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| International Trainings |
| International Collaborative Training Project |
Objective: This innovative clinical project proposes a strategy to diminish the self-perpetuating cycle of bereavement after violent death in the Middle East conflict through a collaborative training of community based support for traumatic grief. By teaching Middle East clinicians - local caregivers with knowledge of local customs, language and conditions already committed to providing support after violent death - the collaborative training builds a knowledge base and skill set to manage long-term grief complicated by rage and retaliation associated with violent death in both populations.
Background: Planning for this collaborative training project was inaugurated by Dr. Rynearson in 2004 and has been sponsored by the University of Washington, Jackson Middle East Center with additional funding from a United States Institute of Peace grant, the Dart Foundation and private donations.
Dr. Rynearson traveled to the Middle East for a series of annual training visits from 2004-2009 and through these repeated on site visits formed a collegial connection with Middle Eastern regional trauma centers at the following locations:
Palestinian Training Sites:
Ramallah: Treatment and Rehabilitation Center for Victims of Torture
Gaza City: Gaza Community Mental Health Program
Israel Training Sites:
Tel Aviv University, School of Social Work
Tel Aviv Israel Trauma Center for Victims of Terror and War
Haifa University, Department of Clinical Psychology
Ben Gurion University, Spitzer School of Social Work
Israel Center for the Treatment of Psychotrauma
Tel Aviv Sourasky Medical Center
Parents' Circle - Families Forum
Tel-Hai College, Department of Social Work
The Community Stress Prevention Center
Regional Training Sites:
Turkey: Medical School of Kocaeli University, Department of Psychiatry
Egypt: University of Cairo, Department of Psychiatry
Jordan: Jordan University, Division of Psychiatry
Jordan University, Department of Psychology
Amman Ahlia University, Department of Psychology
Lebanon: American University, Department of Psychiatry and Psychology
Syria: Damascus University, Department of Psychiatry
Collaborative Interactions and Results:
In 2006 and 2007, Dr. Rynearson organized collaborative training sessions in a neutral setting (Istanbul, Turkey) with a working group of Israeli, Palestinian, Lebanese and Turkish clinicians. This meeting was supported through combined funding from the USIP grant and the Dart Foundation.
Despite continued warfare, the participants felt reassured that their purpose was to focus on the clinical needs of their community members and not on resolving the political differences that divided them.
Each day of the training began with a didactic session highlighting the clinical needs of children and adult family members after violent dying from the faculty (Dr. Rynearson and Dr. Alison Salloum, an expert on clinical support for children) followed by discussion. The didactic sessions focused on community outreach, case identification, clinical measures and protocols of intervention. The remainder of the training encouraged presentations from each of the participants describing their centers efforts in meeting community needs for support and intervention after violent death.
The participants, associates and faculty continued conversation over breakfast, lunch and dinner, further enhancing the opportunity for discussion and engagement.
It is noteworthy that of the eight sites included in the collaborative training, only Ramallah had a support program specific for violent death.
Each of the objectives were accomplished:
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- Protocols for outreach and case identification were distributed
- Treatment manual planning: completed in Arabic and Hebrew
and posted on an internet site: www.vdbs.org
- Multi-site clinical measures registry
- Established network for consultation
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The Israeli incursion into Gaza forced postponement of the third meeting of the International Collaborative project planned for March, 2009 in Jordan. The harrowing situation within Gaza and the sealing of their border made it impossible for the Palestinians to attend a collaborative gathering in 2009.
On October 31st, 2009, Drs. Rynearson and Salloum completed a-one day training on community-based management of violent death bereavement sponsored by Drs. Khoury and Gharzedinne at the American University in Lebanon. The training was well attended and received.
Dr. Rynearson then travelled to Damascus where he made a similar presentation at a lecture at the University of Damascus hosted by Professor of Psychiatry, Dr. Adib Assali. The staff requested additional time with Dr. Rynearson who returned for a half-day training the next day. Dr. Rynearson also met with mental health staffs based in Damascus from the United Nations and UNICEF attempting to develop mental health services for the one million Iraqi refugees residing in camps. Apparently over 80% of the Iraqi refugees have lost a family member through a violent death so the clinicians were intrigued by our systematic program. They also requested further training and asked permission to apply the manualized Restorative Retelling intervention. They were grateful that they could download the manual translated into Arabic.
Long Term Goals: (2010 and beyond):
One-Day Training Seminar: Our next meeting of the International Collaborative group is tentatively scheduled in November, 2010 in Montreal Canada at the annual meeting of the International Society for Traumatic Stress Studies where participants from our project will gather to present a one day pre-meeting workshop describing our clinical training and services
Formation of an organization: Planning and funding for a regional Middle East Study Group on the psychological effects of violent death; form an affiliation of clinicians and academicians from countries of the Middle East to promote research and training for clinicians supporting those suffering from complicated grief after violent death.
Regional funding: Such an organization (an established association of cooperative clinicians and academicians) would be in a unique position of political transcendence in seeking funds to counter the specter of grief after violent death that hovers over the entire region.
Interim Activities:
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- Dr. Rynearson has remained in contact with all of the participants through periodic newsletters to maintain our connection. The Jordanian clinicians were disappointed by the postponement of the meeting in Amman providing their direct involvement in the project, but want to remain involved in our future activities.
- Dr. Rynearson has been invited to serve as a guest editor for the Journal of Traumatology to feature several descriptive papers from our members to highlight our international purpose and objectives. Publication is scheduled for 2010. Descriptive papers have been received by Dr. Rynearson from the collaborative participants that he will edit and submit in the coming months.
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