FINAL REPORT

European Commission

Daphne 1997

Project number 97/248/WC

Organisation de Victimologie et de Psychotraumatologie Européenne

OVEPE

Project Chief: Dr. Philippe Werson

Project Co-ordinator: K. Sadlier

Institut de Victimologie

16 rue Jean Leclaire

75017 Paris

France

March 1999


Table of Contents

Project resume p. 3

General information p. 4

Project Report p. 5

Introduction p. 5

Part I: Treatment and training standards proposals p. 5

Proposed training standards p. 6

Training standards workgroup p. 7

Proposed treatment standards p.15

Treatment standards workgroup p.16

Part II: National reports from the OVEPE network p.19

France p.20

Germany p.23

United Kingdom p.34

Italy p.37

Sweden p.38

Belgium p.39

Part III: Motion for a Resolution to the European Parliament p.??

Project Procedure p.??

Initial goals p.??

Project difficulties p.??

Database Information p.??

Accounting Report p.??

National network reports for France and Belgium are presented in French, as is the Accounting Report. All other information is presented in English.


Project Resume

OVEPE, the European Organisation of Victimology and Psychotraumatology, was founded by Gérard Lopez (France), Gisela Perren Klinger (Switzerland), and Marc Van Knippenberg (Belgium) in November of 1997. Each of these psychiatrists and clinical psychologists works with distinct trauma populations, i.e., victims of war, crime, natural disasters and intra-familial violence. OVEPE is currently being co-ordinated by the Institut de Victimologie (France).

In January of 1998, OVEPE was awarded a start-up grant from the European Commission's Daphne Project. In conjunction with Daphne’s aims, OVEPE seeks to improve mental health services to women and children who have been victimised by diverse aggressions. To date, national OVEPE representatives have been identified in France, Belgium, the United Kingdom, Sweden, Germany and Italy. The role of these representatives is to co-ordinate the creation of a specialised psychotrauma centre network in their respective countries. Expert consultants from Norway (Lars Weisaeth), and Switzerland (Gisela Perren Klinger), have graciously accepted to participate in the project. In addition, a liaison with the European Society for Traumatic Stress Studies has been created in order to pool common efforts towards the enhancement of mental health services to victim/trauma populations.

Two workgroups have been constituted in the areas of training and centre specialisation. These workgroups have proposed guidelines in each of the aforementioned domains. In addition, a motion for a resolution to improve mental health treatment for victim/trauma populations was drafted in conjunction with the European Society for Traumatic Stress Studies and European Victim Support. All of these documents are available to the public.

In terms of the project’s future, the European Society for Traumatic Stress Studies will take over the workgroups on training and treatment guidelines. The continued creation and monitoring of a European psychotrauma treatment centre network will be spearheaded by Gisela Perren Klinger of Switzerland for the 1999-2000 work year.


General Information

1) Organisation: Institut de Victimologie

2)  Project: Organisation de Victimologie et Psychotraumatologie Européenne

3)  Address: 16 rue Jean Leclaire, 75017 Paris, France

4)  Telephone: (331) 40.25.04.04

5)  Fax: (331) 40.25.04.04

6)  Email:

7)  Contact person: Dr. Phillipe Werson

8)  Materials available for distribution:

-  Resolution draft to the European Parliament on improved mental health services to victims of diverse aggressions

-  Proposed European standards for training in psychotraumatology and victimology

-  Proposed European standards for functioning of psychotraumatology centres

All of these materials are available in English

via K. Sadlier,

email :

PROJECT REPORT

Introduction

OVEPE, the European Organisation of Victimology and Psychotraumatology,

was founded by Gérard Lopez (France), Gisela Perren Klinger (Switzerland), and Marc Van Knippenberg (Belgium) in November of 1997. Each of these psychiatrists and clinical psychologists works with distinct trauma populations, i.e., victims of war, crime, natural disasters and intra-familial violence. OVEPE is currently being co-ordinated by the Institut de Victimologie (France).

In January of 1998, OVEPE was awarded a start-up grant from the European Commission's Daphne Project. In conjunction with Daphne’s aims, OVEPE seeks to improve mental health services to women and children who have been victimised by diverse aggressions. To date, national OVEPE representatives have been identified in France, Belgium, the United Kingdom, Sweden, Germany and Italy. The role of these representatives is to co-ordinate the creation of a specialised psychotrauma centre network in their respective countries. Expert consultants from Norway (Lars Weisaeth), and Switzerland (Gisela Perren Klinger), have graciously accepted to participate in the project. In addition, a liaison with the European Society for Traumatic Stress Studies has been created in order to pool common efforts towards the enhancement of mental health services to victim/trauma populations.

Two workgroups have been constituted in the areas of training and centre specialisation. These workgroups have proposed guidelines in each of the aforementioned domains. These guidelines are presented in Part I. Descriptions of national centre networks are described in Part II. Part III presents a motion for a resolution to improve mental health treatment for victim/trauma populations which was drafted in conjunction with the European Society for Traumatic Stress Studies and European Victim Support. All of these documents are available to the public.

Project Report, Part I: Treatment and training standards proposals

Everyday throughout Europe, a significant number of children and adults face terrifying events: rape, assault, homicide, natural catastrophes, major transportation accidents, terrorist attacks, physical and sexual maltreatment. Encountering such situations can leave lasting psychological scars on any of us, scars that place a crushing burden on both personal and social resources.

As society becomes more and more aware of the effects of traumatic events on individuals, an increasing demand has been made on the mental health community to effectively prevent and treat trauma-related psychological suffering. In the last twenty years, trauma-specialised mental health professionals have made important contributions in the field and have disseminated their knowledge through both scholarly papers and training programs. Interest in issues related to victims of traumatic events has led to a recent increase of training courses, some of which risk being spearheaded by unqualified professionals.

In Europe, no co-ordinated accreditation exists for trauma-related training programs or treatment centres. The lack of accreditation means that it is currently impossible to monitor standards. This situation has important implications for the quality of services which mental health professionals ultimately provide victims of traumatic events. In areas as sensitive as the treatment of those who have directly experienced abuse, crime, warfare, natural catastrophes and terrifying accidents, a lack of training and treatment standards risks re-victimising traumatised clients via poor or unsatisfactory knowledge concerning both related psychological disorders and the particularities of the social and legal networks in which victims may find themselves inscribed.

The goal of the OVEPE work groups is to propose the basic architecture for European training and treatment standards in psychotraumatology, i.e., the understanding, prevention, and treatment of those psychological disorders commonly experienced by trauma victims. Training and treatment should be done so with victimology in mind, i.e., the study of the social and legal networks in which trauma victims find themselves inscribed. This report presents the workgroups’ proposals with the hope that it will stimulate efforts to improve mental health services for traumatised persons. The work group underscores that although both treatment centres and training programs do exist throughout Europe, the field appears to be riddled by fragmentation, caused in part by a lack of co-ordination of standards.

Proposed Training Standards

Throughout Europe the paucity of training in psychotraumatology and victimology is becoming an urgent issue: as social stigmas surrounding victimisation are lifted, increasing numbers of mental health professionals will come into contact with victims, yet they are poorly trained to evaluate and treat this population. As such, it is important that they optimise their prevention and intervention approaches via specialised coursework.

Some European Union countries (for example, the United Kingdom) include lectures on trauma and victims during basic medical training. However, the amount and type of training is disappointing and their content often fails to make specific reference to issues related to women and child victims. In addition, this training does not include specialised practical skills that would assist psychiatrists in later treating trauma/victim populations. Sweden is an exception in this respect: it is insisted that psychiatric students treat at least one victim presenting a trauma-related disorder during their medical residency under supervision. However, and as for other European countries, no standardised training exists for either psychiatry or clinical psychology students. Various universities throughout Europe do include courses on victims of trauma during clinical psychology studies, but again, these tend to be the exception to the rule.

For those European psychiatrists and clinical psychologists who wish to enhance both their theoretical and clinical knowledge about trauma victims, the current option is post-graduate training primarily offered by private institutions and organisations. Unfortunately, since no accredited standards exist in the fields of psychotraumatology and victimology, it is not possible to monitor the quality of training dispensed nor its upkeep with research and theoretical developments in the effective treatment of victims.

The OVEPE workgroup on training issues has attempted to address this situation by proposing a basic architecture for education in psychotraumatology and victimology. The workgroup is composed of the following professionals :

Monica Becker Fischer
Institut fur Psychotraumtologie
Springer 26 53804 Much GERMANY
tel. (02245) 91940/919420 / Deborah Lee
Traumatic Stress Clinic
73 Charlotte St., London W1P 1LB UK
Tel/fax 44 171-530-3666/3677
Tom Lundin
Dept. of Psychiatry
Uppsala Univ. Hospital Sparrisgaten 2
S-754 46 Uppsala SWEDEN
tel. (46)18-178822 fax (46)18-178890 / Gisela Perren Klinger
Institut Psychotrauma Schweiz
PO Box 189 CH 3930 Visp SWITZERLAND
tel (41) 279 46 3422
fax (41) 279 46 3423
Marc Van Knippenberg
Centrum voor Psychotrauma
Gitschotellei 230
2140 Antwerp BELGIUM
tel (323)272.2525
fax(323)216.1200 / Lars Weisaeth
Division of Disaster Psychiatry
University of Oslo
Buiding 20, Sognsvannsveien 21
0320 Oslo NORWAY
tel. (47) 22-14-24-90
fax (47) 22-92-36-65
Karen Sadlier
Institut de Victimologie
16 rue Jean Leclaire
75017 Paris FRANCE
tel/fax (33) 1 40 25 04 04 / Roderick Orner
Dept of Clinical Psychology
Baverstock House St. Anne's Road
Lincoln 1N2 5RA UK
fax (44) 1522-546-337

In the workgroup’s report on training, recommendations for standard topics are presented. The content of topic modules should reflect up-to-date practical and research findings. Training is targeted towards four groups of professionals liable to work with trauma/victim populations: emergency workers, primary health care professionals, general psychiatrists and clinical psychologists, and trauma-specialised psychiatrists and clinical psychologists.

a) Emergency Workers

Training for emergency workers is focused on basic psychological first aid/crisis knowledge and skills. Emergency workers include policemen, firemen, rescue workers, paramedics and emergency room personnel. These professionals are often the first to encounter the trauma victim and his or her family, sometimes in catastrophic situations.

Emergency workers' direct exposure to traumatic events places them at high risk for burnout. Furthermore, their position on the "frontline" implies that some of these professionals can highlight the eventual support needs of trauma victims.

Excellent training for emergency workers already exists in several European countries. Based on these programs and on the needs of trauma victims, the OVEPE workgroup proposes that accredited training programs for emergency workers should include:

-  Knowledge of traumatic stress risk factors

-  Knowledge of critical incident stress reactions

-  Knowledge of the preliminary signs of traumatic stress reactions in adults and children

-  Knowledge of information-giving techniques to concerned relatives

-  Knowledge of secondary trauma reactions and available support services

-  Knowledge of media-management techniques

-  Demonstrated proficiency in psychological first aid techniques for both adults and children

-  Demonstrated proficiency in connecting victims to psychotraumatology and victimology networks

It is proposed that accredited training programs for emergency professionals be comprised of 10 hours of knowledge modules and 5 hours of practical skill modules.

b) Primary Health Care Professionals: General Practitioners and Pediatricians

Primary health care providers are often gatekeepers to specialised psychiatric and psychological services. They are likely to see early trauma and stress reactions, which have not yet become rooted. They are also likely to encounter victims of domestic violence and child abuse in the course of general practice. As such, accredited training for this group should be focused on both detection, prevention and referral skills. The group is constituted of both highly qualified health professionals who serve the public, such as general practitioners and pediatricians. In some European countries, nurse practitioners, non-clinical social workers and even clergy members may be appropriate candidates for this training level.

The OVEPE workgroup proposes that accredited training programs for primary health care professionals should include:

-  Knowledge of behavioural and clinical signs of victimisation (i.e., child abuse, domestic violence, sexual assault, torture)

-  Knowledge of national laws and ethical guidelines concerning victim issues, (i.e., child abuse reporting)

-  Knowledge of trauma disorder risk factors

-  Knowledge of clinical signs of acute stress disorders, traumatic stress disorders, and trauma-related dissociative disorders in children and adults

-  Demonstrated proficiency in psychological first aid techniques for both adults and children

-  Demonstrated proficiency in connecting victims to psychotraumatology and victimology networks

It is proposed that accredited training programs for primary health care professionals be comprised of 8 hours of knowledge modules and 2 hours of practical skill modules.

c) Secondary Health Care Professionals: General Clinical Psychologists and Psychiatrists

Ideally, training in victimology and psychotraumatology should form part of the general curriculum in psychiatry and clinical psychology studies. Given that most mental health professionals will encounter trauma-victims at some point in their careers (research indicates that 2 to 15 percent of the general population suffers from trauma-related disorders), the OVEPE workgroup believes that all mental health professionals should have a working knowledge of psychotraumatology and victimology. Furthermore, they should be able to evaluate as well as treat a range of simple trauma disorders and provide appropriate referrals to both victim assistance networks and specialised psychotraumatology centres.