| The
Harvard Program in Refugee Trauma Health Promotion
Administering Organization
Massachusetts General
Hospital
Program Objectives and Unique
Needs Addressed
The Health Promotion
and Evaluation project at the Harvard Program in Refugee Trauma
(HPRT) has been the formalization of a 20+ year collaboration
with the Vietnamese American Civic Association of Greater Boston
(VACA) and the Cambodian Mutual Assistance Association (CMAA).
The goal of this collaboration has been to identify Vietnamese
and Cambodian torture survivors suffering from depression or under-treated
depression, to understand how this affects their overall health
status, and to develop innovative and collaborative strategies
for increasing the health of these survivors. Understanding that
“overall health status” necessitates a holistic approach,
we believe that health is affected not only by the immigration
process of adjusting to another country and associated stressors,
but that health is also affected by the traumas resulting from
having lived through war and political unrest in their country
of origin. Having survived horrific atrocities, Vietnamese and
Cambodian people have an increased risk of chronic health problems,
including hypertension, cardiac disease, asthma, diabetes, cancer,
and hepatitis, as well as depression and posttraumatic stress
disorder.
Program Description
The Health Promotion
program directly targets the dearth of professionally trained
resources by educating large numbers of the Vietnamese and Cambodian
communities about their health and mental health symptoms by clarifying
how to improve their health status through regular contact and
improved communication with their primary care physician. During
the 1st year of the program, a screening tool was developed and
administered to VACA/CMAA clients. During the 2nd year of the
program a Health Promotion class was initiated at VACA/CMAA, with
approximately 10-15 students per class. Participants were encouraged
to share their cultural beliefs and traditional healing practices
as they learned the scientific worldview of their Primary Care
Physician. In the 3rd and 4th years of this project, HPRT worked
on a "Push-to-Cure" initiative: re-screening hundreds
of torture survivors and 'pushing' forward with new and more effective
treatment strategies. This entire initiative, nicknamed "IPC+",
represents the evolution of the Indochinese Psychiatry Clinic's
capacity to offer evaluation and treatment for individuals and
families who have survived mass violence and torture. In addition,
HPRT staff will continue to work with these MAA’s to present
this effective model at national conferences, reach out to community
health centers and other "ports of entry", and continue
to develop and provide health promotion services to their communities.
Resource Materials Used in Program
During the first year,
we developed a screening tool, which is used to screen for depression
and a history of torture. For the Health Promotion Course, we
developed a holistic curriculum. The concept of mental health,
or how trauma affects the overall health of the individual, the
family, and the community, was integrated throughout a range of
medical conditions. Classes are didactic and interactive.
Groups Served by Program
We serve the Vietnamese/Cambodian
community in the greater Boston area.
Program Funding
HPRT was awarded a four
year grant from the Office of Refugee Resettlement and we are
currently seeking additional funding. Twenty percent of each additional
grant we have received during this project has gone to our partnering
Mutual Assistance Associations in order to continue to build and
strengthen these partnerships as well as their capacity to develop
and manage community-based programs for survivors of torture.
Program Staffing and Required
Staff Training
Under the 2004-2005
year grant from ORR, there have been regular training meetings
at HPRT involving several medical experts from Harvard teaching
hospitals to review disease specific topics.
Defining Program Success
The HPRT has a strong
evaluation system in place, including measures that are taken
three times: pre-intervention, post-intervention, and six months
following the intervention. Depressive symptoms are measured using
a Simple Depression Screen (Hopkins Symptom Checklist-25) and
the Harvard Trauma Questionnaire to screen for PTSD and functional
limitations. Confidence concerning health is measured using an
instrument developed by HPRT that includes confidence in areas
such as understanding of health and illness, communication with
Primary Care Providers, and the effects of diet, exercise, and
relaxation on health.
Program Additional Comments
We thank both Captain
John Tuskan of the Refugee Mental Health Program (SAMHSA and ORR)
and the Office of Refugee Resettlement (ORR) for the resources
and support in out Health Promotion activities in the Cambodian
and Vietnamese communities.
Program Outcomes
Program evaluation measures
reflect both a significant reduction in depressive symptoms and
an increased sense of confidence concerning health among participants.
Areas of increased confidence include understanding their medical
condition or illness, the human body and how it functions, preventing
disease through proper nutrition, exercise, meditation or relaxation
techniques, and how to communicate with their Primary Care Providers.
Desired results—reduction in depressive symptoms and increase
in confidence—were significantly higher immediately following
the classes, and these results were either sustained or even stronger
six months later. HPRT is proud that ORR has now awarded direct
funding to both the Vietnamese American Civic Association and
the Cambodian Mutual Assistance Association as a result of this
innovative and collaborative Health Promotion initiative.
Other Key Elements
Working closely with
Ministries of Health throughout the world, HPRT has developed
community-based mental health services primarily in existing local
primary health care systems. HPRT's bicultural partnerships with
international collaborators have resulted in culturally effective
and sustainable programs that rely also on local human resources
and indigenous healing systems.
Program Contact
Harvard Program in Refugee
Trauma, Department of Psychiatry, Massachusetts General Hospital,
22 Putnam Avenue, Cambridge, MA 02139 USA, phone 617.876.7879
| fax 617.876.2360, rmollica@partners.org
www.hprt-cambridge.org
Please visit our additional Web site, www.project1billion.org
for downloadable versions of Project 1 Billion’s Book of
Best Practices and Mental Health Action Plan
Program Dates
This program began in
2002; it is still operating.
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