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.