Could you provide some cost benefit analysis here? E.g. how many children were treated based on the 35k the ACT spent last year, and how did you measure the effect of the treatment?
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Enable communities to cure PTSD in children after state failure
Not fundedGrant
$0raised
1. Project summary
1.1 Hypothesis: Providing critical infrastructure is an effective form of altruism
An effective altruism strategy must have an allocation to the provision of critical services and infrastructure in order to be effective, as there are critical services and infrastructure states and markets won't provide.
The risk-adjusted rate of return for critical service and infrastructure projects is relatively high compared with other investment areas for effective altruists, because we can identify critical services and infrastructure with minimal speculation or need for prediction about the future.
Allocating funds to organisations that provide critical services and infrastructure which states and markets will not, is an effective form of altruism.
1.2 Core problem: Traumatised children with PTSD and no access to a cure
Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities.
Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning... Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life... They confront human beings with the extremities of helplessness and terror, and evoke the responses of catastrophe. - Judith Herman, Trauma & Recovery
PTSD in children is an important problem because PTSD has severe negative impacts on individuals and communities:
Prevalence: PTSD is a global issue, affecting millions of people worldwide. Globally, the lifetime prevalence of PTSD is estimated at around 3.9% of the adult population but rates are much higher in conflict zones and post-disaster areas.
Healthcare Systems: PTSD places a substantial strain on healthcare systems around the world. Treatment often involves long-term therapy and potentially, psychiatric medication. Some people with PTSD may need acute care if they're in crisis.
Economic Burden: Beyond direct healthcare costs, PTSD has significant indirect costs. This includes loss of productivity due to illness, disability, and premature death. Some studies estimate that PTSD costs billions of dollars each year globally.
Social Consequences: PTSD impacts relationships and communities. It can lead to family disruptions, domestic violence, and community discord. The condition can create barriers to education and employment, further exacerbating social and economic disparities.
Inter-generational Impact: There's evidence that the effects of PTSD can pass from one generation to the next. Children of people with PTSD are at higher risk for a variety of mental health conditions. This could be due to both genetic factors and the stress of living in a disrupted family environment.
Refugee and Conflict Zones: In regions of the world experiencing warfare, civil unrest, or mass displacement, PTSD prevalence is significantly higher. This exacerbates the challenges of rebuilding and recovery in post-conflict zones.
1.3 Complicating factor: Regular concurrence of PTSD and damage to critical infrastructure
States and markets leave the problem of PTSD in children largely unaddressed because when there are large numbers of children with PTSD around, it's typically because we are in conditions of state failure: war, genocide, systematic abuse, natural disasters, population displacement.
In these conditions, the state isn't functioning. If it was functioning, we wouldn't be in conditions of disaster/atrocity. And if the state isn't functioning, you don't have the basic infrastructure you need to operate markets or provide clinicians by other means - the clinicians you need today were child soldiers when they should've been in med school, and deploying capital when the local currency is controlled by warlords isn't appealing to outside investors.
This means that the problem of PTSD in children will not be addressed without effective altruism from non-governmental organisations, and the impact of this will be severe, systemic and intergenerational.
1.4 Solution: Train people in local communities to cure PTSD using techniques that can be adapted to local context and do not require previous clinical training or access to costly resources
ACT International (https://actinternational.org.uk/) have a model that addresses the problem.
Our projects focus on trauma training and we specialise in teaching ‘Children's Accelerated Trauma Technique’ (CATT). Most of the people we work with have limited resources and are in communities coping with the consequences of war and violence. We have shown we can train schoolteachers to apply CATT effectively, meaning the intervention can work when clinical resources are limited. We have trained people from 17 countries as well as the UK where we are based. Our cascade model, training local people to help children in their communities, means our work is cost effective and sustainable after we leave.
ACT International’s work has transformed the lives of thousands of children, many of who are refugees fleeing conflict and disaster. Through our training we have helped former child soldiers, victims of genocide, war, abuse, accidents and disasters.
See here for further detail on our solution, including evaluations of CATT interventions in Gaza and Uganda see https://actinternational.org.uk/for-professionals-1.
1.6 Threat: ACT International don't have the funding it needs to employ paid staff, ensure the longevity of their work, or establish sustainable income
ACT International relies primarily on volunteers donating time and expertise and lacks the income to hire executive staff. The organisation relies heavily on its executive chair, and when the incumbent's term finishes it's unlikely that the organisation will be able to continue operating unless the Trustees can hire a CEO who can focus on establishing the charity's long-term sustainability.
2. Project goals
Develop our income strategy and operations
Establish the long-term sustainability of ACT International
Enable our work to continue beyond the current Executive Chair's term
3. How will this funding be used?
The funding will be used to fund an executive team (minimum a part-time CEO) who will be accountable to ACT International's Board of Trustees.
4. What is your (team's) track record on similar projects?
We have a Board of Trustees that includes experts in executive coaching and transformational change (https://actinternational.org.uk/about)
Our Executive Chair has years of experience running ACT International
If we were to secure funding, we would involve expert recruiters in the process
5. How could this project be actively harmful?
There is potential to cause some disruption to our core work. However, without doing this project, our core work is at significant risk of being unable to continue
ACT International's work (though not this particular project) involves training people to work with children who've experienced trauma, in dangerous environments. We're experienced in this and have appropriate safeguarding policies and procedures in place.
ACT International's work (though not this particular project) involves working with trauma and mental health across a wide variety of cultures and belief systems. We apply a child's rights model.
6. What other funding is this person or project getting?
There is no other funding going to the longevity project. In 2022 we raised ~£35k and spent 97% on beneficiary projects.
You can see our previous annual reports here: https://actinternational.org.uk/annual-reviews
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Simon Stewart
over 2 years ago
Hi - thanks for engaging with this, it's really helpful to understand what information people are looking for. I've asked internally for more information to help me answer this, but based on what's publicly accessible:
how did you measure the effect of the treatment?
For a clinical measure we use (https://www.corc.uk.net/media/1267/cries_introduction.pdf).
We did a brief audit of our clinic in Gaza and found 100% of children (69/69) above the threshold for PTSD were below the threshold for PTSD after treatment (https://actinternational.org.uk/burch-catt-gaza).
The Arabic version of the Children’s Revised Impact of Events Scale-8 (CRIES-8), a widely used measure of PTSD in children, was used as the pre- and post- treatment measure. At initial assessment, all 69 children received total scores on CRIES- 8 of over 17, the cut off for a likely clinical diagnosis of PTSD. (Range: 18-40/40) At post-treatment review, the score for every child had fallen to below 17 (range: 4-16/40). Mean reduction in CRIES -8 scores from pre to post intervention assessment was 19.01 (SD= 5.1). The Post-Catt assessment scores (M=10.26, SD= 2.53) were significantly lower than the Pre-CATT scores (M= 29.48, SD= 5.10), indicating that CATT significantly reduced symptoms of traumatic stress, measured using CRIES-8, to below the 17 point cut-off for probable PTSD.
The analysis shows that CATT was an effective treatment for symptoms of trauma in children and young people, including several who had lived with the effects of PTSD for 4 or more years, and despite continued exposure to potentially traumatising events. Parents and children also reported progress in life skills and psychosocial adjustment after CATT. A small group of children were seen for a follow-up review six- to-seven months after finishing CATT. The gains reported after finishing CATT treatment, and low CRIES-8 scores, were maintained in 9 of the 10 children, and further positive gains were reported. This indicated that CATT may help children and young people to develop their psychological resilience to cope with further traumatic events.
No child in the group of 69 showed an adverse mental health event (eg marked mood swings, or high levels of anxiety) during the treatment period, indicating that CATT is a safe treatment in this environment.
Our investment in Gaza during that time period was approximately ~£7k. So about £100 per child. The clinic's costs were ~$300 per child - we are providing training and support to setup, rather than the treatment itself. So our investment continues to show returns as the clinic continues to operate.
We've also done an impact assessment of work in Uganda (https://actinternational.org.uk/cuffe-uganda-catt-assessment).
In Uganda, we trained a team for an approximate total cost of £3580, who saw 858 children during two years of pandemic. So we're get a child treated for approximately £4 of our cost. It's more like £10 per child if we include a stipend being paid by other organisations to the trainees - we're just the training provider.
In IDP and refugee settlements on the border between Uganda and Sudan, the UK-based charity, CRESS (Christian Relief and Education for South Sudanese) employs a team of nine trauma counsellors trained in CATT by ACT International. These counsellors work under the auspices of the Diocese of Liwolo exiled in Uganda, offering trauma therapy and emotional health guidance for a small remuneration of $15 a month. The most common causes of trauma they see are child neglect, rape and sexual abuse.
In two years of pandemic, between November 2019 and December 2021, they saw 858 children, whose treatment is documented in case files. All of them had high CRIES-8 scores at the first assessment, indicating a diagnosis of PTSD. After treatment with CATT, a marked reduction in CRIES-8 scores was seen in all cases, to below the threshold for PTSD, indicating significant improvement or total removal of many of the main symptoms of PTSD such as re-experiencing and avoidance. The large drop in mean scores indicates that CATT is a successful and appropriate technique for treating PTSD in these communities, and that this group of CATT counsellors is very effective...
In two years of pandemic, between November 2019 and December 2021, they saw 858 children, whose treatment is documented in case files. All of them had high CRIES-8 scores at the first assessment, indicating a diagnosis of PTSD. After treatment with CATT, a marked reduction in CRIES-8 scores was seen in all cases, to below the threshold for PTSD, indicating significant improvement or total removal of many of the main symptoms of PTSD such as re-experiencing and avoidance. The large drop in mean scores indicates that CATT is a successful and appropriate technique for treating PTSD in these communities, and that this group of CATT counsellors is very effective.
I think it will be difficult to provide comprehensive figures across all programmes, as we don't always have end-to-end traceability and it will take a few years to understand the return on investment. Once we have trained a counsellor, they can keep providing the treatment indefinitely without us incurring any further cost. Drop-out rates vary by jurisdiction and particular circumstance.
Our trainers are volunteers, the costs are effectively getting a place to do the training, plus some translation of training materials, sometimes a bit of capital investment to get a team off the ground e.g. buy someone in Uganda a bicycle so they can travel to a camp.
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Simon Stewart
over 2 years ago
Had some info back on the Uganda work:
We first trained 19 people from the South Sudanese refugee community in northern Uganda in January 2019, with the support of a Hampshire-based UK charity. It went on to set up a specialist CATT team of 9 counsellors which has now treated 616 children. Our expenditure on behalf of this team since 2019 has been £6450. Our contribution has been focussed on the training element of the work, including community awareness and on training 2 x trainers to train others. The team says it has reached over 2,345 children and young adults through its community emotional health programme.
So, that’s £10.50 per treated child , or £2.75 per impacted child.