Excerpted from:  (2003) Gjakova, the first family-focused community mental health center in Kosovo. With Griffith, J., and Ulaj, J. In Lightburn, A.and Sessions, P. eds.)  Community Practice.  Oxford Press. (in press). Paper and bibliography available from author upon request.

The Kosovar Family Professional Education Collaboration (KFPEC) and Service Based Training (SBT)

Development of the Collaboration

The Kosovar Family Professional Education Collaborative (KFPEC) began in 1999 as a university- to-university collaboration between the Department of Neuropsychiatry at the University of Prishtina; the Institute on Genocide, Psychiatry, and Witnessing at the University of Illinois at Chicago; the Chicago Center for Family Health at the University of Chicago, and the American Family Therapy Academy(AFTA), a professional organization of family therapy teachers and researchers.  (Weine and Agani 2000, Weine, Agani, Rolland in preparation).   I  am one of the team members from AFTA.

Historical, Social and Political Context

          Kosova is a region approximately the size of Kentucky with a population of two million people.  Its status as an independent country or as a province of Serbia is still under debate.  Currently it is a protectorate of the United Nations and NATO troops maintain the peace between Serbs and ethnic Albanian (Kosovars) in the region. The recovery from the war has been difficult.   Approximately 250,000 families suffered directly from violence and/or dislocation.   During the war, 62% of the population had a near encounter with death and an estimated 17% subsequently suffered symptoms of post-traumatic stress disorder (Cardoza et al, 2000).   To deal with this level of distress, the region had twenty psychiatrists, five psychologists and no formally trained social workers.  Many of these professionals suffered trauma and loss in their own families. It is in this context that our collaboration ( the KFPEC) for the development of professional education, between Kosovar and U.S. mental health professionals, was formed. (Griffith et al 2001)

Main Components of the KFPEC.

Focus on Families--  teaching  knowledge and skills for engaging the family as the basic unit for health services.  Family life is the core of Kosovar culture, but Kosovar health and mental health services had not been oriented to families.  Even though “family” is a professed part of the value system of international organizations, most programs have not  used a family approach to mental health services in any meaningful way. 

Focus on Resilience-- clinical work that builds upon the strengths, skills, and practical wisdom of Kosovar families, rather than diagnosing and treating the psychopathology of individual patients.  Most training in mental health provided by aid organizations has emphasized methods for identifying and treating post-traumatic stress symptoms.

Professional Collaboration as a balanced partnership that includes:

·         Administrative, clinical, teaching, and writing activities conducted jointly by paired Kosovar and American colleagues.

·         Planning  by Kosovars of each visit by American consultants, including selection of topics for lectures and workshops.

·         Working in Albanian:  Since there are few Albanian/English bilingual clinicians among  either Kosovars or Americans, all teaching and clinical work conducted with translation, including extensive translation of teaching materials into Albanian.

Long term Educational Collaborations –Development of  a Model

·         Long-term collegial relationships.

·         Reports on family topics written for distribution and publication in Kosova.

·         Reports on model of professional collaboration  presented and published internationally.

·         Manual developed so that  model of professional collaboration  can be adapted by others. .

Service-Based Training (SBT) – The Second Phase of Our  Collaboration

            Although the early work of the project demonstrated that Kosovar clinicians could rapidly acquire skills needed for family-focused mental health treatment, this achievement would have little societal impact without concomitant development of systems of community-based, outpatient mental health services.  Moreover, there was increasing specific concern among mental health leaders in Kosova about the chronically mentally-ill, many of whom suffered from a lack of adequate hospital and outpatient services.  The direction of the project thus shifted to integrate training of professionals with the development of community mental health services, with a primary focus on the chronically mentally-ill.

In 2001, the KFPEC initiated this second phase of its project, named “Services-Based Training (SBT) for Kosovar Community Mental Health and Prevention,” in conjunction with the development of mental health centers in Kosova. (Weine, Agani 2001. Weine et al in preparation).  The Gjakova Center for Mental Health was the first of the mental health centers in Kosova to become operational.   I became part of the leadership and planning team for the project and the co-director of services with my Kosovar colleague, Jusuf Ujai.

Development of these services for the chronically mentally ill and their families was carried out at two regional cities, Gjakova and Ferizaj.  Community nursing teams were developed in each of these sites for family assessment, family psychoeducation, in-home crisis intervention, and medication-monitoring for patients with chronic psychiatric disorders and their families.  These community nursing teams are  supervised by SBT teams from the University of Prishtina that consist of two psychiatric residents and a nurse who participated in the original KFPEC trainings.  The Prishtina team is supervised by the chief of psychiatry and the head family therapist at the Department of Neurology and Psychiatry at the University of Prishtina.  U.S. participation consists of regular two-person team visits that  plan with the Kosovar leadership, and supervise the SBT teams in their teaching and supervision of the community nursing teams.  

Initially, 30 chronically mentally- ill patients in Gjakova and Ferizaj were chosen to receive the new services.  Arrangements were negotiated with families for these patients to live with their families and kin, with the support of the new outpatient mental health services.   Currently, the SBT program is being expanded at the two initial sites to include more patients and their families and will be extended subsequently to five additional Centers for Mental Health that are under development in other cities.