The training of community members as paraprofessionals to provide trauma-focused mental health services provides sustainability of these services in the community. The Center for Victims of Torture (CVT) trained refugees as peer counselors in Guinea and Sierra Leone. The refu­gees themselves were supervised to provide mental health services to others who have suffered torture and war trauma, increasing the number of people CVT could serve and creating a cadre of qualified mental health paraprofessionals in communities that had previously had no mental health services. Paraprofessionals perform many of the tasks of professionals, but within a system of supervision.

The wars and civil conflicts in West Africa have affected such a large proportion of the population, and driven so many people into refugee camps, that an international organization like CVT could not possibly bring in enough staff to meet the need for mental health services. Instead, CVT decided to draw on resources within the camps, eventually recruiting more than 120 refugees as peer counselors, or psychosocial agents (PSAs), in camps in Guinea and Sierra Leone.

The refugee camps provided a concentrated area of survivors needing assistance, as well as a good location for the prolonged close supervision and training needed to assist torture survivors. Many of the PSAs received up to four years of ongoing training and daily supervision before the program moved into the communities where the atroci­ties were committed.

The intensive hands-on training in CVT’s model combines Western psychotherapy with local understandings of trauma and recovery. The program began with a two-week training session, followed by day-long monthly and seven-day quarterly training sessions. These sessions focused on trauma theory, general psychology, counseling, and communication skills. CVT psychologists and social workers worked daily in the camps, modeling behavior and helping PSAs practice their skills. On the job, the PSAs spent ten weeks observing mental health professionals facilitating therapy groups, ten weeks co-facilitating and ten weeks leading a group on their own with periodic supervision. By the end of their training, PSAs are well-versed in the effects of trauma and in trauma recovery fa­cilitation and program evaluation. They are also skilled group facilitators and effective communicators.

For more information on this tactic, read our in-depth case study.

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