Attending to the “whole” child in mental health care: Utilizing a partnership approach to address social risk factors alongside an evidence-based psychotherapy

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Social risk factors, or adverse conditions in which people are born, grow, live, and age1, contribute to greater mental health problems2,3 and lower treatment engagement worldwide.4–7 The prevalence and impact of social risk factors (SRFs) are particularly pronounced in low-to-middle income countries, where too few individuals— and particularly children—with mental health needs receive care. To our knowledge, in global mental health research, we have not systematically developed and evaluated strategies to address SRFs alongside mental health treatments. This study builds on an NIMH-funded trial in Kenya, “Building and Sustaining Interventions for Children (BASIC): Task-Shifting Mental Health Care in Low-Resource Settings” (R01MH112633). The study goal is to develop strategies to address and mitigate SRFs alongside evidence-based psychotherapies (EBPs) using decolonizing methodologies.8 Lay counselors and guardians involved in the BASIC study report that children enrolled in the culturally-adapted EBP (Trauma-focused Cognitive Behavioral Therapy)9 experienced high rates of SRFs (food insecurity, lack of support system), with strong calls for improving outcomes by addressing SRFs in therapy.10–12 Thus, this project responds directly to community needs and addresses a documented challenge to the effective implementation of EBPs given the negative effect of SRFs on mental health trajectory and treatment engagement. The study aims to: 1) Examine the experience of SRFs and the barriers and facilitators to addressing SRFs in therapy through qualitative interviews with PT counselors and guardians who received therapy in BASIC. 2) Collaboratively design impactful and practical strategies to address SRFs in therapy during a 2-day workshop with supervisors and counselors. 3) Investigate whether a 2-day training in the developed strategies and post-training supervision impact counselor-level outcomes (e.g., perceived self-efficacy/self-control, effectiveness, feasibility, and acceptability of the SRF strategies). As many scholars have highlighted problematic influences of coloniality in current and past global research,13,14 the study team will actively work against colonial attitudes by privileging the voice of community stakeholders during all research activities and decision-making throughout the study. Strategies developed through this project have the potential to improve engagement in and effectiveness of the EBP in BASIC and ideally will be generalizable to other EBPs globally. Our ultimate goal is to improve outcomes for individuals with mental health needs in low-to-middle income countries.