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Chandrasekera has been appointed Vice-Chair of the Board
of Directors of the Mental Health Commission of Canada. For more
information, click: Appointment.
Let us know if you or another OASW member is in the
The following article is reprinted with permission from «
Dispatches », a publication of Doctors Without Borders
(MSF) Canada (www.msf.ca).
OFFERING SUPPORT TO TSUNAMI SURVIVORS
Mental Health Care in Aceh, Indonesia
Michelle Chouinard, Social Worker, Meulaboh,
A woman tries desperately to hang on to her three kids while the
water swirls around them. After long minutes of hanging on amidst
the chaos, she loses her grip and one child is washed away and
never found. A blind man finds himself alone, swept away by the
wave. A young girl finds him and they hold on together for several
hours. I don't know what happened to the girl. I do know that the
man found out, upon discharge from the hospital, that seven of his
closest family members had died. As a social worker, these are the
stories I heard every day during my six-month mission with Médecins
Sans Frontières (MSF) in Meulaboh, Indonesia following the tsunami
that hit so powerfully on Dec. 26, 2004. The intense feeling
of loss I felt when confronted with the devastation and losses the
people of Aceh had survived led to a sense of puzzlement and
amazement when I understood that very few organizations were
providing mental health counselling. There was also a significant
gap in mental health knowledge and training within the local health
infrastructure. Therefore, it was an interesting challenge for MSF
to provide basic mental health training to nurses and staff in
local health centres when so many of them were dealing with their
own losses and fears.
There was a real need to help the local people to better deal
with their feelings and anxieties and we addressed this through
individual counselling, group therapy and community-based
discussion groups. We talked about why children ran home from
school when the wind picked up and why, several months later,
people still ran for higher ground on certain days when the tide
seemed higher than usual. Rebuilding homes, rehabilitating farmers'
fields and constructing new fishing boats is very important;
however, it is also important to restore people's capacity to
believe that their environment is safe for them
and their children - allowing them to fall asleep each night
without thinking that, when all is quiet in the camps they live in,
another wave is on its way.
At times I felt our work was such a tiny piece of what needed to
be done, given the number of people that had been affected by the
tsunami, the limits we had in providing support and the few
organisations that were involved in mental health activities.
However, I do know that for those people whom we were able to
reach, it did make a difference, even if it was only to tell their
story to someone objective who had not been through the same
horrifying experience as they had. My hope is that mental health
issues will be much more in the
forefront for humanitarian organisations working in crisis zones,
where people's lives have changed forever.
Go to www.msf.ca
to read a full, one-year report on the work of MSF in Southeast
Asia since the tsunami.
© Copyright MSF Canada
Spotlight on Collaboration
The following article is reprinted courtesy of The Enhancing
Interdisciplinary Collaboration in Primary Health Care (EICP)
When you talk to Brian Match, you realize very quickly that
working in collaboration with others comes pretty much second
nature to him. As a social worker, partnering with different
professionals - whether in the health field, education arena or
other areas - is at the heart of his discipline's whole philosophy.
That makes Brian the perfect fit for his current job as the manager
of a preschool development assessment team (PDAT) in Camrose, a
small community in rural Alberta. The team has been up and running
for three years now and, in that time, has established itself as a
successful model for interdisciplinary collaboration.
"The idea for the team came about when a group of professionals
representing various disciplines sat down and looked at how they
were delivering health care to the children of Camrose and the
surrounding area," explains Brian. "We had a situation where some
kids would sit on a list waiting to be assessed for one thing, such
as speech or motor skills issues, and end up being referred for
other services once their assessment was done. That would mean
another waiting list and that's clearly not the best way to provide
The group decided to form a team that could tackle the issue of
getting different services to these kids on a timelier basis. The
PDAT members included an occupational therapist, speech-language
pathologist, physical therapist, social worker and an early
intervention worker, with a pediatrician or outside agencies pulled
in when appropriate.
The team then set out to establish a service model that followed
a practical and thorough course of action. When a child is referred
to Public Health /Rehabilitation for an ssessment, a brochure is
sent to the family to explain the process. Other materials,
including forms to fill out and questions to answer, are also sent.
Phone interviews can also be conducted. Based on the information
received from the family, a rehabilitation assistant will take
the child's file to the team's monthly meeting where it is
determined whether the child needs to be seen by team, or proceed
with a single-service referral. "Our PDAT model follows a very
hands-on process," says Brian. "When a child is referred to us, the
family is assigned a facilitator - typically a social worker - to
explain how we operate. The social worker will sit down and speak
with the parents while the occupational therapist works with the
child. A speech-language pathologist could sit in on the
occupational therapist's session, as well, or vice-versa, and then
conduct his/her own session. The assessments are done in one day
and the family comes back within a day or two for a conference. A
service plan is drawn up and discussed, with a lot of input from
the family. It's very family-driven."
The benefits of this type of approach have been widespread. For
the families, especially those having to travel several hours for
service, the convenience of conducting assessments by various
professionals in one setting, over the course of one day, is
significant. For other service providers, like the Glenrose
Hospital in Edmonton, the PDAT approach is quite similar to their
own and has been met with a lot of respect. If a child from the
PDAT ends up being referred to the Glenrose Hospital, the wait time
now tends to be shorter because much of the groundwork usually
conducted by the hospital has already been done by Brian's
For the team members themselves, the approach is optimal. Many
cite the cooperative and positive environment that stems from
working toward a common goal with the support of all disciplines.
And the opportunity to consider various viewpoints and to learn
from others is also considered to be a plus.
"The attraction of this approach," says Brian "is that you are
using everyone's strengths and putting them together to get the job
done in a timely manner. That's rewarding for everyone - especially
when your clients are children. Waiting lists create a loss of
valuable time and for kids, time can be critical in helping them to
reach their full potential. This approach allows us to open windows
of opportunity where we can optimize our time and better serve our
clients. It makes for a more satisfying work life." Brian credits
the early days, when the various members laid out the
foundation for the PDAT, as being the real key to their success.
What was crucial was having total team involvement from the ground
up - from putting the plan together, establishing a vision and
mission, and creating a model, through to the implementation
process. The initial PDAT manager was extremely supportive,
encouraging the staff to take leadership and respecting the various
disciplines and their abilities.
The other key to the team's success is its "one day assessment"
model. "You can put together a team approach," explains Brian "but
it's the added ability to make it all happen in a short period of
time that really makes a difference for the children and their
families. I've worked in hospitals and other health care settings
where discussions with other disciplines take place during rounds
or in the odd meeting, but it's when you add a structure and
process to those communications, and factor in what works best for
the client, that you can truly achieve success."
The one ongoing challenge for the PDAT is employee retention.
With such a large draw to urban centres, it can be difficult to
keep staff on board in a rural setting no matter how great the work
environment. The turnover over the last year has been particularly
significant, eating away at what has been a strong core team. "PDAT
is not just a process," says Brian "it's a philosophy - a way of
working - that the core team felt strongly about. With a large
turnover, the teambuilding process has to start all over again. My
main focus right now is ensuring that the adjustment to these
changes is as smooth as possible and that the spirit behind what we
are doing remains intact."
As for the future, there are exciting things on the horizon. The
PDAT model is now being considered for up to four other sites in
the Camrose region. In addition, a specialized regional
second-level team is being created with training from the Glenrose
Hospital to do assessments and create service plans for local sites
or primary teams in relation to Fetal Alcohol Syndrome (FASD). This
specialized team of occupational therapists, speech-language
pathologists physiotherapists, pediatricians, psychiatrists and
social workers will conduct one-day assessments and follow-up with
primary service teams and local sites. Brian hopes this is the
start of a movement into collaborative health care for his region
Brian sees a definite trend toward interdisciplinary
collaboration elsewhere in the province. Doctors are involved with
various primary health projects across Alberta, along with nurse
practitioners, rehabilitation professionals, social workers, public
health nurses and others. In pediatrics, the push for collaboration
is coming not just from the Health sector, but from Education and
Children's Services as well.
"I think we are heading in the right direction with PDAT and the
emergence of specialized secondary teams," says Brian. "But I would
love to expand this type of team approach past pre-school so there
isn't so much of a handoff when the children enter the school
system. I know that the educators feel the same way, so hopefully
it is just a matter of time before it happens."
© Copyright EICP
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