Centre for the Study of Violence and Reconciliation

Trauma Clinic

Introduction

The Trauma Clinic aims to alleviate the effects of violence through the provision of trauma-counselling services to adult and child survivors, and to contribute towards victim empowerment initiatives through training and capacity building, research and advocacy.

Main Activities

Counselling

During this year, we received an average of 80 to 100 referrals per month. Our counselling services included group therapy, individual counselling, play therapy, debriefing, court preparation, psychiatric management, psychometric assessments and parent counselling. Forty-two clients were seen for psychiatric assessments and required treatment for major depression and/or Post Traumatic Stress Disorder.

Armed robbery and car hijacking were the most frequent reasons for referral to the clinic. A large percentage of clients (18 percent) presented with traumatic bereavement as a result of losing a loved one through violence. The clinic routinely also continued to intervene in cases of rape, child abuse, domestic violence, sexual harassment, assault and accidents.

The majority of clients who received counselling were adults. Thirty percent of cases were child referrals; in these cases the caretakers and siblings of these children were usually also seen for counselling. This year saw an increase in referrals of children who had lost one or both parents or siblings, as a result of family murder. These complex cases have required the involvement of multiple members of the clinical team, in order to deal with the emotional impact and upheaval caused by such traumatic events in the surviving children's lives.

After the SABC's public broadcast of the Special Assignment television documentary on police brutality against foreigners, there was an increase in referrals as a result of police brutality The rate of referrals of refugee clients, primarily women and children, has also increased. A large number of ex-combatants were also referred to the clinic, many through the Khulumani Survivor Support Group.

The complexity of cases and the need to work as a cohesive team have necessitated the design of a new case management system so that we can address the needs of the individual as well as attempt to address the client's social circumstances and facilitated interventions through community structures (such as the school and the workplace). Following a process of consultation and planning during the year, the new case management system will be implemented from the beginning of 2001.

The clinic team expanded this year to include more clinical staff employed on a sessional basis. This has provided much needed support to full-time staff in the provision of a counselling service to clients. Frances Spencer has played a valuable role in overseeing the implementation of client interventions and developing the new case management system.

Interacting with the horrors of our clients' experiences through the counselling relationship is emotionally draining and carries a high risk of burnout. As a result, the CSVR clinic continued to provide a programme for staff self-care that included regular supervision, debriefing and staff development and training. The clinic feels proud to have built a stable, professional and cohesive team that has enabled us to engage with the traumatic experiences of our client population. Our team would not have been able to provide such services without the dedicated support of our administrator, Mpho Matlhakola and our receptionist, Mpho Mulaudzi.

Training and Capacity Building

There was a growing demand for training in trauma support skills and victim empowerment during the year. The clinic's training activities have focused primarily on training frontline workers including the police, primary health care practitioners, social workers, teachers, community police forums and officials of the Department of Home Affairs. These frontline workers provide a valuable service to communities, particularly poorly resourced rural and disadvantaged communities.

A total of 30 training workshops were conducted during the year. Training workshops were diversified so as to include not only trauma support work and victim empowerment training modules, but also to link these modules to the specific needs of the various trainees. For example, to help teachers who needed to address the issue of violence in schools, conflict resolution skills training modules were added to the other teacher training materials. Similarly, the high rate of HIV/Aids in South Africa has placed a heavy burden on all frontline workers. This has necessitated the inclusion of a specific component on dealing with HIV/Aids in our training programmes.

The clinic conducted a number of joint training activities with the CSVR Youth Department, the Gender Unit and the Criminal Justice Policy Unit. Cross-departmental training included training within the schools, prisons and with police and community-based organisations.

The clinic's training Coordinator, Sherbanu Sacoor, actively pursued training possibilities within the corporate sector in order to generate income to supplement our donor funding. It is our observation that there is growing interest within the corporate sector for including trauma support skills in the training programmes for human resources managers and employee assistance practitioners - and this presents important opportunities for the CSVR.

Overall, the training activities of the Trauma Clinic have become an increasingly central aspect of our work and we have successfully made inroads in the establishing and developing the capacity of victim support services - not only in Gauteng, but also in far flung rural areas such as Giyani and Bushbuckridge in the Northern Province, and Mafikeng and Schweize Reineke in North West Province.

This year, we have also developed more specialised training in trauma work with children and adolescents and this training has been offered both in the UK and to primary health care practitioners in Gauteng.

The Trauma Clinic training packages also emphasise self-care and the provision of ongoing supervision for care-givers, which helps to ensure the sustainability of these service delivery programmes. It is envisaged that through our national network of trauma service providers, Themba Lesizwe, we will develop standardised training packages on trauma management and victim empowerment containing these elements.

Our training programmes within communities have provided us with valuable information regarding the impact and nature of violence and the difficult circumstances under which frontline workers operate. They frequently have to handle extremely complicated cases, with little or no support. In particular, dealing with HIV/Aids and domestic violence cases present the greatest difficulties to trainees.

Internship Programme and Student Placements

The Trauma Clinic continued to provide practical training placements for students from the University of Witwatersrand during this year. A third-year social work student and a clinical psychology masters student, completed placements in the clinic. Students make a valuable contribution to our capacity to deliver an efficient service.

This year, a counselling psychology student, Mandy Davidson, completed a one-year internship in the clinic. This was a successful placement and in 2001 we will be providing two such internship placements to counselling students.

Outreach Activities

The Trauma Clinic appointed a new staff member, Nomfundo Mogapi, to co-ordinate and further develop our outreach activities, with the result that these were extended into a number of new areas during the year. In this respect we have aimed at strengthening and building on existing initiatives within communities.

Boitumelo Kekana continued to provide counselling services to the Zamokhule clinic in Soweto, where large numbers of sexually abused children receive treatment. We also maintained our programme of training and supervising nurses working with abused children in Soweto.

In co-operation with the CSVR Youth Department, Gloria Hlophe established two therapy groups for youth and children in Soweto. One of these groups provided support for teenage rape survivors and the other group focused on counselling sexually abused boys between the ages of 6 and 7. These groups were run in schools, during school hours, which made it possible for children who might otherwise not have had access to such a service to get help. We also delivered a training component on trauma management in the CSVR Youth Department's training of Soweto teachers.

We received a request to provide counselling and support to the Bethany Children's Home in Berea. The majority of children in the home have experienced violence. The clinic provided supervision and debriefing services for staff of the Home. We were also able to establish a dance-therapy group for the children, provided by a dance therapist, Natasha Duvenage, who has volunteered her services to the clinic.

The Trauma Clinic also assisted the CSVR Education and Media Unit with the Take 5 youth television programme. The programme invites young people to write in with problems they may be experiencing. The Trauma Clinic, under the guidance of Ntsiki Masilo, took on the role of responding to these letters and providing young viewers of the programme with advice and information on issues such as domestic violence, child abuse, Aids, relationships and life skills. This has been a rewarding project and has provided us with a new tool for addressing mental health issues confronted by our youth.

The clinic has also continued to work closely with The Khulumani Survivors Support Group, in providing a debriefing service and training for Khulumani personnel, as well as the provision of trauma counselling for Khulumani members who have survived gross human rights violations. Financial constraints have sometimes made it difficult for Khulumani clients to access our services at the clinic and we have therefore agreed to run therapeutic groups for survivors, in Soweto next year. We consider our relationship with Khulumani to be vital in providing us with a link to survivors of past political violence.

The clinic also worked closely with the CSVR Criminal Justice Policy Unit, providing vital input in the Voice of the Young Offenders Programme. Clinic staff assisted in the facilitation of life skills workshops with juvenile offenders convicted of violent crimes. This programme is significant in that there are very few projects that address the psychological needs of perpetrators in this way.

Our work within the refugee sector presented the clinic with a number of challenges. We worked in partnership with Lawyers for Human Rights and the UNHCR in training home affairs officials who process refugee applications - so as to reduce secondary victimisation.

Tensions and conflicts from the refugees' countries of origin have tended to be replicated within the South African-based refugee communities. This often makes these communities very difficult to work in as they are dominated by mistrust and suspicion. In some instances this has hampered our ability to offer services within these communities, despite their requests for our help. As a result, we have embarked on a process of developing a strategy stipulating our protocols and policy regarding our work with refugees, so that we can retain a non-partisan position and attempt to provide services that meet the needs of the entire refugee community.

Our counselling of adult and child refugees and asylum seekers has also highlighted the xenophobia and resultant discrimination experienced by members of these communities. Under these circumstances, re-traumatisation of refugees is very common and this presents clinic staff working in these communities with a wide range of challenges, including the need to play an advocacy role in respect of the current inadequate provision of care to refugees as well as in relation to discrimination within South African communities.

Volunteer programme

Our volunteer counselling programme was restructured during 2000. Previously, volunteers were trained to work within the CSVR Trauma Clinic only. The clinic now runs two volunteer programmes. One group of volunteers will be trained to provide a counselling service within the clinic itself. These volunteers are mostly university students with some background in psychology or social work. A second trauma management programme for members of community-based organisations, NGOs and the refugee community has also been established. On completion of the training, these volunteers will return to their organisations and the clinic will provide ongoing supervision and support. This will strengthen the capacity of the community organisations to which these trainees return to manage the trauma within their communities.

Marivic Garcia, the coordinator of CSVR's volunteer programme, has consulted with various organisations and as a result, eighteen trainees have been selected for each programme for early 2001.

Research

A number of research papers were produced for presentation at conferences. These primarily related to our clinical work with child abuse and refugees. The clinic is also planning the development of a comprehensive client intake data-base as a research assistance tool in the clinic.

Themba Lesizwe

This year has seen significant developments in the establishment of the South African Network of Trauma Service Providers (Themba Lesizwe). In the latter part of the year, a financing agreement was signed with the European Union. This provides for substantial funding of the trauma sector in South Africa.

As a result of funding that we received from the National Department of Welfare, we were able to make substantial progress in establishing the network of credible South African trauma service providers. In the course of the year under review, Themba Lesizwe was registered as an independent Trust, a board of trustees was appointed, a code of conduct developed and membership and operating principles were finalised.

The name of the Network was changed to Themba Lesizwe which means 'Hope for the Nation', as we felt that this better reflects a national body of trauma service providers that is committed to the healing of survivors of violence and to reducing the levels of trauma and violence in South Africa.

This network has already provided valuable opportunities for the exchange of ideas and information. We have begun to explore models of best practice within the South African context and to develop a national voice around victim empowerment issues such as torture, police brutality and reparations.

With the launch of the network in 2001, the CSVR Trauma Clinic will enter a new phase in its history, as a key and founding member of a national network. We will need to meet the challenge of extending this network to make it as inclusive as possible and to meet our objectives of research, service delivery, advocacy, and training on a national level.

Trauma Clinic manager, Mary Robertson, has played a leading role in the establishment of the network and she is acting co-ordinator until an EU-appointed official takes up office as national co-ordinator in 2001.

Themba Lisizwe was awarded a second tender by the Department of Health for training primary health care practitioners. This confirms the value that such a network has in assisting government in meeting the objectives of its Victim Empowerment policy.

African networks

In the course of 2000, the Trauma Clinic was an active and enthusiastic participant in the Southern African Trauma Coalition, a network of organisations dealing with torture and organised violence in the region. We also participated in a series of meetings in Africa, aimed at establishing a Sub-Saharan African Network of Trauma Service Providers. One such meeting was hosted by the CSVR Trauma Clinic.

Requests to CSVR for training and involvement in projects within Africa are increasing and there is a need for CSVR to develop a clear strategy for our work within Africa.

Challenges

Through our training and counselling interventions, the clinic confronted the harsh realities of the traumatic impact of HIV/Aids in communities, especially in rural and poverty-stricken areas. Our greatest challenge is the emotional impact, on caregivers, of dealing with death and dying. We need to consider ways of reducing the stress and burnout amongst frontline workers, and within our own team, so that we can continue to develop capacity for sustaining victim empowerment initiatives.

A concern expressed by all frontline workers whom we trained is the lack of services for traumatised children. Frontline workers have to deal with complicated child cases, usually without adequate training, supervision or support. Similarly, services for survivors of domestic violence are extremely limited. Having to handle such cases places an enormous burden on already over-stretched caregivers. The extreme levels of violence perpetrated against women and children in our country combined with the emphasis on women and children within the National Victim Empowerment Programme are such that addressing the emotional needs of women and children and/or preventing such violence, poses a serious challenge. The Trauma Clinic, together with our network partners, needs to be much more proactive in articulating the serious plight of these vulnerable groups and in advocating for change.

An ongoing challenge to the Trauma Clinic is the need to evaluate our interventions and to develop new approaches. This is still most evident when working with survivors who have experienced multiple traumas. Such interventions require an approach that addresses issues of safety and building resilience amongst survivors.

An important area for future research relates to family murders. Despite the high incidence of such cases in South Africa, we have a very poor understanding of the causes and longer-term impact on our clients. In order to adequately meet the needs of our clients and to prevent such cases from occurring, there is a dire need for research in this area. The Trauma Clinic has access to survivors of such incidents, and is therefore ideally placed to begin such research.

Future plans and goals for 2001

With the launch of Themba Lesizwe in 2001, the Trauma Clinic aims to play a central role in the development and growth of the network as well as to implement our project plans in the areas of research, training, service delivery and advocacy. We shall strive to maintain a professional service and to work in co-operation with our network partners to build the capacity of other frontline workers and service providers to respond to and advocate for the needs of trauma survivors.

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