Human Rights Committee Report

February 2001

To: AFTA Board and Committee Chairs

From: John Rolland, Chair

Kosovar Family Professional Education Collaborative

The Kosovar Family Professional Education Collaborative has continued to grow and flourish. The project has met its obligations and those participating are very satisfied. Below, is a summary of the third visit that was focused on Brief Intervention Models and Techniques. Also, we have responded to a request from the Joint Distribution Committee, which has a long history as a major Jewish funder of relief organizations, to develop a proposal to advance and expand the current project in the direction of the development of mental health and preventive services in Kosova. You will find attached the summary page of the grant proposal. This proposal was a collaborative effort among Kosovar colleagues and the American team on site. It is a proposal that highlights a resilience-based family approach that draws on the strengths and culture of the Kosovar family. It is important to understand that a primary goal in Kosova is the development of a health and mental health service delivery system in this war-torn region. We are fortunate to have developed our project in collaboration with the mental health leadership in Kosova. Now, design and the beginning of implementation of a long-term strategy is being developed. The groundwork of our project's first year has positioned the KFPEC, and specifically a family-centered model, to play a significant role in this process. Also, we are aware that we need funding to sustain and develop the project into the next stage so that it is less dependent on a purely volunteer structure and effort.

Trip Report: November 28 through December 5, 2000

Team members: Steve Weine (team leader), Judith Landau, Melissa Griffith, Van Griffith,

Jack Saul

Site Visits. As with the previous trips, approximately two days were devoted to site visits and three and one half days to training. Previously visited and new community sites were chosen to help the collaborative group develop a picture of how service and support systems interconnect formally and informally. The visits furthered the process of collaborative discussions about how to gradually develop multi-system collaborative models of care that bridge health services, mental health services, social services and other community-based services. New relationships were forged and old ones strengthened, in order to foster opportunities for work over the longer-term with various mental health support systems.

One site visit was to Slovii. This was the third visit the project has mad there. During this visit, we met with several families that had been seen previously, and several new families. The team felt that it was very useful to develop a longitudinal picture of the families and the village as a whole. It seems that, with each successive visit, the families we encounter become much more comfortable with us, and appear to feel freer to be themselves. For example, in one family, we witnessed much more evidence of generational conflict, which we had previously understood to be a major issue for Kosovar families.

We also made a separate field visit to the International Society for Red Cross and Red Crescent (ICRC). Our team met with families and spoke with ICRC psychosocial counselors about their work with families and communities.

Training. Regarding training, the primary objective was to build on the prior visit's focus on resilience-oriented family assessments and how to conduct brief family interventions. This included a day of didactic presentations with the remainder of the time devoted to skills development through live interviews and group case consultations with a focus on brief intervention models and techniques. The lectures, held at the University of Prishtina Hospitals, were attended by seventy persons and received enthusiastically. There were pairs of lecturers, comprised of American and Kosovar professionals, which worked very well together. The topics were: 1) Identity and Connection with Families (Melissa Griffith), 2) Transitional Therapy (Judith Landau), 3) Hosting Solution-oriented Conversations with Kosovar Families (Jack Saul), and 4) Reflections on the Family Training (Stevan Weine). It is clear that the Kosovars have made great strides in their abilities to present, with greater confidence and clarity. Workshops, which built on the lectures, were both topical and involved live interviews and family case consultation/supervision in large and small group formats. This involved working with the core training group of thirty-six Kosovar mental health professionals. Workshop topics included: Questions about conducting initial interviews (Melissa), Creating a future vision of the Kosovar family training program—a solution-focused exercise (Jack), and transitional mapping and working with a link therapist (Judith).

During one of the training sessions, an unexpected incident transpired. There was a shooting outside, in front of the hotel. This generated an experience of retraumatization for the Kosovar professionals, all of whom had been traumatized by wartime occurances (e.g. refugee camps, loss of family members and homes). The shooting turned out to be the result of a family feud, and not a political hostage situation or continuing warfare. Though the violence posed no real threat to the group, there was an intense period of ambiguity, requiring American team members to assist Kosovar colleagues in coping with the heightened stress levels. An extended period of debriefing was needed that lasted into the following day. This event brought our team to a much clearer understanding of the human reality of violence and its aftermath, and underscored how the resilience of the collaborative team can be helpful in the building of something useful from such an experience.

In addition, the training and writing groups met to discuss current and future planning. The summaries follow.

The Training Group: Summary of Activities

The training group, composed of American and Kosovar professionals (Judith, Jack, Ferid, Afredita, Shukria,), met five times during the third visit of the KFPEC in Prishtina. Some of the identified goals of the training group were planning of the current training on brief therapy and coordination of presentations between American and Kosovar presenters; development and future of the collaborative training process; adjustments to the format for training; team building; and facilitation of the ongoing supervision through email and internet.

The first training meeting was spent exploring the importance of contracts in training with the agreement to write up a summary. The group discussed issues of contracts between therapist and family around consultations, the therapist's contract with the consultant, contracts with supervisors, and with paraprofessionals.

The training group members agreed that the overview of family-oriented interventions and theoretical framework of the first three training seminars with the Americans had been successful in providing a foundation for family-oriented work. The recommendation for subsequent training seminars was to attempt to cover one topic in greater depth during each seminar. This would involve one full day of didactic training, followed by two days of skills development through supervised clinical experience with families on issues related to the topic of the training seminar. The two remaining seminars this year will be: family interventions with children and family approaches to working with severe mental illness and chronic health problems.

The suggestion for a format for supervision with American professionals was to have each trainer spend a day in the field seeing one family in the morning and one in the afternoon accompanied by five team members (three from one team and two from another team). This field (home visit) will take place while the other trainers see families in the morning and afternoon at the hospital or training site.

The training group also discussed training needs and topics they would like to see in the next three years should the program receive further support. The topics included the following:

·  Addiction

·  Grief and Loss

·  Family of origin of the therapist

·  The elderly

·  Community prevention and intervention: schools, media, politicians, police, healthcare workers, parents and extended family members, NGOs, youth organizations, religious and spiritual leaders and healers and their wives, women's organizations, physicians, sports, international organizations

·  Trauma in the family and community

·  Family relational conflict: physical abuse and violence

·  Mental disabilities

·  Learning problems

·  Cultural transition and the family: urbanization, economic/political, mixed populations, globalization

·  Supervision issues

·  Development of collaborative care teams: mental health center teams, pediatricians, addiction services, prison systems

·  Addressing family issues in the public sphere: promoting public discourse and education through community events, media, and the arts

The training group also discussed strategies for maintaining continued contact with American supervisors on a biweekly basis through email on cases seen during the training. It discussed the possibility of future Internet connection and video conferencing. The group also discussed the need to explore training and family feedback evaluation tools. They were given two instruments to review for applicability to the Kosovar context.

The training group agreed that it was important to document the development of this collaborative training program through writing. In particular, the group felt that it should write a piece that could be helpful to others about how outside consultants can come to a country and set up a collaborative training program. The group decided that it would also write about how they use solution oriented approaches with families, as well as a piece on contracts in training.

The Writing Group: Summary of Activities

Kosovar and American professional members of the writing group met five times during the third visit of the KFPEC in Pristina. Van Griffith had prepared collections of all the texts written by KFPEC participants since the beginning of the project. The writing group reviewed these texts, began to identity texts that were not included (especially by Kosovars), and to make an assessment of where the writing work stands at this point. The overall aim of our meetings was to clarify the goals of writing group and to develop a plan that would guide its activities. What are we writing, for whom, and towards what end?

The writing to date has largely focused on three broad areas: (1) the development and implementation of a collaborative engagement and model; (2) case studies and vignettes; (3) topics in family strength and helping families. The group took note of what have been its two strongest pieces to date: (1) the case study written collaboratively by Shqipe Ukshini, James Griffith, Corky Becker and Steve Weine; (2) the piece on initial interview written by Mimoza Shahini and James Griffith. However, we recognize that there are many other strong aspects of other writings that have already been done, especially the more ethnographic/case materials.

The group considered that the writing activities could take place in three frameworks: (1) multi-disciplinary scholarship on the Kosovar family and its strengths; (2) helping to generate professional service oriented resources on their work with the Kosovar family; (3) creation of general public education materials on making Kosovar family's even stronger. The group wrote brief descriptions of each type of writing. The group considered that it was not possible to engage in all three at this moment, but committed to taking steps forward on framework numbers one and two.

Activities have begun to address framework number one, multidisciplinary scholarship, in collaboration with the Kosovar Academy of Arts and Sciences. Afrim Blyta is to complete the description of framework number two in the next several weeks and will forward to members of the group. A description of framework number three is being written by Mimoza Shahini and will be also be forwarded to members of the group. However, work on this third writing activity (public education materials) will be put on hold until the spring.

The group focused on identifying the short-term activities regarding each of these initiatives. With regards to number one (multidisciplinary scholarship) by February, Dr. Ulaj and Dr. Weine plan to have produced:  the conference description; the preliminary introduction; the outline of the text; and one text concerning the development of family focused mental health and preventive services (with Ferid Agani, John Rolland, and perhaps others). Focusing on writing activity number two over the next three months, Kosovar and Americans will be preparing and submitting several articles for publication in international journals: (1) the case study written collaboratively by Shqipe Ukshini, James Griffith, Corky Becker and Steve Weine; (2) the piece on initial interview written by Mimoza Shahini and James Griffith; (3) Therapy, Tradition and Myself by Mimoza Shahini. We agreed that one American would take the lead role on each of these to get the submitted to journals. Those persons are: (1) Steve Weine for the text concerning the development of family focused mental health and preventive services; (2) James Griffith for the case study; (3) James Griffith for the initial interview; (4) Melissa Griffith for Therapy, Tradition and Myself. We also agreed that the group would start another collaborative case study writing, with Afrim Blyta writing the first piece, and Melissa Griffith responding.

Further possible activities of the writing group in the context of the newly proposed initiative were also discussed.

Future Visits

1. The fourth team will go in March. The focus will be: Family Intervention: Chronic Mental and Physical Illness, Multiple Family Discussion Groups. John Rolland (team leader) and James Griffith will be joined by two additional AFTA members with expertise in these areas.

2. The fifth team will go in May. The focus will be: Family Intervention: Child and Adolescent Mental Health. John Sargent (team leader), Corky Becker, Kathy Weingarten will be joined by one additional AFTA member with expertise in children and adolescents.

3. Tentatively, a sixth team that will focus on one of the topics listed earlier will go to Kosova sometime this summer. Future visits beyond that point will be considered within the context of collaborative evaluation of the project accomplishments after one year (this spring) and future goals and additional funding.

John Rolland, MD, current Chair of the AFTA Human Rights Committee, is 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.