Exposure to traumatic experiences is a major risk factor for aggressive behavior. Experienced violence can result in perpetrated violence. Forensic rehabilitation has been proven to guide young offenders back to social integration. Unaccompanied minor refugees’ experiences are often characterized by permanent stress, experienced trauma, as well as perpetrated violence. Informed by the findings of the 5-year ERC Advanced Grant Project MemoTV (Memories of Trauma and Violence), POPP (Putting Offence Prevention into Practice) developed a step-by-step model for a professional training and trauma-focused treatment program within the public health care sector. Each individual stage has been proven effective. A spin-off start-up has been developed to internationally disseminate POPP’s methods.
POPP started with the specific aim to improve the mental well-being and thereby the social integration of unaccompanied, asylum seeking and refugee adolescents and young adults in Germany. Their reported stressors included poverty, organized violence, persecution, the disappearance or death of loved ones, sexual and physical violence, and exploitation. Those having actively participated in violence often have a reduced threshold for continuing to perpetrate violence. Moreover, their psychiatric symptoms are accompanied by physical diseases stemming from immune systems compromised by chronic stress. The consequences of trauma are expensive. Each unaccompanied minor refugee is estimated to accumulate 50,000€ in state costs each year. Each year that they do not receive the support they need has a powerful detrimental impact on our social fabric.
POPP achieved its goals to offer an effective, in-system model for increasing access to trauma-focused treatments through the training of psychotherapists-in-training. Unaccompanied, minor asylum seekers are now receiving the treatment they need from qualified and confident practitioners. The reduced psychological suffering will increase their opportunities for improved physical health, social interconnectedness, and societal integration. It will also reduce the risk of their involvement in perpetrating violence.
However, the innovative solutions developed from POPP do not stop there.
The unexpected challenges of the COVID-19 restrictions and regulations nearly canceled the POPP project. Traditionally, trauma-focused psychotherapy has been delivered in person due to numerous ethical, safety and data security concerns. It seemed unlikely that the project would have been able to re-design a curriculum in accordance with national health standards within the funded action period.
Through consultation and collaboration with colleagues navigating the same challenges in other countries, we were able to finalize a training model that could be delivered remotely. There are now hundreds of new trauma-informed psychotherapists confidently working with heavily burdened young people. All scheduled future trainings are fully booked, and this is just one location in southern Germany. There will soon be tens of thousands more of these desperately needed trauma-focused practitioners entering healthcare systems around the world in the years to come!
Simultaneously, the NET intervention itself was updated to include provisions for remote delivery of the treatment. These new guidelines have already been published in several scientific journals in Europe and North America. Worldwide the number of individuals who will soon have access to empirically proven treatment for trauma spectrum disorders by qualified practitioners is rapidly and exponentially increasing.
These developments resulted in solutions to problems that had not even been targeted at the time the project was proposed. The scope of the impact is jaw-dropping. The POPP model’s sustainability extends beyond feasibility. Tens of thousands of therapists will not need to travel to access training or patients. Hundreds of thousands of patients will not need to travel to access care. POPP set out to offer a proven program to increase access to care in Europe and ended up developing an environmentally, economically, and equitably sustainable model that can be implemented in health care systems around the world.
