SCALING UP WITH TRAUMATIC STRESS RELIEF (TSR)

The TSR programme consists of a series of pilot projects conducted in more than 10 countries.

Evaluative research is key in this pilot phase for purposes of local validation and project adjustment.

TSR has been designed to create a pool of available organized personnel to serve as frontline para-and allied professionals confident and able to relieve traumatic stress in others, going beyond offering Psychological First Aid (PFA), thus becoming an integral part of an expanded mental health referral system. Task-shifting in health is part of a worldwide phenomenon over the past 50 years of sharing simpler functions with para- and allied professionals while reserving more complex technical tasks and leadership roles to professionals, thus increasing workforces and optimizing available skills to deal with the increasing workload (e.g., paralegals, paraeducators, paramedics, paramilitary, parapolice).

While the focus is on the delivery of TSR to unreached traumatized populations, the knowledge and skills provided will also enable those trained to care for themselves and to support their colleagues in highly stressful and humanitarian situations.

TSR Curriculum

The TSR curriculum introduces selected techniques and approaches in a simplified and protocolized form for the purpose of delegating certain routine activities to carefully prepared para- and allied professionals. This is also known as task-shifting to para- and allied professionals.  The techniques and approaches are selected for their effectiveness, safety, and efficiency. They have been empirically validated and are widely used by professional therapists. The TSR curriculum is informed by the Adaptive Information Processing (PDF version) model; the principles of early intervention protocolised interventions; and the latest insights from adult learning pedagogy (experiential learning, hands-on methods, learning through reflection and doing).

The training is conceived in two parts, to be delivered over a minimum of four days. Part I includes a necessary minimum of psychoeducation (theory) while prioritizing exercises for stabilization and working in communities. Part II prepares frontline workers to deliver two simplified group protocols.

The curriculum also defines pre-requisites for organizing such TSR training. These include selection criteria for trainees; professional support being ‘on-call’; and systems in place for referrals, supportive supervision, and evaluative research. Safety is a paramount consideration.

TSR Training Project Locations

Afghanistan

Angola

Bosnia

Brazil

Burkina Faso

DR Congo

Iraq

Jordan

Rwanda

Saudi Arabia

Uganda

USA (Vermont)

Existing translations of Protocols and/or Complete TSR Curriculum

Arabic

Bosnian – all modules

Brazilian

French

Kinyarwanda

Kurmanji

Pashto

Swahili

Ukrainian – module 6 only

Types of Para- and Allied Professionals Trained

Counsellors

Faith-based Counsellors

Junior Psychologists (not EMDR trained)

Medical Doctors

Midwives

MHPSS service delivery personnel

Mountain Technical Rescue personnel

Nurses

Police personnel

Psychosocial workers/assistants

Social Workers

Teachers

Yezidi Women (Harikara)

TSR – Programme Evaluation

A recent publication by Pupat et al., (2022) evaluated TSR training sessions for both para- and allied professionals and mental health professionals from DRC, Rwanda, Uganda and Burkina Faso.

They found:

  • That TSR programme acceptability and feasibility were good.
  • The tools and the training are sensitive to the culture and can be adapted when needed.
  • The trainees understanding of traumatic stress, of when to intervene or when to refer, how and when to conduct grounding or stabilizing practises, how to communicate with traumatized individuals, was found helpful and useful.

A follow-up impact study by Pupat et al., is in progress:

  • Preliminarily results suggest that there is a significant reduction of traumatic stress levels and increase of resilience after 1 to 3 sessions of TSR conducted by para- and allied professionals.

A Summary of TSR programme evaluation findings of several ongoing projects

  • Increase in knowledge was found in all data gathered based on entry and exit questionnaire data.
  • Self-efficacy was increased after TSR training.
  • Traumatic Stress levels decreased after training.
  • Traumatic Stress levels were found high in all project reports, with significant risk of clinical PTSD pre-training in some individuals.
  • Many of the projects experienced some cultural challenges to implement TSR training materials.
  • Overall, the TSR training package were found feasible and acceptable.

Recommendations for future research proposed for TSR

  • Group protocols and evaluation tools need to be culturally adapted and translated to answer to the needs of largely illiterate populations, from different cultural backgrounds.
  • Incorporating body movement techniques, less pen and paper and integrating treatments existing in the communities to address trauma.
  • New exercises which comply with the AIP model (PDF version) and are culturally acceptable could be designed to improve the acceptability and wider use of TSR.
  • To add the use of biometrics in efficacy research, e.g. heart rate variability as a biomarker of stress.

New Initiatives for TSR

  • COVID19 Pandemic has resulted in TSR moving online in the form of a self-help intervention. This supports frontline workers remotely
  • An official, first of its kind TSR Training of Trainers is planned for March 2023 in Paris with 40 participants recruited through several institutions.

In Other Words..

The ‘Facilitator’ trains…‘Participants’ selected from among existing ‘Frontline personnel’…who, once trained, serve as ‘TSR providers’… offering traumatic stress relief to ‘Beneficiaries’ in the community – and to their own colleagues – while continuing to operate in their normal organizational roles.