Process and outcome of child psychotherapies offered in Kenya: a mixed methods study protocol on improving child mental health

Grace Nduku Wambua,Manasi Kumar,Fredrik Falkenström,Pim Cuijpers

doi:10.1186/s12888-020-02611-2

Abstract

BackgroundChild and adolescent mental health problems account for a significant proportion of the local and global burden of disease and is recognized as a growing public health concern in need of adequate services. Studies carried out in Kenya suggest a need for a robust service for the treatment, prevention, and promotion of child and adolescent mental health. Despite a few existing services to provide treatment and management of mental health disorders, we need more knowledge about their effectiveness in the management of these disorders. This paper describes a study protocol that aims to evaluate the process and outcomes of psychotherapies offered to children and adolescents seeking mental health services at the Kenyatta National Hospital in Kenya.MethodsThis study will use a prospective cohort approach that will follow adolescent patients (12–17 years of age) receiving mental health services in the youth clinics at the Kenyatta National Hospital for a period of 12 months. During this time a mixed methods research will be carried out, focusing on treatment outcomes, therapeutic relationship, understanding of psychotherapy, and other mental health interventions offered to the young patients. In this proposed study, we define outcome as the alleviation of symptoms, which will be assessed quantitatively using longitudinal patient data collected session-wise. Process refers to the mechanisms identified to promote change in the adolescent. For example, individual participant or clinician characteristics, therapeutic alliance will be assessed both quantitatively and qualitatively. In each session, assessments will be used to reduce problems due to attrition and to enable calculation of longitudinal change trajectories using growth curve modeling. For this study, these will be referred to as session-wise assessments. Qualitative work will include interviews with adolescent patients, their caregivers as well as feedback from the mental health care providers on existing services and their barriers to providing care.ConclusionThis study aims to understand the mechanisms through which change takes place beyond the context of psychotherapy. What are the moderators and through which mechanisms do they operate to improve mental health outcomes in young people?

Highlights

Child and adolescent mental health problems account for a significant proportion of the local and global burden of disease and is recognized as a growing public health concern in need of adequate services
Child and adolescent mental health problems account for a significant proportion of the global burden of disease [2] and is a growing public health concern
Children and adolescents in low- and middle-income countries (LMICs) contexts are greatly affected by the gap that exists between the need for and the access to mental health services, with the treatment gap estimated to be as high as 90% [1]

Summary

Methods

Study design This study will make use of a naturalistic prospective cohort design to track the process and outcomes associated with psychotherapies. The Y-OQ-2.01 is a parent-report measure of treatment progress for children and adolescents, aged 4–17 years old, receiving mental health services It follows the measure of outcome explicitly and tracks change during treatment. Data collection procedures The study collection period will last approximately 12 months During this time, all new patients at the clinic will be invited to participate, and all parents consenting for their children to participate in the study will fill out the researcher-designed demographic questionnaire, the PSC, and HoNOSCA. This analysis will provide tools to understand outcome occurrence patterns in adolescents dealing with various problems and are receiving care This analysis will highlight the possible interactions between outcome and therapeutic alliance as assessed by both the adolescent and clinician, indicating the presence of covariances that cannot be explained by any other variable in the model and can represent—possibly reciprocal—causal relationships.

Background

Findings