burn out Prevention for Service Providers:
          • Stress Management for managing the anticipated stress of this work and high potential for burn-out.
          • Counselor/Trainer Peer Support Groups: for ongoing service provider support and consultation.
        • Program Development & Innovation: Demonstrating creative innovations in designing, developing, implementing, scaling up, and replicating collaborative programs in local situations experiencing massive need, undeveloped or compromised local mental health care system, and scarce skill and hard resources.
          Ongoing clinical and program consultation with local partner NGOs.

Targeted Trainees

Local psychologists, psychiatrists, counselors, social workers, medical professionals, teachers, students, and relief workers in regions of conflict currently working with or committed to working directly with refugees and victims of violence and natural catastrophe. Priority is given to workers in positions to model and teach skills to others. Both this training of treatment providers and the training of trainers involves key individuals identified and screened by local NGO partner organizations in cooperation with the project team. An addional unique feature of the project is that it sometimes includes trainees from both sides of existing or recent conflicts, and provides a profoundly powerful opportunity for healers coming together to help each other heal their respective communities. The hope is this can help lay the groundwork for future bi-communal cooperation.

Trainers

Expert teams of specially trained mental health professionals in the field of trauma treatment, Post Traumatic Stress Disorder (PTSD), crisis intervention, triage, stress management and coping skills, survivor support groups, survivor advocacy, and conflict resolution. Interdisciplinary team members are gathered from the extensive networks of CBI, IHPA, and our international conferences on conflict transformation and healing. An orientation to the cultural and ethnic context of trainees and victims is provided. Trainers agree to be available on an ongoing basis after and between trainings for clinical consultation and support via Skype, Email, and phone. This soulful work is highly challenging, requires a great deal of commitment, flexibility, energy, and inner strength, and is immensely rewarding.

Local Support and Collaboration

Partnering with and having the support and cooperation of local professional and humanitarian organizations and colleagues, as well as where possible with government authorities, is fundamental to our philosophy and essential to the success of the CTR project. Our organizations work closely with local colleagues as a representative team in developing, adapting, and implementing the project within their society, with an end goal being that the community itself takes on increasing responsibility, management, and development of the services. In addition, local NGO’s cooperate as site hosts to provide and coordinate site logistics, identify and enlist trainees, help coordinate with existing and developing local service systems, etc.

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