Category: Cultural Diversity / Vulnerable Populations
Keywords: Cross Cultural / Cultural Differences | Supervision | Child Trauma / Maltreatment
Presentation Type: Symposium
Background: In LMIC, the global mental health treatment gap is large, with children at particular disadvantage1. Only a small proportion of the available RCTs testing EBT in LMIC have focused on children. One EBT for child trauma exposure and traumatic grief has a substantial evidence-base in the US and other high-income countries2, with a growing evidence-base in LMIC. However, trials have been small or focused on individually-delivered treatment, with local, in-person supervision and intensive expert oversight. Testing group-based treatment and lower-intensity supervision (e.g., remote supervision; lower-levels of expert involvement) offer avenues for scale up, such that more children with need receive treatment.
Methods: Six lay counselors in Tanzania and Kenya were trained to provide Trauma-Focused CBT (TF-CBT). All counselors were supervised by 3 experienced lay counselors in Tanzania; who were supervised one hour each week by a US expert (1st author). In each country, 320 orphaned youth (6-13) with PTS and/or grief due to parental death—and one guardian—were randomized to TF-CBT or usual care (Total N=640). TF-CBT was delivered in 12 group sessions in Kiswahili. 8 same-sex children were in each group, with a concurrently run guardian group (conjoint activities in the last 4 sessions). Participants received 2-4 individual visits for imaginal exposure. In each country, half the groups were in rural areas; half in urban areas. Clinical outcomes were assessed pre and post-treatment by child and guardian report. Interviewers were masked to treatment condition.
Results: Analyses supported a country by setting by condition interaction. Effect sizes were largest in rural Kenya (Child-reported PTS; Cohen’s d=1.52), followed by moderate effects in urban Kenya (d=.55), and small effects in urban Tanzania (d=.39). There was no treatment effect in rural Tanzania, where all youth improved substantially (to sub-clinical). Contextual factors including food scarcity, participant health, and cultural views of orphans will be discussed. Findings have implications for context and provide some evidence for remote supervision (given effects in Kenya).
1. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet Lond Engl. 2007;370(9590):878-889. doi:10.1016/S0140-6736(07)61239-2.
2. Cohen JA, Mannarino AP, Deblinger E. Treating Trauma and Traumatic Grief in Children and Adolescents. New York City, NY: Guilford Press; 2006.
University of Washington
Thursday, November 16
1:00 PM – 6:00 PM
Saturday, November 18
9:45 AM – 10:45 AM
Saturday, November 18
12:00 PM – 1:30 PM
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