Community-based Counselors Research Articles

GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing–based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.

Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal.

Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP). Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment. Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI -5.68 to -1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = -12.21, 95% CI -19.58 to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82). Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interestNone.

Can addiction counselors be trained to deliver Mothering from the Inside Out, a mentalization-based parenting therapy, with fidelity? Results from a community-based randomized efficacy trial

ABSTRACTThis study evaluated methods for training community-based clinicians to deliver a mentalization-based parenting intervention in an addiction treatment setting. Mothering from the Inside Out (MIO) targets psychological deficits associated with early stages of addiction recovery by fostering improvement in parental reflective functioning, the capacity to make sense of strong emotions in oneself and the child. Fifteen addiction counselors were randomized to training in MIO versus a Parent Education comparison, and completed eight training sessions and a clinically-supervised 12-session training case. As predicted, MIO and PE counselors demonstrated fidelity to their respective interventions during the training case. At the end of training, MIO counselors showed greater improvement than PE counselors in clinical reflective functioning, the capacity to make sense of a patients’ mental and emotional experiences. Implications for training community-based counselors in evidence-based attachment interventions are explored.

Stigma, Learning and Inheritance: An Ecocultural Study of Adaptation and Resource use among Families of Children with Down Syndrome in Thailand

Purpose : This study explored family adjustment and access to rehabilitative services for children with Down syndrome, between 0-5 years of age, in the ecoculture of Petchaburi Province, Thailand. Methods : The study used a family systems genogram in focus group sessions at Pra Chom Klao Hospital, and made home visits to the eight participants from five families in Petchaburi Province, Thailand. Qualitative data collection included field notes, pictures and video recordings of the 7 focus group discussions. The analysis used rigorous procedures for constant comparison, analysis of space, content, domains and critical discourse analysis. Results : Participating families had adjusted to emotional ruptures at home by moving out. They were resilient in the face of health, culture, economic and educational stress. Cultural and religious resources, especially from the mother’s side of the family, contributed most during and after health crises in the first 2 years of childhood. Parents were concerned about seriously delayed development of communication skills when their children were in the 2 ½ - 5 years age group. Parent conviction that the children would be lifelong dependants limited the possibilities for fostering independent living and occupations for these children. Conclusion and Implications: This study contributes to family and community-based rehabilitation strategies, stigma reduction and promotion of early childhood intervention for children with Down syndrome in Thailand. It found moderate public stigma, obstacles in educational transitions and resource use, and limited parental understanding of children’s inheritance and future quality of life. The recommendations made are: better development of family support groups and rehabilitation counselling services, language and communication strategies, abuse training for mothers, and discussion on inheritance rights which offer insight into sibling relations and employability. Service provision can consider reducing hospital stigma, advocacy for inclusive public and work-based play areas, increased support and professional development for community-based counsellors and special education centre extension services.

Community-based counselors’ interventions for elementary school-age children coping with trauma

ABSTRACTChild trauma is a mental health concern and more information is needed about treatment in community mental health settings. This article presents results of a focus group and member checking sessions held with counselors who provided therapy for children experiencing posttraumatic stress disorder in a community-based setting. Results indicated that play and art techniques were commonly used during individual child therapy sessions. Sessions were child-directed and allowed children to review trauma experiences in a “safe” setting with an “expert” guide. Several themes were commonly addressed in sessions including opportunities to re-experience, release, and reorganize the trauma, building resilience or self-esteem for the child, promoting safety, and helping the child to regulate emotional reactions and behavior problems. Counselors focused on discussing ways to interact with the child to promote healing and there was a belief that children would return to a positive developmental trajectory after coping with traumatic experiences. Future research needs to address what works for whom, in terms of what interventions are useful in child-directed counseling sessions for children who have experienced specific types of trauma, such as sexual and physical abuse or witnessing domestic violence. Integration of knowledge from evidence-based treatments will also further inform clinical practice with children who have experienced traumatic events.

Community-based mental health counseling for children orphaned by AIDS in China

There is an urgent need to develop scalable approaches to community-based mental health services for children in rural China and other developing countries involving task shifting from clinicians to trained community workers. Evidence is needed about the effectiveness of interventions for children affected by AIDS in rural areas. This article describes an intervention study aimed at developing, implementing, and evaluating a community-based counseling program for the AIDS orphans of Fuyang, Anhui Province, an area of central China where a tainted blood donation scheme infected countless farmers and left many children orphaned by AIDS. In China these children live in rural settings with no access to mental health services. The authors trained a group of community-based counselors to provide group counseling sessions focusing on self-awareness and communication and to provide a basic therapeutic approach for depression and anxiety. The authors conducted a baseline and two follow-up surveys of 39 children who met the clinical diagnostic criteria for anxiety and depression. There was a statistically significant improvement for the children on anxiety, but there was no statistically significant improvement on depression, with greatest gains immediately following the intervention. We demonstrated the feasibility of task shifting for mental health services in this setting.

Organizational Readiness for Change in Correctional and Community Substance Abuse Programs

Significant needs exist for increased and better substance abuse treatment services in our nation's prisons. The TCU Organizational Readiness for Change (ORC) survey has been widely used in community-based treatment programs and evidence is accumulating for relationships between readiness for change and implementation of new clinical practices. Results of organizational surveys of correctional counselors from 12 programs in two states are compared with samples of community-based counselors. Correctional counselors perceived strong needs for new evidence-based practices but, compared to community counselors, reported fewer resources and less favorable organizational climates. These results have important implications for successfully implementing new practices.

A pilot study of community-friendly manual-guided drug counseling

Therapist training manuals that are more “community friendly” are needed to facilitate effectiveness testing and dissemination of treatments to community based setting. The aim of the current project was to create revised versions of individual drug counseling (IDC) and group drug counseling (GDC) treatment manuals for cocaine dependence and to conduct a preliminary study of their effectiveness. After changing the format and context of existing drug counseling manuals to have greater ease of use in the community, draft manuals were given to 23 community-based counselors for their feedback. Final versions were then used in a pilot randomized clinical trial involving 41 cocaine-dependent patients who received 3 months of either IDC + GDC or GDC-alone treatment. Counselors implemented the new treatment manuals with acceptable levels of adherence and competence. Outcome results indicated that substantial change in drug use was evident, but the amount of abstinence obtained was limited.

Science, Social Work, Prevention: Finding the Intersections

Over the past 25 years the science of prevention of adolescent health and behavior problems has matured as a result of longitudinal studies of predictors of these problems and controlled studies of preventive interventions focused on those predictors that have revealed efficacious prevention strategies. This article builds on three Aaron Rosen lectures: Aaron Rosen's call for the use of evidence-based practice in the first lecture in this series, Mark Fraser's call for more intervention research in social work, and Claudia Coulton's explorations of Place of Community in SocialWork Practice Research. It documents key developments in prevention science over the past 25 years and explores what these developments could mean for social work education and research over the next few years. KEY WORDS: evidence-based practice; prevention science; research; social work ********** In my early working days, I lived in a rural fishing community off the coast of Washington. I , was the county's juvenile probation officer. I had a position subsidized by the state through the intensive probation subsidy program. That program provided money for probation officers in Washington counties to do intensive counseling with reduced caseloads in hopes of sending fewer young people to state institutions. I mention this here because it was as a probation officer that I first became convinced of the importance of preventing adolescent behavior problems before young people encounter the juvenile justice system. I worked with young people ages 12 to 17 referred for delinquent behavior and drug possession. Over time, I came to see my job as akin to operating an ambulance service at the bottom of a cliff. We were the emergency workers patching up those who fell over the edge. That experience convinced me that we must broaden crime reduction efforts beyond the justice system to include prevention. I will return to the intensive probation program later in this article. Before 1980 there was little evidence that delinquency or adolescent drug abuse could be prevented. School-based drug prevention programs that were evaluated were found to be largely ineffective (Elmquist, 1995; Hansen, 1992; Moskowitz, 1989). Some studies found that school-based drug information programs were associated with increased drug use among teenagers (Tobler, 1986). In 1980 a review of the delinquency experiments conducted in the United States to that year identified nine well-controlled trials (Berleman, 1980). None of them was effective in preventing delinquency. Perhaps the most notable was the Cambridge Somerville Study, a program of wrap-around services for high-risk boys. Dr. Richard Cabot of Harvard believed that the intervention of a friendly, socialized adult with a vulnerable when the child was still young might lead the child to a normal nondelinquent life. In 1935 he funded a nonprofit foundation that sustained the delinquency prevention study for 10 years. Cabot employed community-based counselors who worked predominantly in the field in this economically disadvantaged community. Services were individualized for each and his parents. The model was casework with the individual boy (Berleman, p. 130). Counselors used their practice wisdom to address needs they encountered. The randomized controlled trial of this intervention showed that the program had no effects on police contacts for delinquency or commitments to state institutions. A long-term follow-up of the program conducted by McCord (1992) found that youths exposed to the program were more likely than the control group to develop serious behavior problems, alcoholism, and mental health problems over their lives. The Hippocratic oath requires that physicians never do harm to anyone. This is our responsibility as social workers as well. Our best conceived interventions could do harm. We must evaluate our ideas to know what outcomes they produce. …