Cross-cultural crisis intervention training via videoconferencing

Introduction

The Sichuan province of China was hit with a devastating earthquake (level 8) on 12 May 2008. The earthquake left 87,150 people dead or missing, 250,000 injured, and 4,800,000 homeless (BBC News, 2009). The Chinese government responded quickly to the immediate crisis with a massive deployment of first responders, military personnel, food, and temporary shelter. The tragic death and destruction led China, for the first time in recent history, to request international assistance for the recovery effort (BBC News, 2009). At the time of the earthquake, a delegation of 14 faculty and students from Widener University (WU) in Chester, PA, were participating in an academic and cultural exchange program at Chongqing Technology and Business University (CTBU), located in Chongqing, China, approximately 300 miles from the earthquake epicenter.

The earthquake struck only 3 days after the WU delegation arrived in Chongqing. As information about the extent of the disaster spread, WU faculty and students at CTBU, along with their CTBU colleagues, were eager to find ways to support the rescue and recovery efforts. CTBU quickly organized a Sichuan Earthquake Fund to collect money for food, tents, medication, and other supplies, raising more than US$10,000 in 1 day. WU students and faculty pooled their money to contribute to the fund on behalf of WU, but the impulse to find other ways to help in the face of such massive devastation remained strong in the hearts of the WU visiting students and faculty.

Intercultural Exchange Program

CTBU’s Intercultural Student Exchange Program was designed to bring together students from several different countries to study Chinese cultural traditions, language, and current development, as well as to have the opportunity to share their cultural traditions with their CTBU Chinese counterparts. Students from universities in Thailand, Korea, France, and the United States were invited to participate in the program, offered for the first time that year. WU was invited to send students and faculty members representing social work and business, the two disciplines that had already hosted CTBU students at WU. The program represented the first opportunity for WU to send students to CTBU, and WU was eager to extend this opportunity to its students. WU decided to conduct a selection process to identify the eight most qualified undergraduates to serve as WU’s student ambassadors to China. Because WU did not want to limit the study exchange applicant pool only to those students who could afford the cost of travel, the University decided to accept the challenge of finding funds to support the roundtrip air travel to China for the study exchange delegation. Pacific Millennium, a multinational corporation with many holdings in the United States, demonstrated its commitment to the US–China intercultural collaboration and generously came forward with the financial resources needed to help support the travel for the eight selected students and their accompanying faculty.

The Intercultural Exchange Program exceeded all expectations. WU and CTBU students, as well as the students from the other participating countries, formed close bonds of friendship over the 3 weeks – sharing academic study, learning each other’s language, exploring the similarities and differences among cultures, and having fun together. WU students departed China with a deep appreciation for their Chinese hosts and a new understanding of the capacity to form friendships across cultures and the extraordinary similarity of the hopes, dreams, and interests of young people, regardless of the country of origin. They left the United States as WU ambassadors to CTBU. They returned home as ambassadors for their new Chinese friends and a commitment to helping and encouraging friends and family at home to gain a greater understanding of China and its people.

Disaster training project

Two weeks after the earthquake, a vice president for Pacific Millennium, which had helped to fund WU’s participation in the Intercultural Exchange Program, contacted the lead faculty member of the WU delegation, who happened to also be the Director of WU’s Center for Social Work Education, to explore the possibility of WU providing clinical expertise in dealing with the aftermath of the earthquake. China’s ability to address the short-term and long-term psychological trauma for the hundreds of thousands of people affected by the quake was very limited. Government and non-governmental organizations (NGOs) were amassing thousands of untrained workers and volunteers on a scale never before experienced to assist quake survivors with the psychological aftermath of the disaster. Providing those disaster workers with the clinical expertise to support survivors became an important focus of effort. WU developed a disaster response training program aimed at helping prepare volunteers, helping professionals, medical personnel, and so on in Chongqing to work with survivors brought to the city. CTBU was designated as the home base for the training, and a third partner, East China Normal University (ECNU) in Shanghai, was identified to assist with the training because of the clinical capacity of its faculty. Thus, the Disaster Response Training Initiative emerged as a collaboration between WU, CTBU, ECNU, and Pacific Millennium.

After a series of meetings, the plan for the training and collaboration took shape. The goal would be to provide training in the specific techniques of crisis intervention for ECNU faculty and students, who possessed clinical skills knowledge, but lacked direct experience applying those skills among disaster survivors. The ECNU clinicians would then offer training – modeled on that which they received from WU faculty – at CTBU in Chongqing for medical personnel, volunteers, students, and faculty. In this way, a cadre of people with the appropriate basic skills for supporting quake survivors during the initial weeks after the quake would be developed and expanded. Time was of the essence. The need was urgent. Five thousand injured survivors were in hospitals in Chongqing and hundreds of orphaned children had been evacuated to Chongqing orphanages. The most immediate need was for psychological post-trauma support for the quake survivors already in Chongqing. ECNU was ready to send a team of faculty and students to Chongqing to run a week-long training program.

In the interim, faculty from the Center for Social Work Education and the Institute for Graduate Clinical Psychology at WU formed a team to develop the training. It was decided that the training would occur via videoconferencing technology and consist of three 3-hour-long training sessions. The topics for the trainings were developed jointly by WU and ECNU faculty to specifically address the learning needs of the faculty being trained, such that they could then train others in Chongqing to intervene with survivors in the region in a ‘train the trainer’ model.

The Disaster Response Training team met to finalize a curriculum for the international training. The content addressed techniques of initial post-trauma psychological support, or ‘psychological first aid’, appropriate to supporting early responses to major trauma. ECNU had requested that each session be devoted to one of the three intervention scenarios – hospitalized individuals who had suffered bodily injury as a result of the quake; families dealing with injured loved ones, the death of loved ones, and/or dislocation; and children who had experienced loss of family, injury, and/or dislocation. These scenarios were anticipated as the most challenging and typical of those to be encountered among the evacuees in Chongqing.

The literature

Videoconferencing technology is a valuable tool in long-distance education, including cross-cultural efforts. It has been employed for long-distance supervision of students (Panos, 2005), teaching an online course to students internationally (Wong and Schoech, 2005), and has been used specifically in social work education (Berger et al., 2009). The use of videoconferencing, in addition to other online modalities, is particularly helpful in recreating the interpersonal interactions in education by facilitating simultaneous interaction and feedback between instructors and students. It also enhances the delivery of instruction with personalization and visual cues (Daft et al., 1987). In social work education, it is particularly useful for modeling work with clients via experiential role-plays.

The use of online teaching modalities specifically benefits cross-cultural education (Buchanan et al., 2008). Videoconferencing provides a forum for education that employs the talents of distant instructors, is cost-effective, and is readily deliverable in a short time frame (Wood and Parham, 1996). Rautenback and Black-Hughes (2012) further report that online technologies are particularly useful in benefitting social work students as they afford the opportunity for cross-cultural exposure and learning not otherwise available. Videoconferencing technology specifically provides access to professionals who might otherwise be unavailable while maintaining an interactive and personal classroom experience.

The use of videoconferencing has also been documented as effective (Gillies, 2008; Hoolahan et al., 2007). Videoconferencing has even been effective in several disciplines, including those who serve clients (Beeber and Miles, 2001; Jorm et al., 2010; Smith et al., 2012). Kidd and Stamatakis (2006) compared ‘live’ students to those in videoconferencing and found that both had high rates of success and satisfaction. The interaction that videoconferencing allows between teacher and learner was noted as particularly important in increasing the efficacy of videoconferencing compared to other long-distance modalities (Gillies, 2008).

There are several challenges in cross-cultural education and the use of videoconferencing, particularly in training for disaster response. Regarding the use of videoconferencing, the foremost difficulty cited is the technology itself, particularly regarding knowledge about the software on each side, the stability of the platform used, and uniform technical support (Panos, 2005; Schweizer et al., 2003). Additionally, there are challenges to individualizing conversations within the videoconference and managing parallel conversations (Schweizer et al., 2003).

Cross-cultural training itself has several challenges. These include language barriers, cultural practices, and varying systems of care. Other challenges in cross-cultural education include the perception of mental health professionals, types of services and methods of practice, the structure of educational experiences, and cultural differences in interpersonal relationships, particularly the therapeutic relationship.

The literature provides several strategies for dealing with challenges. Developing ongoing feedback mechanisms between students and trainers is pivotal in ensuring the intended delivery of material (Wong and Schoech, 2005). Other methods of communication, such as email and videoconferencing, are often helpful in providing auxiliary information and feedback for the planning process. In addition, logistical considerations such as time management and scheduling need to be considered (Rautenback and Black-Hughes, 2012).

Strategies to deal specifically with the challenges of videoconferencing include establishing relationships, planning thoroughly, establishing a structure but maintaining flexibility, and documenting and reflecting on the work throughout the process (Barniskis and Thompson, 2012). The contextual setup of the training is also important, particularly to make the setting amenable to the content and the students receiving the training (Barniskis and Thompson, 2012).

Learning about the culture and its norms can help offset disparities in cross-cultural training. Using collaborative methods in teaching is important to get feedback from participants and allow them to help set the context of knowledge application within their culture. The use of translators and partners at the training site also helps deal with communication and ensure the engagement of participants.

Theoretical foundation

Our curriculum development and training were based on socio-cultural theories of learning, theories of disaster management, crisis intervention theory, and crisis in context theory which uses the ecological model of social work practice.

Socio-cultural theories of learning guide the process by focusing on the context of the learning and knowledge application, collaborating with students about their learning and its application, co-creating experiences in the learning for mutual meaning-making with students, and awareness of context in the application of learning and skills (Littleton and Whitelock, 2004; Mercer, 1995). This theoretical framework was particularly important because of the cultural differences of those we trained and even more so because of the cultural differences with those they would help with our training. Our interactions with participants in the training were constantly guided by the collaborative discussion of the practice setting, including cultural norms, service systems, and beliefs about receiving help. Similarly, our interventions were molded throughout the training to respect customs and the participants’ knowledge about the victims they would serve. As such, approaches and language used were modified throughout for the appropriate application to their practice context.

Theories of disaster management guided our consideration of what victims of the earthquake may be experiencing, what relief services were being put in place, and the dynamics of the communities where the disaster struck (DeWolfe, 2000). With this knowledge, we were able to help participants understand the process of what had and would happen to their victims, as well as the larger systems dynamics at play. Walking them through the phases of disaster recovery, including threat, warning, impact, heroic, inventory, honeymoon, disillusionment, and reconstruction (DeWolfe, 2000), helped them understand how and why people were reacting the way they did. Since normalizing traumatic reactions is so important, they needed this information to appropriately assess the victims they served and help them understand the process they were experiencing.

Crisis intervention theory helped outline the steps of the interventions for victims. The six-step crisis model of James and Gilliland (2007) included defining the problems, ensuring safety, providing support, examining alternative coping, planning, and obtaining a commitment to action. Participants were not only taught the six steps but also coached to modify their progression depending on what survivors were dealing with and how they were progressing as each person responds differently. It is imperative that relief workers meet survivors where they are and allow them to progress through phases of recovery at their own pace as long as safety is not a concern. As we progressed through the steps of intervention, we also collaborated with participants to contextualize interventions within their culture, including ways to provide support, coping strategies and resources available and utilized, and attitudes toward accessing services.

Crisis in context theory (Myer and Moore, 2006) expands on crisis theory to consider the context of practice. It asserts that crises have various layers that affect people, and each should be considered when providing crisis services. Similarly, there is reciprocity between individuals and systems, and interventions should assist people in negotiating these. This was particularly important to discuss in the Chinese culture and guided our socio-cultural approach to developing the training and interventions. The Crisis in Context theory also adheres to the person-in-environment and collaborative models that ground our social work practice (Poulin, 2010).

The curriculum

Each of the three sessions organized around these scenarios began by reviewing the basic principles of ‘psychological first aid’ for the specific targeted population, followed by role-plays demonstrating the appropriate supportive skills. After each role-play, discussion and questions further elucidated the lessons of the day. ECNU faculty and students were then given the opportunity to practice the skills through their own role-plays, again followed by questions and discussion. After each training session, collaboration via email was conducted between point persons from each so that the next session could be adapted to address unanswered questions and modified to better meet the needs of the trainees.

The following outlines summarize the main points in each session:

Individuals:

Children

Families

The videoconferencing technology worked almost flawlessly, allowing the WU and ECNU participants to concentrate on the training content with little distraction. Technicians on both sides of the world worked to maintain uninterrupted transmission and maximize video and audio fidelity. The technology worked so well that during the last session interactive role-plays were conducted with ECNU trainees playing the role of survivor(s) and WU faculty demonstrating the intervention skills – an across-the-world interactive role-play. Approximately 40 ECNU students and faculty participated in the trainings, and written feedback from the participants at the conclusion of each session as well as the entire program indicated that the sessions had been extremely useful and well received.

Approximately a week later, a team of ECNU faculty and students began the week-long Disaster Response Training in Chongqing, hosted by CTBU. They had more than 70 participants, including physicians, nurses, helping professionals, and CTBU students and faculty. Over 40 Chongqing hospitals sent staff to the trainings. By all reports, the ECNU trainings were highly successful and significantly added to the cadre of people with basic skills for post-trauma ‘psychological first aid’ and services to survivors commenced immediately throughout the region. In addition, this project served as capacity building for future relief interventions.

This training project taught the US trainers a great deal about the opportunities and challenges involved in cross-cultural collaboration and the use of videoconferencing for training. Following is a discussion of those issues from the literature and our experience.

Opportunities

In our training project, we found the use of videoconferencing technology invaluable. After the earthquake, the pivotal response time for disaster relief services needed in China called for immediacy and ready access to faculty resources that would not have been available otherwise. According to Yip (2005), mental health services, social work services, and human services, in general, are still at a rudimentary level in China. Mental illness disorders are not well understood by the population both in general and traditionally; those suffering from mental disorders are either cared for within the family or placed in very poorly staffed psychiatric hospitals or reeducation facilities. Government-supported human services are minimal and/or delivered by untrained civil servants. Mental health services that are available are generally only accessible to the more affluent individuals. Furthermore, mental health service infrastructure in China provides very little opportunity for a relatively small cadre of trained clinicians to practice application of theoretical knowledge.

Access to state-of-the-art crisis intervention methods afforded the Chinese professionals the opportunity to learn new ways of responding to victims of disaster, such that they expanded their practice knowledge and skills for better outcomes with survivors and had an opportunity for simulated application. Crisis intervention following a disaster is pivotal to providing support and relief for psychological trauma and for preparing survivors to be receptive and able to access further services. Psychosocial interventions from international resources are used to support psychological first aid for large numbers of people who have been subject to disasters (Bourassa, 2009; Su et al., 2013). Given our emphasis on clinical skills in the training, the use of experiential role-play was necessary to practice the skills and communicate dynamically about the challenges faced with the population served. The technology also assisted with examining the role of nonverbal communication in interventions, which enhanced engagement of the audience since translation services were used throughout the training. This heightened awareness of the importance of nonverbal communication in the crisis work occurred via modeling by trainers and then was directly discussed as the Chinese professionals processed their observations of cultural differences in the delivery of services.

Challenges

Cross-cultural training has particular challenges, as stated earlier. In our training project, we were challenged by the language difference. While we employed translators, we did find that the training was not as fluid as we had anticipated and required conscious pacing by instructors to ensure that the material and intent was understood. In addition, there were some words that we used that were not readily translated for the Chinese professionals, requiring additional time to explain the concepts. One such example was the word ‘warm’ to describe the professional approach needed with disaster survivors. General knowledge of cultural norms was important in our training. We did have faculty who had spent some time in China studying the culture, and we used this expertise to orient our trainers. Nonetheless, it was an issue that we were aware of throughout the training, both in our interactions with the Chinese professionals and in teaching them to relate to others via interventions. We did modify some of our general practices to conform to Chinese cultural norms as much as possible and frequently engaged the participants in discussions about how these approaches would work in their cultural context. Another issue was timing. Although simple, it proved to be a logistic consideration that affected the quality of the training because of the time it was done. Due to a 12-hour time difference, training occurred at 6:30 a.m. in the United States and 6:30 p.m. in China.

As mentioned earlier, a challenge facing current-day China is the paucity of its human service infrastructure and its lack of capacity to respond to urgent human service needs, such as those encountered during and following disasters. Social work services in China are vastly different than in the United States, and the profession has recently experienced a resurgence. Social work was introduced in China from the West in the early 1920s. By the 1930s, a handful of mainland universities were offering courses in social work (Yip, 2007). The nascent profession, however, suffered a major blow with the advent of the Cultural Revolution in 1949, when the Communist government banned it, along with many other disciplines of study deemed to be ‘counter revolutionary’. For the next 30 years, social welfare services, to the extent they were provided, were seen as a governmental responsibility and were administered in government-owned and government-operated work units staffed by untrained personnel and overseen by governmental bureaucracies.

A major shift in social service provision occurred in the late 1980s when, under the leadership of Deng Xiaoping, China began its dramatic transition to a market-driven economy. Previously owned and operated government enterprises were rapidly privatized, and what meager social services had been available through the work unit disappeared. Over the next few decades as China has adapted to a market-driven economy, it has gradually moved to a hybrid social welfare system that relies largely on quasi-governmental local community units, NGOs, and, to a very small extent, the private business sector.

The notion that trained professionals were needed to assist vulnerable individuals re-emerged in the late 1980s, along with the shift to a market-driven economy. In 1988, the Ministry of Education formally approved the development of social work programs, and programs began to appear in universities across the country, especially in the major municipalities and wealthier provinces (Law and Gu, 2008). By 1998, the newly formed China Association of Social Work Education had 37 institutional members (Yip, 2007). The growth of a professionally trained social work workforce has, nevertheless, been very slow and hampered by a variety of factors, including the absence of a social service infrastructure to provide employment and/or career advancement opportunities, the low prestige of the profession, and a cultural context that emphasizes self-reliance in the face of personal adversity (Law and Gu, 2008; Yip, 2005).

The method of teaching in China has historically been very traditional and hierarchically framed, with the teacher having the authority and delivering material via lecture. Students in China are used to being passive recipients of teaching methods. Our collaborative teaching methods, which included interactive dialogue, called for an adjustment from the Chinese professionals. This actually ended up being instructive as our method of working with clients is also collaborative, so a discussion of such teaching methods facilitated the learning about interventions. Thus, a learning environment was created that focused on collaboration, mutual goal setting, and sharing of experiences and interpretations. Kornbeck (2001) characterized this type of educational experience as being reminiscent of Ferdinand Tönnies’ ‘Gemeinschaft’ orientation with its use of community-oriented dialogue and skill-building exercises, as opposed to the ‘Gesellschaft’ model that emulates the imposition of state and societal structures.

Best practice methods call for the social worker–client relationship in the United States to be collaborative in nature, where the client is engaged as the expert in his or her own experiences (Poulin, 2010). Whenever Western clinical methods are introduced to new cultural contexts, they must go through a process of indigenization. Yip (2005) argues that mental health is a Western concept rooted in Western cultural notions of satisfaction with one’s social role, self-expression, and positive social adjustment. In contrast, the notion of mental health in China, while increasingly influenced by Western culture, is still dominated by a complex integration of the traditions of Chinese medicine, Confucianism, and Taoism that emphasizes emotional constraint, acceptance of social role and status, fatalism, and filial loyalty. Additionally, as discussed earlier, China’s traditional hierarchical societal organization tends to position the professional as the ‘expert’ to whom one goes to ‘fix’ a problem. Consequently, the Western approach to social work intervention as a collaborative process aimed at assisting individuals in their efforts to self-actualize and self-advocate is ostensibly at odds with the Chinese cultural context (Lin, 1981; Yip, 2005).

Whether or not Western, specifically US, methods of social work practice can be applied to the Chinese cultural context is a hotly debated issue. Many caution against professional imperialism and argue for the need to indigenize social work practice and that the profession’s interest in furthering its professional identity places great pressure on promoting universalistic approaches to practice (Gray, 2008; Gray et al., 2007; Yuen-Tsang and Wang, 2002). Others claim that the profession’s ethical commitment to culturally competent practice and sensitivity to local culture support renders indigenization an ‘inherent professional requirement’ (Huang and Zhang, 2012). However, they further claim that it is critical not to permit an emphasis on indigenization to undermine modernization of social work interventions across cultures.

In order to avoid the sin of professional imperialism, yet openly share state-of-the-art US approaches to crisis intervention, the training team continuously reminded the trainees that they had the responsibility of ‘translating’ the methods presented into their cultural context. The team followed each exercise with a discussion of the appropriateness and relevance of the intervention methods in the Chinese cultural and social context. Quite surprisingly to the team, more often than not, trainees reported that the crisis intervention methods presented were generally highly applicable to their cultural and social context.

Coping with challenges

Disaster response itself has a great many challenges, including working with victims, logistics, and vicarious traumatization. Victims can exhibit a vast range of symptoms in reaction to disasters, and practical needs must be addressed. In addition, helping victims manage the array of services and negotiate them to find their loved ones can be very challenging. It is important for workers in disaster relief to understand the systems in place for providing practical services such as water, shelter, and transportation. In our training, we reviewed these imperatives and then summarized the array of responses that individuals might be having in response to the disaster. We also covered the unique needs and characteristics of children and those dealing with loss of a loved one or disabling injuries. By arming the Chinese professionals to deal with ‘worst case scenarios’, they were better prepared for what they would face in the field and more likely to be familiar with the array of trauma reactions with which they were likely to deal.

Vicarious traumatization experienced by relief workers is a critical issue in disaster relief efforts. Our trainee group was generally unfamiliar with the concept. In a cultural context in which stoicism and fatalism are highly valued, the readiness of relief workers to acknowledge their own stress is limited. Nevertheless, the trainees believed that sensitivity to vicarious trauma reactions, given the devastation and impact of the Sichuan earthquake, would be essential to mounting an effective mass crisis intervention.

Some of our training strategies have already been discussed, including the use of translators, purposeful timing and delivery of the training, orientation to cultural norms and differences, as well as social work services in China, technical logistics with videoconferencing technology, and modifications to intervention methods. We employed other strategies, some of which were suggested by the literature. These include adaptation to cultural differences, use of technology other than videoconference, planful approaches to training, awareness of contextual issues for both the training and the interventions, methods of international collaboration, and self-awareness of the trainers.

General planning for cross-cultural training needs to be done in a systematic and sensitive manner. This includes the development of goals, assessing potential barriers and actions and orienting all people on the project (Carrilio and Mathiesen, 2006). In addition, it was important to assess our participants’ knowledge of clinical social work practices and their experience with disaster relief, including working with some of the special populations involved, such as children and the elderly. For our project, several planning meetings took place, both in China and in the United States. The curriculum was also reviewed for translation, prepared into PowerPoint for simultaneous broadcast, and paced for timing to include examples and experiential exercises. In addition, a general orientation was done for all trainers in the specifics of this earthquake and victims, and of challenges facing victims of disasters in general. We recognized that internal structures in China were potentially very different from ours and that procedures for disaster response may differ as well (Puig and Glynn, 2003). Best practices in disaster response were researched in preparation for the development of the curriculum so that maximum impact could ultimately be achieved with victims.

Adaptation to cultural differences needs to be proactive for trainers and students alike. Trainers, in particular, need to orient themselves to the culture and recognize where differences may be. As we did, an orientation to the country’s recent history, political and economic conditions, as well as the role of social work in the country is important (Carrilio and Mathiesen, 2006). We even decorated the wall behind us in the training with Chinese art to make it a more inviting setting for the delivery of the training. We were also continually aware of our camera presence and used informal feedback mechanisms with each other during the training to keep ourselves as visually engaging as possible. Having a PowerPoint presentation that followed the training points that was translated helped students integrate the lessons more successfully. The use of experiential methods, especially role-plays, also contributed greatly to this integration, as they help with the meaning-making of students and enhance the collaborative experience (Murphy and Gazi, 2001). While distance learning can potentially emphasize a chasm between learner and student, we found participants readily engaged. The technology seemed to fall into the background and did not impede our work.

Finally, it was imperative that the trainers engage in continual self-reflection to assess differences in culture, intervention approaches, and teaching pedagogy. Recognition of the cultural context, awareness of difference, and willingness to address issues of oppression and privilege in the trainings are important so that the students feel as empowered and respected as possible, and the training is relevant to the issues they are facing (De Anda, 2008). We were also acutely aware of our approaches to social work practice and engaged in reflection about differences with our training participants and best practice methods.

Evaluation

Assessment, evaluation, and planning continued throughout the training project. We regularly included feedback mechanisms within the training sessions that allowed for collaborative planning and amendment to meet the needs of participants. We solicited feedback from participants in each training session both verbally and via an evaluation survey. Due to the language difference and the timing of the training, however, the surveys were not completed by many participants, and those that were completed were communicated to us in a summary form. The coordinators of the training program for us onsite in China did solicit feedback from participants after each session and communicate with us via email. Follow-up conference calls, email exchanges, and review of the curriculum were done with planning partners from all of the institutions. The trainers had ongoing ‘debriefings’ to assess the curriculum, its delivery, technology issues, and methods. We used feedback about the training, mostly communicated via email, between sessions to amend the curriculum and methods as necessary. All of the feedback was positive, and participants felt that they were really learning what to do to help people in their region. They reported that they had confidence in our expertise about the intervention models and were grateful for our collaborative approach to the sessions, specifically in asking for their opinions and feedback about the cultural context of their practice. At the end of the training, we had a discussion via videoconference about the efficacy of the training, their satisfaction, and their comfort in applying the knowledge. All participants indicated that they felt it was effective and helpful in preparing them to work with survivors and also helping others to do so. They felt engaged in the learning and commented on how ‘real’ and ‘approachable’ the instructors were, especially caring about their grasp of the material and ability to apply it in their setting. While these evaluative data are more anecdotal than research based, the training was well received and reportedly effective.

Conclusion

Through this disaster training project, we were able to quickly mobilize resources and knowledge to train approximately 40 mental health professionals in China to train others in techniques of disaster response. Within 2 weeks of our training, approximately 70 other professionals from several different hospitals in the region were trained to provide relief and did so in the weeks immediately following their training. The use of videoconferencing technology, best practices in cross-cultural and disaster response training, and our own attunement to the issues and needs of participants ensured that the training met the intended goals and facilitated relief services for thousands in China following the earthquake. Throughout the process of planning, developing, delivering, and evaluating this training, we learned several lessons about the opportunities and challenges in cross-cultural disaster training and ways to manage them. Other clinical disciplines can readily apply these lessons to their fields and engage in rich educational experiences across the world, and those who do not have certain professional expertise readily available can benefit from these methods in order to access the necessary training to deliver quality services.