Lay Counselor Perspectives of Providing a Child-Focused Mental Health Intervention for Children: Task-Shifting in the Education and Health Sectors in Kenya.

Shannon Dorsey,Leah Lucid,Christine L Gray,Augustine Wasonga,Rosemary D Meza,Grace S Woodard,Noah S Triplett,Caroline Soi,Kathryn Whetten,Prerna Martin,Cyrilla Amanya

doi:10.3389/fpsyt.2019.00860

Abstract

The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors’ perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in specific government-supported sectors that might scale up and sustain mental health care for children and adolescents. In western Kenya, these sectors include Education and Health. Data come from a large hybrid effectiveness-implementation study examining implementation practices and policies in either or both sectors that support successful implementation of a child-focused intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT), for children and adolescents who had experienced parental death. We examined lay counselors’ self-report of acceptability, feasibility, and appropriateness of TF-CBT. Lay counselors were teachers (n = 30) from the Education sector and Community Health Volunteers (CHVs; n = 30) from the Health sector, who were part of Sequence 1 of a large stepped-wedge, cluster randomized trial. Lay counselor self-report surveys included reflective and formative measurement of acceptability, feasibility, and appropriateness administered after lay counselors in both sectors had experience delivering the locally-adapted, group-based TF-CBT intervention. Descriptive statistics (means, standard deviations) were used to understand counselors’ perspectives stratified by sector. Both teachers and CHVs endorsed high acceptability, feasibility, and appropriateness of TF-CBT, with lay counselors’ responses on items from the formative measures providing some insight into specific aspects of acceptability, feasibility, and appropriateness that may be important to consider when planning for implementation support. These early findings suggest that both sectors may hold promise for task-shifting of mental health care for children and adolescents but also underline the importance of considering the multiple facets of these three implementation outcomes as well as lay counselor context (Education vs. Health).

Highlights

Mental health disorders have increasingly become recognized as a prominent cause of global morbidity, with a significant portion of the world’s population—450 million people—affected [1]
The goal of the present study is to assess counselor-perceived acceptability, feasibility, and appropriateness of a trauma-focused intervention for children and adolescents in the context of a task-shifting, implementation science-focused study in western Kenya. We examine these constructs with the first lay counselors from two different sectors, Education and Health, who delivered Traumafocused Cognitive Behavioral Therapy (TF-CBT) [23] for children who experienced the death of one or both parents and have related mental health symptoms [30, 31]
Our results provide preliminary evidence that lay counselors in both sectors perceived TF-CBT to be a satisfactory intervention, doable in their respective settings, and that delivering TF-CBT is compatible with their role and sector’s approach to helping children

Summary

Introduction

Mental health disorders have increasingly become recognized as a prominent cause of global morbidity, with a significant portion of the world’s population—450 million people—affected [1]. Adolescents, and young adults 5 to 24 years of age bear a high burden of mental illness. It is the leading cause of YLDs for this age group [3] and 75% of mental disorders commence during this period of life [4]. The treatment gap is as high as 78% for adults [6] and even greater for children, with a median of only 0.16 of children in LMICs with mental health illness receiving any treatment [7]. The funding gaps are correspondingly accompanied by shortage in human resources, as demonstrated by the relatively low mental health staff ratio of 1 per 100,000 population compared to more than 50 staff per 100,000 population in high-income countries (HICs; 10)

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