I have been working with vivo (Victim’s Voice) for more than 12 years. Our mission is to overcome and prevent traumatic stress and its consequences within the individual and the family, as well as the community, safeguarding the rights and dignity of people affected by violence and conflict. vivo developed Narrative Exposure Therapy (NET) as an intervention to address Post-Traumatic Stress Disorder (PTSD) at the individual level, but my expertise lies in developing systematic interventions for families. I have adapted the evidence-based Parent Management Training-Oregon (PMTO) Model for families and piloted it with different communities affected by war and organized violence. This work is conducted internationally in post-conflict countries such as Uganda, Sri Lanka and Mexico, as well as with immigrant and refugee communities here in the U.S.
Improving Mental Health Starts at the Family Level
Many of the individual effects of traumatic stress also have relational components that are often transmitted from generation to generation. Things like domestic violence, substance abuse, harsh parenting practices and any number of emotional regulation or anxiety-related problems can be a direct consequence of decades of war and poverty. These issues impact one’s ability to go to work, to do chores, to effectively parent, and in many ways, to be fully functional in everyday life. While it is certainly practical (and perhaps necessary) to focus on individual-level treatment of PTSD, it can be life changing to interrupt this cycle of violence and maladaptive coping at a systematic level by helping parents effectively support their children. I am currently testing PMTO informed models across different cultural and trauma contexts—and preliminary results have been very promising.
While there are similarities in the impact of traumatic stress around the world, there are also differences. The issues affecting families in Uganda, for example, are very different from those in the U.S. Uganda has been devastated by civil war, and one major challenge is incorporating children back into the community who had been abducted and forced into becoming soldiers. U.S. immigrants and refugees face their own set of challenges such as stigma, adjusting to a new culture and limited access to proper mental healthcare. This can be a chaotic time for these displaced families—and their numbers are higher than ever. Minnesota has one of the highest per capita rates of refugees in the U.S., and while we certainly have a long way to go, the University of Minnesota is proud to lead the way with research that is responsive to our community needs.
Another major project I have been involved with is developing screening tools for improving mental health in refugee populations. My colleague Patty Shannon and I have addressed this growing need in several phases of research. We know a medical exam is needed within three months of refugees coming to the U.S. Of course each state is different regarding whether or not mental health is included in that exam. We also know refugees have a higher likelihood of PTSD from war specific regions, yet if we are not screening for mental health, what are the implications? Many communities do not have the infrastructure in place to effectively respond to immigrant and refugee mental health concerns. To help deal with this issue, we conducted focus groups across four different local refugee communities to identify cultural expressions for certain mental health symptoms. We then developed a screening tool that is now being tested with these groups. My work will also be focused on the next phase of piloting PMTO informed, culturally relevant models with various refugee groups.
Cathy Solheim, another one of my colleagues, also has a long track record of working in refugee communities. She tackles things from the area of economic well-being. Many families come from places with no cash economy, understanding of credit, food stamps, etc., and the economic realities here are very foreign concepts. Together we are partnering to intervene with refugee families in the areas they struggle with most.
Much has been said about the power of resilience in overcoming extreme adversity. While this is surely important, it is crucial to understand the other factors in play. When systematically oppressed groups of people escape to regain their human rights and possibility of survival, we know these people are predisposed to having PTSD symptoms and relational challenges within their families. We must do a better job of promoting awareness across different community system levels (such as schools, medical clinics, churches, social agencies) and developing effective preventive and intervention models to support these already vulnerable families. We need to bring awareness to the families themselves by aiding in removing the stigma of getting help.
For more on these issues and countless others impacting human rights around the world, please take time to get involved in Human Rights Day on Wednesday, December 10. For more on our work in Uganda, please read this story from CEHD’s Connect Magazine.[sc:elizabeth-wieling]
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