Elsevier

Child Abuse & Neglect

Volume 37, Issue 12, December 2013, Pages 1175-1185
Child Abuse & Neglect

An evaluation of trauma focused cognitive behavioral therapy for children in Zambia

https://doi.org/10.1016/j.chiabu.2013.04.017Get rights and content

Abstract

To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5–18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N = 58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p < 0.0001), and severity of shame symptoms (p < 0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.

Section snippets

Background Work in Zambia

This project was preceded by a qualitative study that found that abuse and neglect were significant problems, as reported by local women and children, for HIV-affected children (Murray et al., 2006). Subsequently, mental health assessment measures were locally validated (Murray, Bass, et al., 2011). A community-based participatory research (CBPR) approach consisting of focus groups with the community and local stakeholders and feedback loops was used to discuss possible interventions to address

Setting

This project took place in 7 different centers located in Lusaka and Kabwe, Zambia. These centers were locations run by CRS partner organizations, the Ministry of Health (MoH) and/or Project Concern International KidSAFE. Centers included 2 hospices, 3 centers for street youth, 1 child care center for children infected or affected by HIV, and 1 Ministry of Health Clinic. As part of their standard practice, the centers receive referrals from home-based care workers (volunteers) who provided

Results

Of 343 children assessed for this project by community health volunteers, 59% (202) had scores equal or higher to 39 points on the PTSD-RI scale and were therefore put on a list to be offered TF-CBT treatment (see Fig. 1). No children were found to have the exclusion criteria of severe substance abuse or psychosis.

Of the 202 cases, 187 (92.5%) said yes to the invitation to participate in the TF-CBT program. Fifteen of the original eligible children who received an offer letter (7.4%) refused

Discussion

This paper describes a project carried out by Catholic Relief Services in Zambia, in collaboration with Johns Hopkins University. To our knowledge, this is the first study to examine the feasibility of TF-CBT in Africa with an OVC population using lay-workers as counselors. This research also uniquely represents a collaborative partnership between an academic institution as a technical advisor and a non-governmental organization (NGO) wherein monitoring and evaluation was imbedded into

Conclusions

This study fills a critical gap in addressing global trauma within children and youth in LMIC by highlighting a collaborative partnership between an NGO and an academic partner that evaluated the feasibility of an EBT (TF-CBT). These partnerships are important in considering not only scientific knowledge but also sustainability in low-source settings. The recruitment process indicated a significant need for trauma-focused mental health services among an OVC population. This is supported by

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      TF-CBT is one of the most researched and efficacious mental health treatments for trauma-exposed youth. Over 23 randomized controlled trials across the U.S. and the globe have documented its effectiveness at treating posttraumatic stress symptoms (PTSS) in children and adolescents (Cohen et al., 2017, pp. 74–80; de Arellano et al., 2014), including youth in low- and middle-income countries like Zambia (Murray et al., 2013), the Democratic Republic of the Congo (McMullen et al., 2013; O’Callaghan et al., 2013), and Kenya and Tanzania (Dorsey et al., 2020). In the United States, TF-CBT applications have also been developed for Hispanic youth (de Arellano et al., 2012) and American Indians and Alaska Natives (BigFoot & Schmidt, 2010).

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    The preparation of this article was supported in part by the following: NIMH K23 Grant (MH077532; LM), and Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI) (LM).

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