Telehealth Approach to Enhance Treatment Capacity and Monitoring Practice in Mental Health Service in the Post-Conflict Setting

Lack of local expertise to address the consequence of trauma has been major impediment for the reconciliation in the post-conflict setting. The present work is part of a randomized controlled trial of effectiveness of interdisciplinary intervention in war victims in Kosovo, using telehealth concept for therapy adjustment, clinical education and supervision.

Three Kosovar clinical psychologists were trained by an accredited CBT supervisor from Denmark in a 35-hour workshop in Pristina to provide cognitive behavior therapy (CBT) to war victims. After the workshop they were involved in a 6-month randomized controlled trial under long-distance coaching and supervision from Denmark. Each psychologist provided 60-100 treatment sessions (from 90 to 150 hours) during the trial and received 1-2 hours weekly supervision via videoconferencing (60 hours in total), and 40-hour in-person performance monitoring by reviewing the audio tapes of selected treatment sessions with CBT supervisors. The psychologists also assisted at baseline and follow-up assessments (30 hours) and received feedback from an independent local assessor. We fulfilled the European Association For Cognitive and Behavior Therapies (EACBT) Standards for Training and Accreditation for CBT therapists.

The model substantially reduces the cost and length of expat specialist staying in the field. Use of telehealth technique enhances the ability of specialists to provide coaching and feedback to local health workers, which improves the treatment integrity and data reliability. The local workers were highly motivated by on-the-job development and certification program. This approach addresses the gap between workshop-learned theories and skills and actual practice in the developing countries.