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Uppala Chandrasekera has been appointed Vice-Chair of the Board of Directors of the Mental Health Commission of Canada. For more information, click: Appointment.

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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, Indonesia

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) Initiative (www.eicp-acis.ca).

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 health care."

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 team.

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 and others.

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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