CENTER FOR SURVIVORS OF TORTURE

Goals and Results - Outcome‐Based Evaluation Measurements
The program goal of Center for Survivors is to assist survivors and their families during the process of healing and recovery, so they can focus on their health, begin the recovery process, discover and build new support networks, and move toward productive, meaningful, and fulfilling lives. The primary program objective is to provide high-quality, holistic, strengths-based, trauma-informed services to survivors to help them manage their health and rebuild their lives. Secondary objectives are to increase access to care, raise awareness in the community, and maintain the sustainability of high-quality care for survivors through education, training, and strategic partnerships.

CST utilizes several methods to measure a client's therapeutic outcomes. First, the client identifies therapeutic goals, and these goals are measured and documented toward incremental attainment. Next, the Harvard Trauma Questionnaire-Revised (HTQ-R) is used to measure the reduction rate of PTSD symptoms, initially and then at six-month intervals, by the clinician. In addition, clients describe their experiences and future orientation, helping the CST clinician and client together identify and pursue the development of coping skills that make mental health improvement sustainable. We rate symptoms and progress using the Children's Depression Inventory II.

CST tracks the 25 data points in our database and participates in the National Consortium of Torture Treatment Programs (NCTTP) data collection project (for more than ten years) following the American Counseling Association's (ACA) Ethical Code. In order to track client data, our data manager uses a modified MS Access database.

Our services
We provide wraparound services, which have been a best practice for many decades, and treat the whole client in the context of being an individual, a member of a family, a part of a culture and a survivor of repeated trauma, in a culturally competent manner:
• Counseling: Evaluation, diagnosis, evidence-based treatment: individual, group and family therapy: Trauma-Focused Cognitive Behavioral Therapy and Solution-Focused approaches
• Medical care: Diagnosis, treatment, pain reduction, wound care, physiotherapy, prescriptions
• Case Management/Social Services: Clients work with case managers to set and achieve goals and obtain food and housing stability leading to self sufficiency
• Direct Aid: Food, transportation, medications, and other urgent needs
• Forensic Reports: Clinical evidence
• APB Education Program: Community college easy-entry programs

CST treatment is extremely effective. Over 82% of clients meet their counseling goals within six months. They are able to resolve grief and trauma and integrate their experiences into the larger context of the person they are. They experience a decrease in the frequency and intensity of symptoms and are able to eat, sleep without nightmares, concentrate and feel joy again.

In addition, despite the intense trauma and high rates of depression and PTSD, CST has not had a single client commit suicide. We credit our very effective intake and screening process that includes referrals for hospitalization when necessary, along with our effective counseling and full supportive services that provide the necessities of life and enable clients to develop and maintain hope.

1. Remarkably, in 2017, CST provided free comprehensive services to a total of 728 survivor clients, 452 adults, and 276 children.

2. CST successfully provided holistic services that restore the whole person, healing the body, mind and spirit. As in the previous project period, we met our clinical objectives including, a marked decrease in the numbers of CST clients experiencing mental health symptoms, specifically symptoms associated with post-traumatic stress disorder, depression, and adjustment disorder. The program also provided clinical services for survivors of with chronic and persistent mental illness such as schizophrenia and bipolar disorder, pain management and increased their ability to access supportive services such as supplemental security income, counseling programs in the schools, employment opportunity training and community/peer-support resources. Reduction in symptoms and access to support systems allowed survivors of to become more successful in education, employment, and family and work relationships, increased their financial self-sufficiency and integration into American communities. Clients who needed medical care or psychotropic medications had access to doctors at CST and referrals and were able to access prescription medications at no or low cost.

3. Through 32 different sessions, CST trained 439 professionals from voluntary agencies, health clinics, pro-bono professionals, school survivor programs, so they could be better informed regarding the mental health needs of survivors, how to screen for mental health concerns, and how to make appropriate referrals. These trainings took place in person, and CST held 12 monthly learning luncheons and utilized high-speed videoconferencing to leverage resources. CST awarded an average of 6 hours each for continuing education credits to clinicians who hold licenses in LMFT, LPC, and LMSW as part of our commitment to train professionals who want to provide pro-bono counseling services for survivors.
4. Long-term program impact included improved mental health; quality of life; wellness; self-sufficiency; English proficiency; employment' economic status; support systems; community involvement by clients; legal status; general health status; housing; relationships; and impact on future generations.

For clients in this program, in a six-month reporting period we saw:
• 43% of clients became proficient in English
• 61% of clients reported having an established support network
• 78% of clients were able to implement skills learned at CST in other settings
• 85% of clients reported improved mental and physical health and quality of life through our goal-oriented services.
• Clients developed business plans with the help from National American University and received funding to start their business with the help of CST volunteers, board and community college.

We perform complete assessments as part of the intake process, set significant but realistic goals in collaboration with clients and measure progress utilizing the same tools used in the intake process. We use best practice, evidence-based assessment tools: the Harvard Trauma Questionnaire for adults and the Children's Depression Inventory 2 for children. Other proven psychological testing instruments are utilized responsibly for assessment when indicated.

In a one-year period, we expect to achieve:
• 84% of individuals will meet their counseling goals within six months—they will be able to eat, sleep without nightmares, concentrate and feel joy again
o Baseline – 83%
• 82% of adults will demonstrate a 0.5 or more (on a 4.0) scale improvement on the Harvard Trauma Questionnaire for symptoms after 6 months or less of counseling.
o Baseline – 80%
• 71% of children will demonstrate a reduction of symptoms as evidenced on the Children's Depression Inventory 2 after 6 months or less of counseling
o Baseline – 70%
• 83% of clients with Posttraumatic Stress Disorder will experience a decrease in the frequency and intensity of symptoms—flashbacks, depression, anxiety, headaches, paranoia, nightmares, hopelessness, emotional numbness, stomachaches, backaches, loss of appetite.
o Baseline – 82%
• 93% of clients who need medical care and medications will receive it from CST and/or referrals to other providers and through community medical providers
o Baseline – 92%
• 85% of clients will meet a minimum of 3 case management goals within 6 months
o Baseline – 83%
Longer-term program impact includes improved mental health and quality of life for clients, wellness, self-sufficiency, English proficiency, occupational, employment, economic status, support systems, community involvement by clients, legal status, general health status, housing, relationships, and impact on future generations. For clients in this program, after 12 months we expect:
• 75% of discharged clients have met and maintained counseling goals for at least 12 months
• 78% of clients become proficient in English.
• 85% of clients report having an established support network.
• 90% of clients are able to implement skills learned at CST in other settings.
• 85% of clients report improved mental and physical health and quality of life through our goal oriented services.
• 85% of clients experience educational improvement, financial literacy, and ultimately become employed after high school, certificate training, or college.
• 80% of clients apply for citizenship after five years and consider themselves to be a contributing member of their community.
Population to be served: Survivors who are eligible individuals, having suffered in foreign countries and presenting in the U.S. At CST, we help those who have suffered because of who they are or what they believe, and it is our commitment to help restore their spirits and rebuild their lives.