title: [Dissemination of psychotherapy modules for traumatized refugees : Experience gained from trauma work in crisis and conflict regions].
abstract: With each additional accumulative exposure to severe and traumatic stressors, the likelihood of developing mental health problems and physical diseases increases. Displaced individuals have usually experienced a number of serious threats to health due to organized violence in their home country or attacks during the flight. Frequently, domestic violence adds additional strain to the stressors experienced. The resulting impairments in psychosocial functioning reduce the resources needed for social adjustment and integration. Social exclusion then in turn often further aggravates the existing mental health complications. For the treatment of trauma spectrum disorders, different evidence-based psychotherapies are available. In high-income countries, trained and licensed psychotherapists are typically in positions to apply such interventions; however, even an advanced system with a high capacity, such as the psychotherapeutic care offered in Germany, severely struggles to manage the demands associated with the rapid addition of hundreds of thousands of displaced people. Germany's mental healthcare system at present lacks the resources, both human and technological, to effectively manage the present demands. Systematic scientific studies in resource-poor regions of war and conflict have demonstrated that the dissemination of effective treatment to local personnel, even with limited training, results in substantial improvements in the mental health challenges within the community: Organized as a cascade model, members of the refugee community learn to identify weakened fellow citizens requiring in-depth diagnostic interviews. Educated, bilingual individuals acquainted with their country's healthcare system (e. g. nurses, teachers and social workers) receive training to conduct structured interviews and evidence-based interventions under the supervision of centrally organized licensed psychotherapists. More complex cases are referred to local psychotherapists, psychiatrists or specialized treatment centers. These humanitarian efforts are based on the convention for the protection of human rights and secure the safety, freedom and dignity of these persons.
authors.affiliation: vivo international NGO, Konstanz, Deutschland. Thomas.Elbert@uni-konstanz.de.|Klinische Psychologie und Kompetenzzentrum Psychotraumatologie, Universität Konstanz, Universitätsstr. 10, 78457, Konstanz, Deutschland. Thomas.Elbert@uni-konstanz.de.
authors.forename: T
authors.initials: T
authors.lastname: Elbert
authors.affiliation: vivo international NGO, Konstanz, Deutschland.|Klinische und Biologische Psychologie, Universität Ulm, Ulm, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Wilker
authors.affiliation: vivo international NGO, Konstanz, Deutschland.|Klinische Psychologie und Kompetenzzentrum Psychotraumatologie, Universität Konstanz, Universitätsstr. 10, 78457, Konstanz, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Schauer
authors.affiliation: vivo international NGO, Konstanz, Deutschland.|Klinische Psychologie und Psychotherapie, Universität Bielefeld, Bielefeld, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Neuner
mesh_terms: D003144:Communication Barriers; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods*; D011613:Psychotherapy / Q000193:education* / Q000379:methods; D012036:Refugees / Q000523:psychology*; D012944:Social Support; D040921:Stress Disorders, Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014857:Warfare
keywords: Counsellor; Mental health; Narrative exposure therapy; Posttraumatic stress disorder; Screening