Consortium MeetingNarrative Report 2013

• Vision

• To reach a Palestinian society governed by the rule of law and respect for human rights principles and free from all kinds of oppression.

• Mission

• To make a specialized institution that represents a knowledge base in the field of mental health, to enhance the efficiency and abilities of local community cadres to deal with mental health problems.

• Strategy

• To provide supportive and therapeutic services in the field of mental health to children, families, torture and human rights violations victims.

Contribution to Improve the Mental Health Situation of the

Gaza Strip Population

Project (1): COPE• This program aims at helping

parents develop their skills and abilities, to improve their relationship with their children, increase collaboration, problem solving and confidence building.

• 6 groups of parents including 141 mothers were formed during the project, in cooperation with 3 kindergartens, and 3 associations across Gaza strip.

• The results showed the positive effect of the project according to the reviews of mothers.

Challenges

• Some fathers refused to attend the sessions.

• Some couples preferred to be separated during sessions.

• Some of the associations lacked proper training halls, and some mothers preferred to hold the sessions in their areas instead of going to far places.

Project (2): School Mediation• Aims to reduce the level of violence and to encourage the

resolution of disputes by peaceful means among children.

• It also aims to provide the necessary support for children who have been subjected to violence, which enhances their resilience and protects their mental health.

• The program was implemented in 6 schools after signing the memorandum of understanding with the Ministry of High Education.

• A 25 hours training course was held for school counselors and a number of teachers.

• The professionals trained 203 students on school mediation skills, and held a graduation ceremony for mediators at the six schools where the program was implemented.

• Post training phase:

• 111 specialists conducted supervisory visits to schools to follow up the implementation of school mediation with student mediators and counselors.

• 6 workshops targeting 142 parents and teachers were held, addressing different topics, including trauma, psychological and behavioral problems faced by teenagers.

• 6 recreational trips were organized for the mediator students.

Resu

lts

• 96% of participants were satisfied with the topics.

• 94% praised the content of the workshop and its suitability for their daily needs.

• 88% of participants wanted to apply their newly acquired skills in their schools.

• Choosing 203 students instead of 180 students as a result of high demand.

• A marked improvement was noticed in the academic level of 7 students who joined the school mediation program.

• In a first of a kind gesture, a group of students who completed their school mediation training in 2010, took the initiative to apply the program in their neighborhoods in 2013.

• One of the schools reported that this program is the first to target the school since its foundation 14 years ago.

Summer camps are a preventative and developmental method of psychological intervention, to help children mature in the social framework, and to protect them from mental and psychological disorders in the future.

Project (3): Summer Camps

Lets Have

Fun “3”

During the Project

Project (4): Activating Counseling Units

• Based on the Memorandum of Understanding that was signed with the Ministry of Education, the Programme continued its efforts to provide community mental health services within the educational system.

• The formation of a joint committee from the Ministry of Education and the Programme to follow up activities in schools.

• 6 new schools were selected to host the new counseling units.

• The professionals conducted 133 weekly supervision and intervention visits to the counseling units, including 86 new cases, who were discussed with the school counselors, and conducted individual and group sessions for a group of 238 children.

• A 25 hours training Was held for school counselors working in the 12 selected schools.

• 8 awareness meetings Were held for about 126 parents and 128 teachers.

• The role of counseling units was not only limited to the selected schools, but also extended their services to neighboring schools.

• According to clinical results, 25 cases were transferred from the counseling units to Community Centers Affiliate to the Programme, to receive the necessary specialized intervention.

• A unified registration file was developed and imposed in the targeted schools, that’ll be used by the Ministry of Education for all counselors, which has a significant role in the development of documentation system at the schools of the Ministry.

Project (5): Play Therapy Unitsfor Early Childhood

• The Programme continued its early childhood Intervention throughout systematic interventions with 16 kindergarten across the Gaza Strip.

• In addition, it established play therapy units in targeted kindergartens to provide a healthy environment for children, which enables them to grow and reach their full potentials.

Activities of Play Therapy Units for Early Childhood

• 105 evaluation and intervention visits targeting:

• 13 QSN kindergartens

• 3 new kindergartens

• Number of beneficiaries: 220 children

• 40 awareness sessions targeting 497 mothers.

• 48 Supervision Sessions

Activities of Play Therapy Units for Early Childhood

Organizing 16 recreational trips

Referring 4 cases to the Programme for an advanced therapy

Project (6): Specialized Therapeutic Interventions for Families and Children

Throughout the report duration, The Programme’s specialist provided 1408 therapeutic intervention

sessions as follow:

Therapeutic intervention

services for children501 children

66% males

34% females

New cases 221 cases145 males

76 females

Follow up cases 280 cases181 males

99 females

EGG services 142 cases86 males

56 females

Physiotherapy services 31 cases8 males

23 females

• According to clinical data, the most common diagnosis among treated children were:

• PTSD

• Enuresis

• OCD

• Epilepsy

• Depressive disorder

جلسات إشراف

55جماعية,

جلسات إشراف فردية

8للمهنين,

إستشارات نفسية

لألطفال 189

Rehabilitation and Integration of Orphans in Community Project

• The project targeted 421 children who lost their dependents during the Israeli aggression on Gaza in January 2009, and the second aggression in November 2012.

• 225 intervention session were implemented for groups of children.

Activity Numbe

r

Age

Activities at local associations

such as role playing, drawing, and

narratives ..etc

140

children

7 - 12

years old

Psychodrama groups 69

children

12 – 17

years old

Mind and Body groups 140child

ren

12 – 17

years old

Psychological Distress sessions

for mothers of orphans

69

children

Recreational trips 211

children

• The Programme uses the Strength and Difficulties Questionnaire scale (SDQ), to assess the effectiveness of therapeutic intervention with children, this scale briefly examines the behavior of children between 3-16 years, and includes 25 items divided in the form of five evaluation standards as follow:

Decrease of emotional problems after the intervention

From 54.7% to 34.8%

Decrease of behavioral problemsFrom 54.8% to

42.5%

Decrease of ADHDFrom 14.1% to

4.4%

Improvement of peers relationshipFrom 76.6% to

86%Social behaviors did not show a

remarkable improvementFrom 11.3% to

11.4%The questionnaire total showed a decrease

in problems and a 19.97% improvement after a month of treatment

From 69.1% to 55.3%

Strategic Goal 2Promote the Understanding and Community

Adoption of Practices Suitable for the Standards of Human Rights and Mental Health

Project (1): Raising Community Awareness in the Field of Mental Health and Human Rights

• Is considered one of the most important activities to fight stigma related to mental health, and to promote human rights principles.

• Most important implemented activities:

42 Radio Episodes

6 TV Programs

17 Articles

During the year 2013, a scientific material was prepared for three awareness brochures, which were finalized and printed at the beginning of the year 2014.

• The Community working in this field views the Programme as a primary provider of more specialized treatment and rehabilitation for victims of torture.

• The Programme provided 28 legal advice related to humane issues, in cooperation with the Physicians for Human Rights organization (PHR) – Israel, and the Legal Center for Freedom of Movement (GISHA), as 19 of these cases were patients who were not approved to be treated in hospitals.

• 9 cases were reunited with their families.

• The Programme continued to document 20 cases of torture patients.

• A Memorandum of Understanding was signed with:

Project (2): Advocacy and Lobbying for Human Rights

• Two training sessions were held, targeting 45 officers working at the Ministry of Interior; to raise the level of knowledge and awareness among workers in the field of law and to respect human rights.

• A training manual for mental health and human rights was prepared for police officers, which would be useful in future training for this group, and all employees working in the field of law in the future.

• The Programme contributes through its membership in the National Committee for the Protection of Rights in forming Palestinian NGOs, which is a coalition of 14 non-governmental civil institutions, hosted by Al Dameer Association for Human Rights.

Project (3): Specialized Therapeutic Intervention for Victims of Torture and Human Rights

Violations and their Families

Activity Beneficiaries

Therapeutic interventions for

victims of torture and humans

rights violations

1130

56% males

44% females

Therapeutic interventions for

victims of torture and humans

rights violations including new

cases

343

206 males

137 females

Follow up cases 787428 males

359 females

Professionals conducted 3867 clinical sessions as follow:

The Programme offered 2367 therapeutic interventions as follow:

Activity Beneficiarie

s

General disorders patients 486 57% males

43%

females

New cases 66 43 males

23 females

Follow up cases 420 234 males

186 females•EGG service was provided to 200 cases, including 116 males and 84 females.•Physiotherapy service was provided to 96 cases, including 76 males and 20 females.

Challenges

• The Programme used the International Classification of Functioning (ICF) questionnaire, as a tool to assess the effectiveness of therapeutic interventions for adults, and the results showed:

• Improvement by 20.4% in the capabilities of patients between the first and second sessions,

• In addition to improvement by 17.2% between the second and third sessions.

• Patients refused to fill in their (ICF) questionnaire, and some of them filled in the first evaluation only, so it must be taken into account the use of other follow up methods in the future, and to think about the most appropriate means to achieve this goal.

Project (4): Rehabilitation and Occupational Therapy for Patients of Mental Health and Victims of Human

Rights Violations

• The Programme developed a guide for occupational therapy and rehabilitation interventions, and signed a memorandum of understanding with the Directorate of Mental Health Department at the Ministry of Health, for the success of the occupational therapy project. In addition, a referral mechanism was established in 2012 and continued in 2013.

• The results showed the high number of patients who were transferred to the Occupational Therapy and Rehabilitation Center after signing the memorandum of understanding with the Ministry of Health.

• The vocational training enhanced the social and psychological safety of professionals, and contributed to the strengthening of resilience and social development.

Project (5): Rehabilitation and Integration of Orphans in the

Palestinian SocietyWorking with Al Rabee Institution for Juveniles Care

• A training course entitled "Advanced Training in Dealing with Juveniles" was held for (30) professionals from the Ministry of Social Affairs and Al Rabee Institution.

• Conducting 26 weekly supervision sessions.

• 40 home visits targeting juveniles.

Working with Al-Amal Institute for Orphans

• A 24 hours training course was held targeting 15 professionals working at Al-Amal Institute for Orphans.

• The Programme’s professionals conducted 29 weekly professional supervision sessions.

• The professionals also conducted 30 home visit to orphans in order to:

• Assess the status of the family.

• Monitor the behavioral and emotional problems among children.

Strategic Goal (3):Strengthening the Programme's Role as a Unique Center in Treatment Development and Provision of Community Mental Health

Services

Project (1): Integration of Mental Health Within the Primary Health Care Service.

• The Programme signed an agreement with the Islamic University to provide theoretical and practical training for Psychiatry students in February, May, and November 2013.

• The number of 54 students included 23 female and 31 male students.

Professional Development in the Field of Mental Health

• Eight professionals were selected to receive a training program led by Dr. David Becker from Germany, Dr. Patric Hammerle, and Dr. Conrad Frey from Switzerland.

• The training included several visits to get to know the practices and methods of service delivery in Berlin. After their return, they held a training to new trainees and supervised them throughout the hole training period.

Challenges• Timing of the training in

Berlin was inappropriate, because several main directors of departments had to leave, which coincided with the consortium meeting.

Results• The Programme is

considered an institution that oversees the work of other institutions, and the capacity building of professionals working in the field of mental health.

• This project provided a rare opportunity for those working in the field to exchange experiences among them.

• This exchange established a dialogue between professionals working in different institutions or disciplines.

Project (3): Capacity Building of Partner Associations working in the Field of Mental

Health and Human Rights

• A training program was developed to meet the needs of trainers, to enhance their ability to promote early detection of cases that need intervention and provide basic services, and transferring cases that need special intervention.

• Trainees expressed their desire to transform the traditional perspective of their work of focusing on families’ economic evaluation, to expand their services to include intervention on social levels as well.

• The 10 training days of 40 hours included:

• Social intervention techniques.

• Child development.

• Children mental disorders and means of intervention.

• Symptoms of psychological disorders.

• Stress management and dispute analysis.

Project (4): Academic and Scientific Programs for Professionals Working in the

Field of Mental Health (High Diploma Program)

• The Programme prepared in partnership with an external expert the high diploma program, as a response to the needs of mental health professionals in Gaza Strip. In addition, two new courses have been added (Profession Ethics and Families Intervention).

• A study of higher education needs in the field of mental health showed the importance and effectiveness of the diploma program in meeting community needs, it also suggested certain modifications to be brought into the application based on the recovery process and evidence.

• Since 1997, the Programme has provided the community with more than 150 professionals in the field of community mental health.

• Because the course “Family Intervention” is still innovative in Gaza Strip for academics and local trainers, the Programme searched for an international expert in this field, and had an agreement with the Italian expert Dr. Guido Veronese to begin a training in May 2014.

Project (5): Standardizing Psychosocial Manuals

The Programme concluded the “Standardization of Psychosocial Manuals in the Gaza Strip" project, which aimed at standardizing four psychosocial manuals suitable to the Palestinian environment.

• Participants assured that their experience in standardization has contributed actively in creating a Palestinian vision for the standardization of manuals.

• Participants expressed their desire and willingness to standardize new manuals within their organizations, through the development of professional psychosocial references consistent with the Palestinian environment and local culture.

• Working with other institutions contributed to the increase of positive change in communication between institutions, acceptance of other opinions, developing the capacity of participants and their critical thinking, strengthening positive behavior, and building their confidence in their professional ability regarding standardization.

Strategic Goal (4)Crisis Intervention

Project (1): Studies to Specify Common Problems

• The Programme conducted a study entitled (Long-term Psychological Effects of the Recent Israeli Aggression on the Palestinian Children and Parents).

• The survey was conducted by Researcher Dr. Vivian Khamis between October and December 2013.

• The study contributed to the development of scientific basis about the long-term effects of the recent Israeli aggression on the mental health of Palestinian children and parents.

• Which was used in the mental health sector and psychosocial support, supervised by the World Health Organization and UNICEF.

Project (2): Capacity Building of GCMHP and Society to Deal with Crisis

• The Programme selected 21 mental health professionals (14 females and 7 males) and five psychologists (3 females and 2 males), then formed ten multi-disciplinary teams of professionals.

• The teams received a 40 hours training on intervention techniques and most common problems, and started to intervene after the training with community field work through visits to homes, kindergartens and community institutions.

• The Programme partnered with “Mercy Corps" in order to integrate programs in the field of psychosocial support for children and families affected by the aggression on Gaza.

• The Programme developed a training program targeting 30 (8 males and 22 females) workers in the psychosocial field from 16 local institutions, partners of Mercy Corps in Gaza Strip.

• The program included 30 hours of theoretical training and topics related to intervention after crisis.

• Cooperation with "Mercy Corps" enhanced the impact and sustainability of joint programs for the sake of beneficiaries, especially that it deals with 16 local institutions that provide psychosocial services to thousands of traumatized children.

Project (3): Free Telephone Counseling Line

• 776 callers benefit through 1288 calls.

• beneficiaries were classified as follow:

• 75.4% females and 24.6% males.

• Of which 8% were children and 92% adults.

• Most problems experienced by callers were as follow:

• 58.8% psychological problems,

• 20.2% social problems,

• 10.7% behavioral problems,

• 8.1% emotional problems.

• Beneficiaries during the morning period were 52.3%,

• Beneficiaries during the evening period were 47.7%

1800222333

• The results showed that 47.7% of beneficiaries held a university degree, while 52.3% held a high school degree or less.

• The results showed that 31.7% of beneficiaries are housewives, and 43% are students.

• Social and behavioral problems were more common among female beneficiaries, especially widows and divorcees.

• Follow up reports indicated the emergence of new phenomena in Gaza Strip, such as increased drug use, especially among young people, and increased levels of stress and anxiety among housewives and students as a result of the deteriorating economic situation.

• The free counseling line Service covers all Palestinian territories, including West Bank, the results showed that 2.2% of beneficiaries were from the West Bank.

• The percentage of female callers was 74.4%, this is an indication that females may have difficulties accessing mental health centers as a result of stigma related to mental health and living in remote areas.

Project (4): Intervention after the Israeli War on Gaza strip in 2012

• The professionals intervened at community level in all affected areas as a result of the Israeli aggression, the teams conducted 1959 home visits, benefiting 10249 people.

• The Programme targeted 10 kindergartens in the affected areas in Gaza City and the northern areas of Gaza Strip, which have been targeted by the recent Israeli aggression, where ten play therapy units in these kindergartens were furnished and provided with toys.

• Forming and preparing 10 teams of multi disciplinary mental health experts.

• Psychologists conducted 200 weekly intervention and supervision visits to kindergartens which benefit nearly 1,300 children.

• The Programme held 100 public meetings in the affected areas across Gaza Strip, which benefit nearly 2480 mothers and fathers.

• Nearly 600 parents benefit from the crisis management sessions. In addition, 45 parents benefit from the psychodrama sessions.

• The Programme prepared a set of 24 episodes in two local radio stations, to raise awareness in community mental health issues.

Strategic Goal (5)Development and Sustainability of GCMHP

Project (1): Building the Capacities of GCMHP Staff

• A professional at GCMHP obtained a PHD certificate in psychology, and four others obtained master degrees in different disciplines. In addition, a PHD graduate was able to publish scientific articles in an international journal.

• Many international trainers and experts in clinical and intervention fields have visited GCMHP, and held different training courses to its professionals.

Project (2): Strengthening GCMHP Role Locally and Internationally

• The Programme organized an international scientific conference in cooperation with the "GIZ“ organization, in the presence of nearly 120 local and international participants, experienced in the field of mental health and psychosocial support.

• A Korean delegation of 5 students from the “Medical Peace Foundation” visited the Programme to inquire about the effects of the Israeli violations and violence on the psychosocial situation of the Palestinian society, in order to use it for research purposes.

• The Programme hosted an American medical delegation of different fields from the "Physicians for Social Responsibility“, to build the capacity of medical staff and perform surgeries.

Challenges

• Stigma due to mental health issues.

• Staff turnover rate in the targeted institutions.

• The number of applicants for training programs are beyond the Programme’s capabilities.

• Difficulty hiring Researchers.

• Lack of sufficient coordination between institutions working in the field of mental health.

Lessons Learnt• The diversity of services and the

importance of tasks distribution.

• GCMHP is the provider of moral services in Gaza Strip

• Professional guidance, supervision and taking care of service providers must be a part of the professional process.

• Partners are more aware that marginalized groups have the right to mental health services.

• Partnership agreements with various institutions is essential to the organization of work.

• The need to develop a model of community mental health to be a scientific reference to the provision of services in Palestine.

Sustainability• Long term experience and good reputation on the professional

level had a role in attracting financiers interested in alleviating the psychological effects of political conflicts.

• Development of a strategy to maintain secure financial resources for the Programme and its activities.

• Projects aiming at capacity building, which enhances continuity and professional development, to provide specialized services in community mental health.

Success Stroies

• A tenth grader complains of his fear of exams, confusion and lack of concentration, the counseling unit helped him overcome his fear and build his self confidence, he passed his monthly exams successfully.

• Student “X" was subjected to sexual harassment, verbal and physical abuse by a group of students, his school counselor intervention contributed in providing moral support and boosted his self confidence, making him more resilient.

• Her parents ambitions for her to obtain the highest score in secondary school made her extremely anxious and tense. The counselors analysis of the situation in an objective way has contributed to the amendment of their thought in a more rational manner.

• Difficult circumstances of her family, and being deprived of her father’s tenderness has made her more aggressive at home and school. Following her up at the counseling unit contributed to modifying her behavior, made her calmer and more adaptive to her teachers and her classmates