A Decentralized Service Delivery Model Benefits Clients and Providers at SURVIVORS By Carin Anderson, MSW Intern

Social work, like other human service professions, requires the clinician to practice self-care to balance work with physical, emotional, and psychological well being. This is especially true when working with torture survivors. Even those such as immigration court clerks or interpreters need to be cognizant that the work they are doing can have an effect on their mental health. This effect is called vicarious trauma. Survivors of Torture, International (SURVIVORS) has created a decentralized service delivery model to spread out the rewards and also the challenges such as vicarious trauma amongst our supportive community. Clinicians are also able to extend their professional network to assist interdisciplinary colleagues in serving a population with complex posttraumatic stress disorder, anxiety, depression, and physical pain.

A network of providers has been established through recruitment by the clinical team and word of mouth. The network of providers is able to offer a variety of skills and approaches – children, neuropsychology, EMDR, etc. – to best fit our clients’ needs. Additionally, many of our contractors speak languages other than English which lessens our need for interpreters and increases the quality of the sessions for our clients. The network of providers spans San Diego County and clients are able to access contractors closer to their homes as most have to rely on public transportation. One detrimental outcome from experiencing torture is a general mistrust of others after such severe acts of violence have been committed against themselves. The network enables clients to build trusting relationships with professionals in the community beyond our staff members.

One of our network clinicians is Nicola Ranson, LCSW, who completed her MSW from SDSU in 1994. Nicola takes the strengths perspective when discussing her work with torture survivors. She explained that there is a false idea that working with torture survivors is all about trauma. Further, she said, “the awareness of vicarious trauma and the danger of re-traumatization goes hand in hand with focusing on the healing journey and resiliency” of the torture survivors. To minimize re-traumatization and vicarious trauma, clinicians need education and training. Nicola specializes in Somatic Experiencing, which was introduced to her through a training at SURVIVORS. Working with SURVIVORS has provided Nicola with a diverse, multicultural clientele that speaks to her international background and interests as an avid traveler who has previously lived in England and Canada. These are clients that she would not necessarily meet in her private practice and she genuinely enjoys them. The clients from SURVIVORS supplements and balances her private practice with a case load of about 3 – 5 survivors of torture at one time. The work is also tangible for Nicola. There are injustices all over the world and work with torture survivors allows Nicola to have an impact on the situation without traveling across the globe. Concrete successes with clients come from the psychological evaluations that are done for the clients’ asylum cases. Nicola stressed the importance of continual re-evaluation and humility in her clinical practice with clients to ensure the best care.

For SURVIVORS, the decentralized service delivery model helps to protect our staff from vicarious trauma because they do not hear the stories of torture and complex trauma throughout the day, every day. With contracted workers, the organization’s overhead is reduced with fewer staff. Because of this, we have been able to serve more without major budget increases. The organization can better adapt to the highs and lows of referrals and intakes as crises around the world are ever changing. Lastly, the decentralized service delivery model is a mission driven strategy: to help build a community of healing and a safe haven for torture survivors in San Diego, as well as, educate professionals and the public about torture and its consequences.

The following are needed to become a mental health contractor:

Attend a Journey to Healing Tour

An interest in working with international clients of diverse backgrounds and languages

Knowledge of trauma-informed care

Currently licensed (LCSW, MFT, PhD psychologist)

Current liability insurance

Completed application

References checked

Screened by program manager

Live Scanned

MOU agreed to and signed by both parties

Able to work with interpreters

Once a clinician is approved to join the network, they are matched with clients based on geography and clinical specialties. Clinicians are prepared for the work with torture survivors through shared resources like healtorture.org and encouraged to continue consultation with their supervisors and the clinical team at SURVIVORS. If you are interested in becoming a network provider or volunteering with SURVIVORS please contact our program manager, Dr. Mahvash Alami at (619) 278-2400.

(A special “thank you” to Nicola Ranson, LCSW, for meeting with me in between client sessions at Survivors of Torture, International.)