Massachusetts General Hospital
The Harvard Program in Refugee Trauma
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.
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.
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.
We serve the Vietnamese/Cambodian community in the greater Boston area.
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.
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.
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 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.
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.
This program began in 2002; it is still operating.