2016 CDC Pilot Successful, But Not Scalable

 

In 2016, EmancipAction partnered with Mahima Home, Kolkata to pilot India's first "Critical Recovery Center” focussed on providing mental health care for child victims of sex trafficking. EmancipAction was established to make this intervention possible - in response to rescue organizations in India were struggling with a critical gap in the care available to children rescued from sex trafficking.

In this pilot we provided individual mental health assessments and treatment plans for all children in the home, and trained housemothers to provide trauma-informed care. Mental health interventions were individualized and provided by professional psychologists. The results were clear and encouraging. Rates of depression and anxiety were significantly reduced, and cases of suicidal ideation plummeted. Housemothers felt better equipped for their jobs and reported that the atmosphere of the home was calmer and happier. These results were consistent those reported by our benchmark mental health assessment centre in Cambodia, where survivors who were given quality mental health care were found significantly more likely to heal and restore their lives than those who had not. 80 percent of girls who received good mental health care managed to finish their education, find and retain employment and avoid "re-victimization”, compared to only 20 percent who had not.

While these positive results were very encouraging, our biggest challenge would be scaling the model due to a severe shortage of trained mental health caregivers, and significant cost. At the time, there were only 3 psychiatrists and just .5 clinical psychologists for every million people in India. Also, it became clear that the need for such care was enormous. With hundreds of thousands of traumatized children in institutional care and no access to mental health support, we knew we needed to find a cheaper and more scalable solution.

2018 Project Savera: Phase 1 Feasibility and Acceptability

In our search for a scalable solution, we looked to the experts at Columbia University’s Global Mental Health Lab and Harvard University’s Dr. Vikram Patel to learn from their successes in "task shifting”: that is, training lay people to provide simplified mental health interventions. Ultimately, we partnered with Dr. Patel’s organization, Sangath, to design and launch "Project Savera”– an evidence based, scalable mental health intervention, designed to meet the specific needs of girls aged 11-18 who have endured a variety of Adverse Childhood Experiences (ACEs) and residing in childcare institutions in India. This intervention was delivered by lay members of the local community, trained as Mental Health Workers (MHWs). Phase One of the study was a Feasibility and Acceptability Trial which was launched among 110 girls residing in three private, faith based childcare institutions in Goa, and two public institutions in Mumbai.

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2019 Project Savera: Phase 2 Feasibility and Acceptability

While Phase 1 of Project Savera was deemed an overall success, we learned a great deal about the unique issues faced by children in institutional care and how to make the curriculum even better suited to the specific to their needs. We were also given some enthusiastic feedback on how make it more fun and engaging(they are teenagers, after all). Phase 2 of Project Savera was launched as a Feasibility and Acceptability trial in 2019 among 113 adolescents aged 11-18 years and 28 caregivers in 3 institutional childcare facilities in Mumbai.

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2020 Project Savera: Phase 3 Impact Study – ON HOLD

Much to our disappointment, the COVID-19 pandemic has put our Impact Study, due to launch in 2020, on hold due to safety concerns for children living in institutional childcare facilities in Mumbai and across India. During this time, we continue to be very concerned for the socio-emotional health of the children we serve, and have had been given unique permission to work with those with acute needs – especially girls experiencing suicidal ideation - via one to one tele-counselling.

The opportunity to harness the power of technology presents a unique opportunity for EmancipAction and the many children who currently have no access to the mental health care support they need. We are currently seeking partners to help us transfer our curriculum onto a video-based micro learning platform, and thereby reach many thousands of children quietly suffering and in need of our help

 

Khemka's Story:
How Trauma Care Builds Courage and Opens the Doors to Freedom

Khemka initially resisted rescue and struggled with the government authorities when they brought her into our Critical Recovery Center (CRC) at Mahima in Kolkata in early 2016. Khemka was just 15 when she was sold into a life of sexual exploitation. Initially, she fought for her freedom and resisted, but the punishment for resisting was extreme, cruel and ultimately fatal for many. Eventually, she stopped fighting. Like many girls who survive the "breaking" stage of trafficking, she gave in to the abuse and manipulation of her captor and submitted to his authority. Days of violence and nights of sexual abuse became her norm. She was labelled a "prostitute” and gave in to this new identity. Somewhere in the process, she stopped seeing herself as a victim in need of rescue – and hence, the resistance when it came years later.

After just a few months in the CDC, Khemka turned 18 and, as a legal adult, insisted on being released from the CRC’s protective care. She was following a familiar pattern among abuse victims, and intended to return to her old, familiar life with her abuser. Her budding self-esteem was yet fragile, and she still found it easier to believe the lies her captor had told her - about the filth that she was and the life she deserved – rather than the unknown alternative she had been told about at the CDC: a life of freedom and redemption. Khemka’s return trip was fraught with turmoil. The closer she came to her captor's house, the more she remembered the pain, shame and emptiness of her former life. She considered how much she had grown during her time at the CDC, and the people who had poured kindness into her life. She realized that she was at a crossroads, and for the first time, the decision on which way to go was hers alone.

Khemka made the courageous and life affirming decision to return to Mahima, complete the counselling program and was supported in her search for and placement in her first formal job.

Through her hard work and with the professional support and care she needed, Khemka found the strength to persevere and work towards the restoration of her life, breaking through the mental chains of her trauma.

Khemka's victorious story shows the pivotal impact that trauma care can have for children who have survived the horrors of trafficking or other such abuses. With good care, survivors can build the skills and courage to rewrite their own stories.


 
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