The APS Grant for Intercultural and/or International Projects of up to $10,000 supports innovative projects that have an intercultural and/or international focus, particularly in countries where psychology is an emerging discipline. Dr Elizabeth Newnham MAPS, Post-doctoral Fellow at Harvard School of Public Health, and Research Associate at The University of Western Australia, was awarded an APS Grant in 2011-12 to train psychologists in Sierra Leone working with war-affected youth. A characteristic of the Sierra Leone civil war that raged from 1991 to 2002 was the brutal recruitment of children into rebel groups and armed forces. These children were forced to take on roles as front line soldiers, spies, porters, cooks and sexual slaves, and often witnessed and were victims of severe forms of violence, with significant implications for their physical and psychological health. Elizabeth shared her experiences and insights about the APS Grant project in Sierra Leone with InPsych.
How did you come to be involved with the project in Sierra Leone?
In my postdoctoral research at Harvard School of Public Health, I have been working with Associate Professor Theresa Betancourt to investigate the long-term trajectories of psychological adjustment in a longitudinal study of more than 500 male and female war-affected youth from Sierra Leone. We’ve learnt that the effects of war do not end with the cessation of violence. Ten years on from war, issues of daily adversity, difficulty with emotion regulation, grief, and lack of educational and vocational opportunities were particularly salient for youth.
To address these issues, Dr Betancourt, a team of collaborators from Judge Baker Children’s Center, Yale University and City University of New York, and I developed the Youth Readiness Intervention, a group mental health treatment using evidence-based techniques suitable for war-affected youth in Sierra Leone. We collaborated with Sierra Leonean partners and community members to adapt the treatment to the setting and ensure cultural validity.
To support delivery of the intervention, Dr Adeyinka Akinsulure-Smith, Dr Betancourt and I conducted a training workshop for community mental health workers in Sierra Leone. We spent two weeks conducting intensive training, which comprised didactic learning, demonstration and role plays in both English (the official language) and Krio (the lingua franca). The training was highly collaborative: for each session we drew from local expertise to tailor the intervention and its delivery, which was a critical factor in its success. Following the training, we continued to provide supervision by phone, in partnership with a local supervisor, for ongoing guidance and professional development throughout the year. These steps were vital to ensure that staff are supported in their delivery of the treatment in a setting that is severely resource-restricted.
How did the APS Grant assist you in your work in Sierra Leone?
The APS Grant provided the financial support necessary for me to travel to Sierra Leone and lead the training workshops, and conduct ongoing supervision by phone throughout the trial. This grant was integral to the delivery of the training program and provided support for the clinical team through professional development, access to journal articles, guidance on referrals, and assessing fidelity to the treatment.
Following our training workshop, the local clinical team went on to train other community mental health workers, creating a potentially sustainable cycle of capacity building. We are currently conducting a randomised controlled trial to determine the effectiveness of the treatment and its ability to prepare youth for future education and vocational opportunities. I am incredibly grateful for the opportunity and the great partnerships it has created, and look forward to trialling similar systems of training and supervision at home. These issues are comparable to those facing many youth in our nation. Complex trauma resulting from abuse, displacement, neglect, injury or disaster affects a large number of Australian and refugee youth. Many rural and remote communities have potential to benefit from distance collaboration similar to the partnerships we developed in Sierra Leone and I hope to explore this model in Australia in the future.
What are some immediate and/or longer term mental health and wellbeing issues confronting the people of Sierra Leone?
Sierra Leone’s health system was destroyed during the war and its recovery has been slow. It has a highly centralised mental health system, with only one psychiatric hospital based in the capital city, Freetown. The psychiatric hospital is staffed by a retired psychiatrist, a medical officer and two psychiatric nurses. There are very few community services and there are no psychiatry or psychology training programs. However, the landscape of mental healthcare is changing. The Sierra Leonean Government launched the nation’s first Mental Health Policy in October 2012, and efforts are being made to prioritise psychological practice.
For youth, it will be important that mental health services attend not only to the trauma resulting from war, but also the significant issues that arise in the post-conflict setting. Our research suggests that interventions should address the daily adversities most salient to young people, such as difficulties with emotion regulation, anger and drug use, and improving coping skills and interpersonal functioning. Empowering adolescents and youth will strengthen the nation’s capacity for social, political and economic growth.
What kinds of personal qualities and professional skills were most valuable to you during that time?
I think compassion, flexibility, openness to new experiences and ideas, and a sense of curiosity were vital. When working with populations who may have low levels of literacy and different cultural expectations for the therapeutic process, it’s important to be able to adjust quickly and be guided by your in-country partners. Developing the program with the local clinical team enabled important discussions about issues pertinent to youth, creative ways to deliver CBT techniques, the rationale for psychological intervention in post-conflict settings, and cultural traditions in Sierra Leone. It really highlighted the value of great team work and the role that psychologists can play in post-war regions. Having chickens wander into the training room brings its own challenges too!
What has the experience meant for you as a person and as a psychologist?
Working in post-conflict settings is an enriching experience, and I am fortunate to work with wonderful people. I learnt so much from the clinical team in Sierra Leone, who taught me about the incredible resilience of youth, families and communities, and how we can work towards addressing the issues that remain. Psychologists have an important role in advancing evidence-based and culturally valid interventions, and guiding the rigorous evaluation of treatments.
One important lesson was in the value of self-care for the clinical team. Many of our clinicians lived through the war and continue to work in a region of ongoing insecurity. Awareness and recognition of the difficult nature of our work as psychologists, and the importance of boundaries and support were an important lesson for me. However, hearing reports of the clinicians’ goals, how they handled challenges that arose and their impressive achievements throughout the year was a wonderful and inspiring experience.
Is there a take-home message for us as psychologists here in Australia, and as global citizens?
There are a number of exciting opportunities for psychologists in Australia to work with psychologists and local mental health workers globally. It is vital that this engagement be collaborative, respectful and sensitive to local needs. By building capacity in low- and middle-income nations through partnership with local organisations, we have an opportunity to develop more engaging, targeted and ultimately more sustainable treatments that can be integrated into current systems of healthcare.
It is important also to examine opportunities for collaborative engagement in areas of need in Australia. There are numerous communities within our own nation that could benefit from collaborative training and ongoing distance supervision of community mental health workers. As psychologists, we have a great responsibility to engage with models that will support culturally appropriate and sustainable healthcare in areas that may not have access to comprehensive services. Collaborative partnership is the key to providing evidence-based care for children and youth in remote communities.
The 2011-12 APS Grant was awarded jointly to two different projects. The other recipient, Dr Angela Ebert MAPS, was interviewed in the June 2013 edition of InPsych for her project developing master class training for psychologists in Rwanda (see www.psychology.org.au/publications/inpsych/2013/june/APS-Grant-Rwanda/).
APS Grant for Intercultural and/or International Projects 2013
CALL FOR APPLICATIONS
Applications are now open for the 2013 APS Grant to encourage and support innovative projects that have an intercultural and/or international focus. Applications should aim to develop and implement a project that is culturally meaningful for the target country or community and its people, and that promotes intercultural collaborations between Australian psychologists and those in the specified region.
The value of the Grant is $10,000, which can be divided into smaller Grants for two or three separate projects. The Grant is to be used to support the establishment and implementation of a successful and sustainable project. The Grant is not intended to support research projects unless there is a clearly demonstrable outcome in relation to the aims of the Grant.
Further information on the criteria for the Grant can be obtained from www.psychology.org.au/about/awards/intercultural/
Closing date for applications is Friday 27 September 2013
For enquiries about the Grant please contact [email protected]