Breakout K- May 17, 2013
1. Scaling Up Care for Orphans in Tanzania: A Task-Sharing Approach to Mental Health Treatment
Presenter: Shannon Dorsey, PhD
Authors: Shannon Dorsey, PhD,1 Karen O’Donnell, PhD,2 Kate Whetten, PhD,3 Wenfeng Gong, MA,4 Dafrosa Itemba,5 & Rachel Manongi6
1University of Washington; 2Duke University School of Medicine; 3Duke University; 4Johns Hopkins University; 5Tanzania Women Research Foundation; 6Kilimanjaro Christian Medical Centre
Abstract: Global mental health is increasingly receiving research attention. Nearly ten randomized clinical trials in low and middle income countries (LMIC) have demonstrated the effectiveness of evidence-based practices (EBP), however, only one trial focused on adolescents, none on children, despite the high mental health gap for this population (Saxena et al., 2007). Furthermore, very few D&I questions have been included in trials, despite the focus on task-sharing (training non-mental health professionals to deliver mental health interventions) and its relevance to implementation science. We examined feasibility and clinical outcomes for children and adolescents receiving Trauma-focused Cognitive Behavioral Therapy (TF-CBT) in Moshi, Tanzania, an area of high HIV prevalence and orphaned children. TF-CBT was provided to single sex groups (ages 7-10; 11-13), using a task-sharing approach. The study employed the Apprenticeship Training Model (Murray, Dorsey et al., in press), developed specifically for training, supervision, and iterative, collaborative adaption with local lay counselors. Post-treatment, children had significantly reduced PTSD and traumatic grief or shame at post-treatment (PTSD Child-report; β=15.38; p<.001; Guardian report; β=11.19; p<.001) with improvements maintained at follow-up. Presentation will include feasibility and outcome data, multimedia, and discussion of active learning training and supervision strategies, as strategies for scale up.
2. A Transdiagnostic Mental Health Intervention in Low Resource Countries: An Alternative Solution to Mental Health Implementation Challenges
Presenter: Laura Murray, PhD
Authors: Laura Murray, PhD,1 Shannon Dorsey, PhD,2 Maythem Alyasiry,3 Amir Haydary,4 & Paul Bolton, MBBS, MPH1
1Johns Hopkins University Bloomberg School of Public Health; 2University of Washington; 3Department of Psychiatry, Iraq; 4Ministry of Health, Iraq
Abstract: A growing research base demonstrates that evidence-based treatments (EBT) are transportable, adaptable, acceptable, and effective in low and middle income countries (LMIC) (e.g., Bolton et al., 2007; Patel et al., 2011) using a task-shifting approach (i.e., counselors with limited or no prior mental health training). However, the singular focus of most EBT on one clinical problem (e.g., depression) is a barrier to scale up, reducing ability to address the mental substantial health treatment gap in LMIC. Transdiagnostic interventions teach a set of common practice elements delivered in varying combinations to address a range of problems. Components-Based Intervention (CBI) is a transdiagnostic approach developed for LMIC and is currently being tested in two RCTs for adult survivors of torture in Southern Iraq and at the Thailand-Burma border. Presentation will focus on the novel intervention development, training, supervision, and outcomes in both sites. Pilot cases showed a 75% decrease in clinical symptoms (Iraq) and 54.5%/55.2% decrease in depression and trauma symptoms respectively (Thailand). Functioning impairment also decreased at both sites. These findings, combined with growing US-based evidence, suggest that a transdiagnostic approach may be an alternative for implementation and scale-up challenges of addressing mental health problems in LMIC.
3. Implementation of Cognitive Processing Therapy Provided by Community-Based Paraprofessionals in the Republic of Congo: Influence of Therapist Factors Randomized Clinical Trial
Presenter: Debra Kaysen, PhD
Authors: Debra Kaysen, PhD,1 Shelly Griffiths, MSW, LICSW,1 Cindy Stappenbeck, PhD,1 Janny Jinor, MSW, LCSW,2 Paul Bolton, MBBS, MPH,3 Jeannie Annan, PhD,4 Katie Robinette, MPH,4 & Judith Bass, PhD, MPH3
1University of Washington; 2Morgan State, Baltimore, MD; 3Johns Hopkins University Bloomberg School of Public Health; 4International Rescue Committee
Abstract: Need for mental health care services for sexual violence victims in eastern Democratic Republic of Congo (DRC) has been documented but few services exist. Therapies developed in the West with established efficacy with female rape victims have not been tested in low resource settings like DRC. Growing literature addresses the adaptability of evidence-based psychotherapies cross-culturally and in resource-poor contexts. One dilemma for implementation in low resource settings is to what extent complex treatments can be delivered successfully by paraprofessionals. In this study, we will discuss results of adapted Cognitive Processing Therapy for use in DRC. Congolese community-based paraprofessionals were trained and supervised in delivering group CPT. Hierarchical linear modeling was used to examine change over time. Based on preliminary analyses of weekly self-report measures, there was a significant reduction in mental health symptoms over time (b= -2.04, p<.001). Women whose therapists post-training were rated as more competent in CPT delivery showed a greater decrease in symptoms over time (b= -0.42, p=.015). Further analyses will examine the impact of therapist education and years of experience in predicting client outcomes. Findings suggest that complex therapies can be administered successfully by paraprofessionals with training and supervision.