Intervention Journal

July 2015 - Volume 13 - Issue 2

ARTICLES

Task sharing in rural Haiti: qualitative assessment of a brief, structured training with and without apprenticeship supervision for community health workers
Authors:
McLean, Kristen E.; Kaiser, Bonnie N.; Hagaman, Ashley K.; Wagenaar, Bradley H.; Therosme, Tatiana P.; Kohrt, Brandon A.

FIELD REPORTS

REFLECTIONS, COMMENTS, LETTERS

REVIEWS

SUMMARIES

Summaries in Arabic
Authors:
Editors
Résumés en Français
Authors:
Editors
Summaries in Russian
Authors:
Editors
Summaries in Pashto
Authors:
Editors
Summaries in Sinhala
Authors:
Editors
Resumenes en Español
Authors:
Editors
Summaries in Tamil
Authors:
Editors

From the editor: breaking new ground and old favourites

 
Our regular readers may be surprised to discover that this issue has no special focus or theme, unlike the last four issues. However, that does not mean that there is nothing new to discover, nor that there are not a few old favourites with a new twist, as well.
 
Breaking new ground

For the first time, Intervention is introducing a Key implications for practice box at the beginning of each main research article. This has been a growing trend in other journals, one which the Editorial Board felt was an important addition to provide clear, concise information on how the research presented can be applied in the field. Our regular readers will be aware that this bridge between theory and practice is a key element in Intervention, and one which we hope to continue to develop with this additional information. Please do let us know your views on this new addition to the journal articles.

The other new ground came about neither through design nor intention, but was a random happen stance that we would like to note: all of the first authors of our main research articles are women. This is the first time ever, in the history of Intervention,that this has occurred.

Recent, highly controversial, research by Ingalhalikar (2014) suggests that ‘male brains are structured to facilitate connectivity between perception and coordinated action [i.e. they tend to focus in on tasks], whereas female brains are designed to facilitate communication between analytical and intuitive processing modes [meaning they move between associated and non-associated concepts and multi-task]’. This would suggest that male and female researchers may have different approaches to a subject, and the editors at Intervention would very much like to know if our readers have noticed such differences in approach as you read our offerings this amazingly, rich and multi-layered issue.

 
Articles

The first main article is by María Vergara, Emilia Comas, Irada Gautam & Uma Koirala and examines ways the relationship between mother and child can be supported within a context of domestic violence. They describe a pilot parenting programme in Surkhet, Midwestern Nepal, specifically developed to support mothers with past, and ongoing, experiences of domestic violence. The programme is not aimed at ending such structural violence, which in the context of this programme is another question, but here the focus is on establishing meaningful relationships between the mothers and their children in order to improve their interaction, and in recognition of the impacts of such violence on both generations. The pilot is encouraging, and while it is important to work with the actual, daily reality of these women, I can’t help but wonder why these kinds of initiatives cannot be coordinated with programmes to reduce the domestic and structural violence that colour the daily reality of this group of women and children.

There are so few studies that address MHPSS in Myanmar, that we were thrilled to receive the contribution from Maria Vukovich and Gwen Vogel Mitchell. They present a study on an eight session psychotherapy group programme, Sharing Circles, working with specific vulnerable groups, such as lesbians, gays, bisexuals and transgender people, those who are unsure of their sexuality, formal political prisoners and people living with HIV/AIDS. Sharing circles is a method for improving psychosocial support and reducing psychosocial symptoms. The programme shows a slight improvement regarding psychological stressors, depression, anxiety and stress, but, maybe equally important for groups that are marginalised or excluded, the participants felt part of a group, also essential for wellbeing.

The article of Kristen E. McLean, Bonnie N. Kaiser, Ashley K. Hagaman, Bradley H. Wagenaar, Tatiana P. Therosme and Brandon A. Kohrt presents a qualitative assessment of a brief, structured training (with and without apprenticeship supervision) for community health workers. The authors implemented a multi-stage, transcultural adaptation for a pilot, task sharing training in Haiti. They studied both trainings on task sharing training and supervising. In their research they conclude that, post training supervision is one of the strongest predictors of behaviour change. This studies pleads for a serious consideration what kind of supervision is needed and best when implementing programmes. Too often, the type of supervision is not taken into consideration

And, last but not least, in terms of the main articles, Shweta Verma presents qualitative research that examines not only the many roles that women take on; ‘a widow, a victim, a mother’, but also looks at resilience and wellbeing within the complexities of women's lives in Kashmir. She shows that it is too simplistic to speak of people who are resilient or not, or whose wellbeing is good or not. The paper highlights the different identities, strategies and negotiation skills this group of women use to improve their wellbeing. Through one case study she presents, the impact of different contexts are clearly highlighted; one context stresses victimhood, while another may stress the fact that she is a widow or a mother. Labels, such as: resilient/non resilient; adaptive/maladaptive; or doing well/not doing well, often does not adequately address the daily realities in which people cope with adversity in multiple ways, and in multiple contexts.

 
Old favourites, new twists

The very first Editor-in-Chief of Intervention (and current member of the Editorial Board), Guus van der Veer, has contributed much over the years, both to these pages and to the development of the field. As such, in my opinion, his opinion matters. So, while we often reserve Field Reports for issues that focus on one topic, event, intervention or regional situation, the field report offered by Guus van der Veer in this issue is informed and infused with his own opinions and methods of working on the important issue of what organisers of capacity building projects need to know before they hire a trainer. So, while this field report may be seen as a mix of a personal reflection and field report, it gives such clear instructions and suggestions for facilitating a training course for psychosocial workers and/or mental health staff, I decided to publish it as a field report. In it van der Veer also describes what should be included in a report of a workshop for MHPSS workers and what organisers of capacity building projects need to know about training psychosocial workers and mental health staff.

The Personal reflection from Nadim Almoshmosh is also a slightly different twist to most Personal reflections, in that his paper is a plea to MHPSS workers and agencies for better coordination to begin to alleviate some of the extreme, and ongoing, suffering of Syrian refugees and those internally displaced. Almoshmosh is a psychiatrist of Syrian origin, and therefore best placed to address the mental health needs of Syrian refugees, having seen it from early on in the conflict. I can only agree that these issues need to be addressed quickly, but in a way that ’does no harm’ and has a chance of actually doing good, having seen first-hand the refugee camps and impacted communities in Turkey and Jordan. His experience shows that the ‘4Ws’; Who is Where, When, doing What in Mental Health’ developed by the IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings (2012) is sadly not (yet) common practice in the field. Furthermore, the question is raised if in such an ongoing humanitarian crisis, what actions should one organisation take to ensure better coordination of efforts and quality of interventions?

Another favourite feature repeated in this issue is the Book review. The book reviewed in this issue, could ironically be applied to many of the ongoing humanitarian crises highlighted throughout the issue. Global Mental Health: Principles and Practices, Vikram Patel, Hayy Minas, Alex Cohen & Martin J. (Eds.), was reviewed by another favourite contributor and member of the Editorial Board, Pau Pérez-Sales, and highlights the book's strong focus on human rights and the need to develop methodologies for local, reality based approaches, with strong cultural, social and political components.

The final favourite, brings us back to the beginning, as the issue actually opens with what is quickly becoming a common thread in these pages, a further discussion of the contribution of Vikram Patel in the ‘New frontiers’ Extra issue of Intervention (12.4). Patel stated in that issue that the world of global health is too ‘supply driven’. He questioned if we engage with the people suffering in a way that makes more sense to the beneficiaries or the support agencies. Anica Mikuš Kos responded in the last issue (13.1), by raising the question of how to translate and implement the ideas presented. In this issue, Derrick Silove contributes to the debate on how to integrate ideas and practice. Silove describes the difficulties for researchers and clinicians to integrate a worldview of the global and transcultural mental health movements. According to Silove, the problems lie in the fact that we treat diagnostic categories as if they are concrete or ‘real’ entities, while diagnoses are more useful abstractions and not indicators of a psychopathological process. Further, that the ‘Mental-Social Gap’ is itself an artificial distinction we make between the mental and social worlds.

As always, we would very much enjoy any opinions our readers would like to contribute.

Marian Tankink

Editor-in-Chief

 
References
IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings. Who is Where, When, doing What (4Ws) in mental health and psychosocial support: manual with activity codes (field test-version). Geneva: WHO. (2012).

 

Ingalhalikar M., Smith A., Parker D., Satterthwaite T.D., Elliott M.A., Ruparel K., Verma R.. Sex differences in the structural connectome of the human brain. Proceedings of the National Academy of Sciences 2014; 111 2:823–828.doi: 10.1073/pnas.1316909110.
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Authors:
Tankink, Marian

ARTICLES

Supporting the relationship between mother and child within the context of domestic violence: a pilot parenting programme in Surkhet, Midwestern Nepal

This paper describes the experience of a group based parenting programme for mothers with past, or ongoing, domestic violence experience in Surkhet district, Midwestern Nepal. Twenty women took part in the programme, with meetings every three weeks over a period of nine months. The results, after data triangulation, showed significant improvements for the majority of caregivers with respect to: (a) increased understanding of children's attitudes, feelings and behaviours; (b) improvements in management of conflict situations within the family; and (c) greater empowerment and self-confidence. Some of the main challenges encountered by the facilitators while running the sessions are discussed. This encouraging experience suggests that a combination of programmes, using behaviour, relationship and psychotherapeutic approaches, can be a source of support to reduce negative parent/child interactions for mothers harmed by violence. Presenting this study provides an opportunity to examine some of the current challenges of supporting parenting skills within violent environments.

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Authors:
Vergara, María; Comas, Emilia; Gautam, Irada; Koirala, Uma

Sharing Circles: learning from a community based psychosocial intervention model implemented with vulnerable populations in Myanmar

The last several decades of ongoing conflict and oppression in Myanmar (as it is now officially known) has had an extensive psychological and emotional impact on its people. Unfortunately, there has been a distinct lack of psychosocial programming provided through culturally appropriate methods in Myanmar. This study investigated an eight session psychotherapy group called Sharing Circles. Trained local staff implemented a group intervention in Yangon, Myanmar with 57 Burmese participants from Yangon identified as belonging to one of three vulnerable groups. Preliminary findings suggest the Sharing Circles may be an effective psychosocial technique for improving psychological symptoms and providing psychosocial support. Limitations included: lack of a comparison group, relatively small sample size, convenience sample, and simple pre and posttest design. Further, well designed, studies of group interventions with identified vulnerable groups are needed to confirm and clarify initial findings as well as to evaluate its potential application in other conflict affected regions.

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Authors:
Vukovich, Maria; Mitchell, Gwen Vogel

Task sharing in rural Haiti: qualitative assessment of a brief, structured training with and without apprenticeship supervision for community health workers

Despite growing support for supervision after task sharing trainings in humanitarian settings, there is limited research on the experience of trainees in apprenticeship and other supervision approaches. Studying apprenticeships from trainees’ perspectives is crucial to refine supervision and enhance motivation for service implementation. The authors implemented a multi-stage, transcultural adaptation for a pilot, task sharing training in Haiti entailing three phases: 1) literature review and qualitative research to adapt a mental health and psychosocial support training; 2) implementation and qualitative process evaluation of a brief, structured group training; and 3) implementation and qualitative evaluation of an apprenticeship training, including a two year follow-up of trainees. Structured group training revealed limited knowledge acquisition, low motivation, time and resource constraints on mastery and limited incorporation of skills into practice. Adding an apprenticeship component was associated with subjective clinical competency, increased of confidence regarding utilising skills and career advancement. Qualitative findings support the added value of apprenticeship according to trainees.

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Authors:
McLean, Kristen E.; Kaiser, Bonnie N.; Hagaman, Ashley K.; Wagenaar, Bradley H.; Therosme, Tatiana P.; Kohrt, Brandon A.

A widow, a victim, a mother: rethinking resilience and wellbeing within the complexities of women's lives in Kashmir

Using a case study, this paper describes initial results from qualitative research with women widowed as a result of conflict in Kashmir. Recognising resilience as a process that contributes to a sense of wellbeing, this paper highlights how this process also often involves experiencing and exercising overlapping identities of being a ‘victim’, ‘widow, and a ‘mother’ for women within conflict contexts. Further, the paper questions simplistic readings of resilience and wellbeing that classify people as resilient or not resilient, and classify relationships, identities, and feelings in terms of ‘good’ or ‘bad’ by reflecting on questions such as: ‘is belief or portrayal of oneself as a victim unhelpful or negative? Or, is worrying bad?’ The case study included here is one of the fifty qualitative interviews conducted as part of PhD research on resilience among women widowed due to conflict in Kashmir.

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Authors:
Verma, Shweta

FIELD REPORTS

Training workshops for psychosocial workers and mental health staff: what organisers of capacity building projects need to know before hiring a trainer

When invited to facilitate a training course for psychosocial workers and/or mental health staff, I am sometimes confronted with unrealistic expectations: the person commissioning a training expects a detailed programme that describes exactly what subject matter will be covered, and precisely when. In other cases, I am requested to design a programme that connects to an earlier training, facilitated by another expert in the mental health and psychosocial support field. Here, I sum up what, in my opinion, should be included in a report of a workshop for mental health and psychosocial support workers, what organisers of capacity building projects need to know about training psychosocial workers and mental health staff, and what should be asked of a trainer they intend to hire.

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Authors:
van der Veer, Guus

REFLECTIONS, COMMENTS, LETTERS

Some reflections on the article of Vikram Patel ‘Rethinking mental health care: bridging the credibility gap’ in the Intervention Extra Issue: New Frontiers

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Authors:
Silove, Derrick

Highlighting the mental health needs of Syrian refugees

This personal reflection discusses the author's personal involvement supporting the mental health needs of Syrian refugees. The mental health needs of this population includes a wide range of psychological problems that require further evaluation to fully understand. The scale of the problem is huge, affecting large numbers, some of whom were subjected to prolonged torture and witnessed daily bombardments. Many other factors add to the refugees’ misery, including: their ordeal before reaching safety, uncertainty of the future, feelings of entrapment and humiliation. There are also the general effects of forced displacement, the stigma surrounding mental health issues, and lack of means and trained professionals. Host communities have been overwhelmed and unprepared to deal with such huge demands. While several aid agencies have been involved, there is a lack of coordination resulting in either missing out whole communites and duplication of efforts in others. Additionally, these challenging environments affect conducting studies with, often, highly frustrated populations and some results may be skewed as a result. This paper ends with suggestions of what can be done to improve approaches to providing some relief in this unprecedented and continuing crisis.

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Authors:
Almoshmosh, Nadim

REVIEWS

Patel Vikram, Minas Hayy, Cohen Alex, Prince Martin J. (eds.). Global Mental Health: Principles and Practices. Oxford, Oxford University Press, 2014 (512 pages). ISBN...

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Authors:
Pérez-Sales, Pau

SUMMARIES

Summaries in Arabic

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Authors:
Editors

Résumés en Français

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Authors:
Editors

Summaries in Russian

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Authors:
Editors

Summaries in Pashto

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Authors:
Editors

Summaries in Sinhala

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Authors:
Editors

Resumenes en Español

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Authors:
Editors

Summaries in Tamil

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Authors:
Editors