Kosovar Family Professional Education Collaborative (KFPEC)

John Rolland and Stevan Weine

The American Family Therapy Academy is collaborating with the University of Prishtina, the University of Illinois at Chicago, and the University of Chicago affiliated Chicago Center for Family Health in a project called the Kosovar Family Professional Education Collaborative (KFPEC). The overall aim of this project is to enhance the capacities of Kosovar professionals to build on the strengths and resources of Kosovar families to better address their mental health and health service needs in the midst of a war-torn region. We are co-leading this collaborative with Ferid Agani M.D, Associate Director of Clinical Services at the University of Prishtina.

Currently, the University of Illinois at Chicago is working with the psychiatric leaders of the provisional authorities in Kosova, in collaboration with the WHO, to draft a strategic plan for the mental health services for Kosova using community-based services. Ferid Agani has been in Chicago at the University for the past month to facilitate that effort. These relationships and efforts provide a framework for the Kosovar Family Professional Education Collaborative (KFPEC).

Ivan Pavkovic who co-directs the Project on Genocide, Psychiatry, and Witnessing at the University of Illinois, has been instrumental. Ivan is originally from Croatia and was very central in mental health reforms in Bosnia and Croatia in the aftermath of war. He went to Kosova this past fall for extended discussions regarding development of the project. The key ingredients are a resilience-based, family-centered effort to deal with recovery from trauma and loss that will be ongoing. In February there were a number of meetings in Chicago and consultation within the Human Rights Committee to make this project a reality.

For the past eighteen months, the two of us have been collaborating on a major grant from the National Institute of Mental Health as part of their effort to support research into the mental health consequences of torture. This project, CAFES: offers family education and support for the Bosnian refugee families (20,000 individuals) in Chicago. This project is unique in its use of trained Bosnian group facilitators for a nine-session multi-family discussion group format. Most recently, we have been funded to provide similar services to Kosovar refugee families.

In our team project in Kosova, over an initial ten-month period (April 2000 to February 2001) we aim to enhance an existing collaboration between the University of Prishtina and the University of Illinois at Chicago by forming a collaborative with the American Family Therapy Academy and the Chicago Center for Family Health, and centers upon family-focused education and training. We want to build knowledge and technical expertise in the general area of family work for a large number of professionals and para-professionals in Kosova. We will provide advanced more intensive training in specific family interventions with smaller groups of identified professionals and para-professionals in Kosova. Finally, we will evaluate the impact of training and participation in this collaborative effort from Kosovar and international perspectives and to use that data as a basis for articulating a model of education in international family work that can be adapted to other cultures coping with trauma and loss.

The family, with its strengths, is central to Kosovar life, but health and mental health services are generally not oriented to families. Although "family" is a professed part of the value system of international organizations, most programs do not define, conceptualize, or operationalize a family approach to mental health services in any substantial or meaningful ways. Recognizing that the psychosocial needs of refugees, other trauma survivors and other vulnerable persons in societies in transition far exceed the individual and psychopathological focus that conventional trauma mental health approaches provide, this project aims to begin a collaborative program of family focused education and training that is resilience-based and emphasizes family strengths.

This collaboration includes family professionals from AFTA, and professionals, para-professionals, and other family advocates from Kosova. The Kosova professional group is to consist of mental health professionals (psychiatrists, psychologists, social workers) and health professionals (physicians, nurses). It will bring together a group of Kosovars which is heterogeneous with respect to discipline and workplace.

To establish a true collaborative, international experts are needed to help Kosovar helping professionals to develop the knowledge and skills that will enable them work more effectively with families, particularly to help strengthen family resilience for coping and recovery from trauma and loss. We, in turn, need to have a fuller picture of the world of the Kosovar families, its strengths, beliefs and values, and needs. What are the particular cultural meanings of suffering, emotional distress, mental illness, and mental health treatment to families? How can we identify the idioms used by families to affirmatively represent suffering, which may be used in engagement interventions? We need the active help of Kosovar professionals, paraprofessionals, and families to help them to achieve this learning.

The project will consist of a series of educational activities, which will bring together international family professionals and Kosovar professionals. The international team, consisting of four to six family professionals, will visit Kosovar in April 2000. Over the next ten months, there will then be no less than four follow-up visits with pairs of international professionals. Each visit will consist of several educational activities: 1) seminar series on general family issues; 2) small-group intensive workshop on developing practical family skills in a specified area; 3) site visits and ethnographic inquiry.

It is expected that as a result of participating in this initiative, Kosovar professionals will have: an enhanced understanding of family approaches; acquired specific practical family skills that they can utilize in their work; enhanced sense of professional identity and work as well as morale; and developed collegial relationships with American professionals. Kosovar professionals will produce written reports on important family topics for distribution and possible publication in Kosova; American faculty will produce written reports on the model of family education for presentation and publication internationally. This model/manual will be developed so that it can be adapted to other cultures/settings worldwide. The collaborative group will produce a summary report, which makes recommendations for future family work in Kosova.

At the February AFTA Board meeting at the Roberto Clemente Family Guidance Center, we discussed this project, and had a compelling dialogue on several basic issues of language and values which underlie this proposition. We would like to address two of those issues.

Kosova, not Kosovo. Our collaborators say it is who they now are. Concerns are raised: Does that mean we are supporting another extreme ethnic nationalism? No, it should not. We are engaging in the same way that literally hundreds of international groups are, with the Kosovar people and the legitimate organizations. The governmental status of Kosova is a work in progress, and will be so for some time. Working with Kosovar professionals and organizations creates the opportunity for advocating for peace and open society in the new Kosova. Our training will be offered to everyone, but the reality is that currently the region is mostly ethnic Kosovar. We, like other NGO's and relief organizations, need to see this as a starting point. There is no other group in there with a family-based model and the type of systemic approach to conflict resolution and reconciliation we have to offer.

We choose the word collaborative because this word choice denotes a two-way relationship between Kosovar and American professionals, intentionally distinct from the usual train the trainer approach. Trauma training, with very few exceptions, tends to pluck health and mental health professionals from their existing structures, and pour knowledge onto them in the transient structures provided by the international community. Four organizations are working together here, and the relationship must be clearly beneficial to all. Specifically, the Kosovars must not be passive recipients of American wisdom. They must do things, from the beginning, which enhance their functioning as professionals in the world of Kosova. They are also teachers, especially on the Kosovar landscape, families, values, and services.

We see this as an important and exciting learning opportunity for all parties and look forward to more dialogue on these and other issues within the AFTA community. At the upcoming Annual Meeting in San Diego, a portion of the Human Rights Forum will be devoted to reporting on this project and the initial AFTA team's visit to Kosova.

John Rolland, current Chair of the Human Rights Committee, is Associate Professor of Psychiatry and co-director of the Center for Family Health at the University of Chicago and its affiliated post-graduate family therapy training institute, the Chicago Center for Family Health.

Stevan Weine is Associate Professor of Psychiatry at the University of Illinois at Chicago where he is co-founder and co-director of the Project on Genocide, Psychiatry and Witnessing. He is the author of When History is a Nightmare: Lives and Memories of Ethnic Cleansing in Bosnia-Herzegovina (Rutgers, 1999).