Hill Martin, Everson Mary Lynn
Associate Director, Research and Evaluation, Heartland Alliance Marjorie Kovler Center. Correspondence to:
Former Senior Director, Heartland Alliance Marjorie Kovler Center. Correspondence to:
Torture. 2019;29(3):5-26. doi: 10.7146/torture.v29i3.115202.
Heartland Alliance Marjorie Kovler Center (Kovler Center) is a torture treatment program located in Chicago, Illinois. Established in 1987, Kovler Center provides medical, mental health, and social services, as well as coordination with legal services, to a diverse population of survivors. Historically, Kovler Center used clinical measurement instruments to assess depression, anxiety and posttraumatic stress, but staff was challenged with finding the best way to assess and ultimately measure changes in functional domains. The purpose of this paper is to describe (1) the Kovler Center framework, philosophical pillars, and model of treatment; (2) the comprehensive outcome evaluation program, including the Marjorie Kovler Center Well-Being Questionnaire (MKC WBQ); and (3) the results and implications to date.
Kovler Center measured outcome data utilizing three instruments including a well-being tool and supplemented the data with a satisfaction survey. These instruments were administered at intake and re-administered at six-month intervals up to 24 months.
RESULTS/DISCUSSION: With nine years of data, Kovler Center can now provide valid and reliable findings in diagnostic and functional changes, with 86.6% of its clients reporting fewer symptoms of anxiety and depression, 83.1% reporting fewer symptoms of trauma, and significant improvement in employment status, housing status, and physical health after receiving services for 24 months. Indicators significantly correlated with clinical improvement at 24 months include stable housing, stable employment, region from where survivors came, number of days between initial assessment and program admittance, number of services (medical, psychological, social) received while in the program, number of medical problems diagnosed with while in the program, and number of psychological problems diagnosed with while in the program. From the Generalized Linear Mixed Models (GLMM) analysis, the total number of psychological problems and whether or not the participant had a secure legal status while in the program were demonstrated to explain the variance in anxiety, depression, and PTSD. Females were more likely to experience depression while in the program compared to males, and participants from the Middle East were more likely to experience symptoms of depression and PTSD compared to participants from Africa.
Since, medical, psychological, and social indicators are demonstrated to correlate with or predict clinical outcomes, this highlights the need for comprehensive and holistic treatment programs for survivors of torture.
Heartland Alliance玛乔丽·科夫勒中心（科夫勒中心）是位于伊利诺伊州芝加哥的一个酷刑治疗项目。该中心成立于1987年，为不同类型的幸存者提供医疗、心理健康和社会服务，以及与法律服务的协调。从历史上看，科夫勒中心使用临床测量工具来评估抑郁、焦虑和创伤后应激，但工作人员在寻找评估并最终衡量功能领域变化的最佳方法方面面临挑战。本文的目的是描述：（1）科夫勒中心的框架、哲学支柱和治疗模式；（2）全面的结果评估项目，包括玛乔丽·科夫勒中心幸福感问卷（MKC WBQ）；（3）迄今为止的结果及意义。
科夫勒中心使用三种工具测量结果数据，包括一种幸福感工具，并用满意度调查对数据进行补充。这些工具在 intake 时进行管理，并每隔六个月重新管理一次，最长持续24个月。
结果/讨论：有了九年的数据，科夫勒中心现在可以在诊断和功能变化方面提供有效且可靠的结果，86.6%的客户报告焦虑和抑郁症状减少，83.1%报告创伤症状减少，在接受24个月的服务后，就业状况、住房状况和身体健康有显著改善。与24个月时临床改善显著相关的指标包括稳定的住房、稳定的就业、幸存者来自的地区、初次评估与项目准入之间的天数、项目期间接受的服务（医疗、心理、社会）数量、项目期间诊断出的医疗问题数量以及项目期间诊断出的心理问题数量。从广义线性混合模型（GLMM）分析来看，心理问题的总数以及参与者在项目期间是否具有安全的法律身份被证明可以解释焦虑、抑郁和创伤后应激障碍的差异。与男性相比，女性在项目期间更有可能经历抑郁，与来自非洲的参与者相比，来自中东的参与者更有可能经历抑郁和创伤后应激障碍的症状。
由于医学、心理和社会指标被证明与临床结果相关或可预测临床结果，这凸显了为酷刑幸存者提供全面和整体治疗项目的必要性。
