| dc.description.abstract |
The large burden of mental health disorders among young people worldwide calls for scalable prevention and treatment models
that reach children and families in low-resource settings. This paper describes the development of an evidence-informed family
therapy intervention designed for lay counselor delivery in low-resource settings and presents findings on the feasibility and
acceptability of implementation in Kenya. Qualitative data guided the development of a components-based family therapy that
integrates multiple strategies from solution-focused and systems-based therapies, as well as those from parenting skills training
and cognitive behavioral therapies. Eight lay counselors delivered the intervention, with 10 families completing treatment. Lay
counselors demonstrated adequate fidelity and clinical competency when treating families with a wide range of presenting
clinical problems. Unique elements of the implementation model proved feasible and acceptable, including recruiting Bnatural^
lay counselors from communities already engaged in informal counseling for families; participants indicated trust and respect in
the counseling relationship that facilitated their participation. Both counselors and families reported positive perceptions of
intervention content and strategies, including those least similar to local counseling practices. Results support the potential of
this implementation strategy that aims to add evidence-based practices to local practices and routines rather than creating new
cadres of lay counselors or health workers. Supervision, provided by psychology student trainees, also proved feasible and
mutually beneficial, with phone-based supervision as acceptable as in-person meetings; this suggests the potential feasibility of
this model for use in remote locations. Future directions include integrating these delivery approaches into existing social
structures to develop and evaluate a comprehensive implementation model for scale-up. |
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