Attending to the 'Whole' Child in Mental Health Care: Utilizing a Partnership Approach to Address Social Risk Factors Alongside an Evidence-based Psychotherapy

Abstract

Background: Social risk factors, or adverse conditions in which people are born, grow, live, andage (World Health Organization, 2008), contribute to greater mental health problems (Bender et al., 2015; Martin et al., 2016) and lower treatment engagement worldwide (Fleury et al., 2014). The prevalence and impact of social risk factors (SRFs) are particularly pronounced in low-to- middle income countries (LMICs), where too few individuals—and particularly children—with mental health needs receive care. However, within LMICs, to our knowledge, strategies to address SRFs alongside mental health treatments have not been systematically developed or evaluated. Methods: Building on an NIMH-funded project (BASIC; Dorsey, Gray, et al., 2020; Chapter 2) and grounded in decolonial praxis, we invited participants ranging from children and guardians who received and lay counselors that delivered an adapted form of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2016) in western Kenya to develop strategies to target SRFs. We first aimed to examine both the experience of SRFs and how lay counselors are or could address SRFs within TF-CBT through qualitative interviews with children, guardians, and counselors (Chapter 3). A deductive thematic analysis and synthesis informed the next phase of the research in which lay counselors were invited to participate in a workshop including discussion of qualitative findings and development of strategies facilitated by TF-CBT supervisors (Chapter 4). Following the workshop, the research team finalized and integrated two main strategies into a training for additional lay counselors to attend. During the training, counselors learned how to incorporate (1) coping with discrimination and stigma and (2) economic empowerment skills within TF-CBT. Results from the qualitative analysis reveal that in the face of SRFs, counselors were already addressing SRFs, though typically by using their own personal money and resources (Chapter 3). Participants also identified a variety of strategies that do not require extensive financial support, which were further developed during the workshop and training (Chapter 4). After participation in the training, lay counselors perceived the strategies to be feasible, acceptable, and effective. However, through a paired samples t-test, we found no change in their ratings of self-efficacy and self-control in addressing SRFs three months after the training (Chapter 4). Discussion: Through the qualitative findings, we highlight the importance of centering participants’ needs and existing resources in the adaptation of evidence-based practices. Overall, the development process and the strategies reported in this paper may support the engagement in and effectiveness of evidence-based practices in Kenya and globally.