SAGE Mental Health

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A recent study of orphaned children in five low- and middle-income countries, including Kenya, showed that more than 90% experience trauma by age 13; annual incidence of a traumatic event is 25%. The result is substantial burden of post-traumatic stress and its long-term sequelae. Yet, the mental health services gap in African countries is the highest in the world, and resources for children are particularly scarce. Scale-up of mental health interventions through task-shifting models has great potential to narrow the mental health services gap. Lay counselor delivery of evidence-based treatments can be implemented with fidelity and result in reduced post- traumatic stress. Now, there is an urgent need for strategies that facilitate sustainability of scaled-up interventions and, equally important, a need to equip leaders and policy makers with information about the generalizability of the interventions to other communities. The goal of this K01 Mentored Research Scientist Career Development award is to expand the candidate’s expertise to the science of dissemination and implementation. Through a rigorous plan including coursework, directed reading, applied research experience, and individualized mentorship from globally-recognized scientific experts, the candidate will acquire competencies in 4 areas: (1) content expertise in dissemination and implementation of mental health evidence-based treatments, (2) mixed methods tools for conducting sustainment research to identify strategies enabling the continuation of scaled-up interventions, (3) approaches to generalize trial results and extend the policy reach of evidence-based treatments, and (4) professional development to become an NIH-funded independent investigator conducting culturally-sensitive research in low-resource settings. The candidate has a team of interdisciplinary senior scientists who are thought leaders in their respective fields, led by Primary Mentor Dr. Kathryn Whetten and co- Mentors Dr. Shannon Dorsey and Dr. James Moody. They are joined by three Scientific Advisors, Augustine Wasonga, Dr. Kearsley Stewart, and Dr. Daniel Westreich. Their mentorship will guide a set of research aims that expands an ongoing NIMH-funded implementation effectiveness trial in western Kenya. This research specifically begins after all 40 sites in a cluster-randomized clinical trial are at least one year post-implementation. Both qualitative methods and social network analysis will be used during the sustainment phase to identify the critical strategies employed by lay counselors and the structural elements of their social networks that facilitate continued sustainment. In addition, generalizability of the intervention effects in children will be estimated for all This research is directly responsive to local interest in understanding the potential for broader scale-up, addressing NIMH Strategic Objective 4 “Strengthening the Public Health Impact of NIH- Supported Work,” specifically Objective 4.2 to “Strengthen research-practice partnerships to expedite… sustained implementation...of evidence-based mental health service.” Results will identify testable strategies to achieve continuation of mental health interventions implemented in low-resource settings. orphaned children in Kenya.