Innovative Guidance Helpline to Treat People with PTSD - Observatory of Public Sector Innovation

NATAL’s Helpline was developed 20 years ago to provide an accessible and destigmatized method for those traumatized by terror and war. The Helpline provides state-of-the art trauma-informed mental health care. Twelve years later, in partnership with Pastor Harris and his community, the model was adapted to help Chicagoans cope with trauma from urban violence. This international partnership trained 40 caregivers to help hundreds of callers annually, resulting in healthier outcomes and behaviours.

Innovation Summary

Innovation Overview

Israel is a world leader in trauma-informed care. In 2001, the internationally renowned Israeli non-profit, NATAL, started a Helpline using their experience to help callers cope with “transparent wounds” (i.e. depression, anxiety, agitation, dissociation, confusion, physical arousal, avoidance, guilt, oversensitivity, withdrawal, blunted affect, potential substance abuse, risky behaviours and even violence and suicide) caused by exposure to terror and war based on the following principles:
1. The three fundamental stages of healing: creating security, reliving the trauma story, and rebuilding the connection between the victims and their communities.
2. Well-trained volunteers and non-professionals can serve as a great tool for initial guidance by helping in the democratization of mental health knowledge and expanding the amount of 'first liners' in mental health emergency aid.

The Helpline has been offering a combination of phone interventions and therapeutic support. It provides easily accessible and non-stigmatizing services to traumatized individuals. The Helpline provides both crisis intervention and long term emotional support.

Innovative aspects of the Hotline include:
1. Being totally anonymous
2. Three modes of services provided: one time call, short term guidance, and long term guidance
3. The caregivers being heavily screened non-professionals who complete 90 hours of intensive training
4. Continuity of care is provided, including placement in treatment

In 2013, Pastor Harris of Bright Star Church in Chicago came to Israel and was able to see the NATAL Helpline in operation, sparking the formation of an incredible partnership. One year later, NATAL’s model was adapted and scaled to help Chicagoans cope with the trauma and Post Traumatic Stress Disorder (PTSD) experienced as a result of urban violence. NATAL provided training and support to equip local staff in Chicago’s inner city with the tools, knowledge, attitudes, skills, and expertise to provide a culturally appropriate version of the NATAL model.

This unique international collaboration helped establish The Urban Resilience Network (TURN) and created a cultural bridge that brought together different histories, lifestyles and values. TURN has destigmatized and legitimized mental health care in the inner city of Chicago, which is a community suffering from long and deep-seeded traditions of rejecting mental health services.

The social innovation resulting from the partnership has benefited both Israeli and Chicago callers as sharing experiences and lessons learned have provided a feedback loop that has enhanced service delivery on both sides of the ocean. NATAL completed thorough assessments in order to properly adapt the programming for TURN prior to having two cohorts of on-site training for local staff and 22 online sessions in 2021 due to the COVID-19 pandemic. These staff members have been able to serve as pillars of community resilience through the Helpline as the reduction in trauma reduces violent and retaliatory behaviours in the communities.

The next stage in this partnership is to bring the NATAL’s model to scale in other urban communities in the United States and globally by working with partners to identify and make modifications as required to keep the model culturally responsive and reflective of community values and resources.

Innovation Description

What Makes Your Project Innovative?

In addition to the innovative aspects of the program mentioned above (anonymity; three different services, non-professional caregivers, continuity of care) the partnership in itself, as well as the strong focus on providing not just cutting edge trauma-informed care, but also culturally responsive services, are highly innovative elements. One of the most unique and innovative aspects of the Hotline is the important role of well trained non-professionals who are able to relate to those suffering from trauma, regardless of whether the source of that trauma is terror in the Middle East or urban violence in an American metropolis.

Furthermore, the Helpline is able to offer long term guidance despite being anonymous so that those suffering from mental distress who feel that admission would lead to being stigmatized can still receive the services they need. People can reach out for help and receive guidance that will hopefully lead to in-person clinical treatment.

What is the current status of your innovation?

This successful partnership has inspired the partners to see where else the Israeli expertise could be exported in a way that supports the realities of local American communities.

Due to the COVID-19 pandemic, training became very difficult, however, the team was able to train 12 new team members and to develop new online outreach methods to address people in quarantine and to adapt to a 'hybrid' educational and communal services. The partners have been working together to find additional ways that mental health training can ease racial and distress and of ways to scale the model to other communities throughout the US.

Innovation Development

Collaborations & Partnerships

Pastor Harris and his community from Bright Star Community Outreach and NATAL are the primary partners for this project..

The Israeli Consulate in Chicago and Mt. Sinai Hospital in Chicago have played an important role in the project by providing support. Northwestern Medicine and UChicago each contributed funding for the TURN program.

Additionally, the United Way of Metropolitan Chicago and The Jewish United Fund of Metropolitan Chicago have been important partners.

Users, Stakeholders & Beneficiaries

The primary beneficiaries and users are the callers suffering from trauma.
Chicago is the third largest city in America and its government is an important beneficiary and stakeholder.
Based on socio-economic research conducted in Israel, NATAL’s models build resilience in individuals and communities and were shown to turn each dollar spent into $5.50. The program saves on budget spent on social support and medical treatment and increases tax revenues from greater employability of users.

Innovation Reflections

Results, Outcomes & Impacts

The Hotline in Chicago receives over 1,000 calls per year and had a major increase due to the COVID-19 pandemic. In Israel there were over 13,750 calls in 2020. The program has enabled both organizations to develop unique services for PTSD, general stress, and the legitimization of mental health in underprivileged communities.

Since the Israeli Hotline has been started, there has been tremendous impact. There is growing interest and support internationally for the model and NATAL has been awarded the Award for Public Advocacy from the International Society for Traumatic Stress Studies (ISTSS).

Chicago’s implementation has led many organizations to contact Pastor Harris in order to understand how to implement the model in their communities.

Challenges and Failures

Reproducing NATAL’s successful hotline required strong investment in cultural adaptation. While many of the needs were similar, some important details of the different traumas caused difficult changes and adaptations. Furthermore, the cultural differences between NATAL’s team and the Bright Star Church community demanded attention in addressing the sensitive issue of mental health in accordance with local practices, cultures, and beliefs.
Another challenge was the use of volunteers. In Israel highly trained volunteers being caregivers worked well, but in Chicago there was a need to compensate the caregivers to be part-time workers.
In developing the model there was the constant challenge of democratizing mental health since professionals felt uncomfortable outsourcing mental health support to advocates, ambassadors, and non-professionals in the community. Over time the model has been proven to promote resilience and educate others about self-care through programs like the Helpline.

Conditions for Success

With over a decade of experience and a strong infrastructure including different implementations, the Helpline was built on a strong base that had support from various professionals. NATAL’s evidence-based approach was able to garner traction and to operate successfully even when having to change methods in order to suit different cultural needs.

Furthermore, it is crucial to have inspirational and hardworking leadership like Pastor Harris and NATAL’s Judy Recanati. Without Pastor Harris’ continuous work and dedication to making his community better and without Judy Racanati’s vision and wealth of knowledge, there would have been no chance of success. Local leadership must be courageous enough to take on mental health and its stigma and there must be trust between the different organizations. This trust builds over time, but both sides need to come with open minds and hearts in order to trust each other.

Replication

NATAL has been able to run a similar program with the Wounded Warriors Project in the United States. While this program has faced different challenges, the replication has shown that NATAL’s training can help a wide variety of people suffering from trauma and PTSD.

The best way to replicate this program has been through a process of assessment, training, implementation and guidance. This process provides actionable insights into what can be done to make the program a success.

Lessons Learned

There have been many lessons learned, but the biggest ones have been to focus on cultural adaptations at the start, to trust local knowledge and to maintain and grow that trust, especially when dealing with organizations from two very different countries across. Also, understanding that it is possible and that very different organizations can work through difficulties.

One of the best ways to have success is by viewing the collaboration as a unique partnership instead of being a way of scaling. With these kinds of endeavours, the impact of having interdisciplinary and multicultural teams in both the contributing and recipient organizations that act with professional confidence and cultural modesty is immeasurable and is crucial for success.

Anything Else?

NATAL also does incredible work with first responders in the United States. They have built a partnership with firefighters, paramedics, and other medical professionals in New Jersey. This program is focused on operational stress management and has led to the preparation of many trainers who are then able to help their peers.

NATAL has developed many practical tools to raise awareness, research, prevention, and treatment of PTSD and stress. The years of incredible work have led to the organisation becoming a member of Victim Support Europe and Child Helpline International and to being awarded the Award for Public Advocacy from the International Society for Traumatic Stress Studies (ISTSS).