TY - JOUR
T1 - Identification, modification, and implementation of an evidence-based psychotherapy for children in a low-income country
T2 - The use of TF-CBT in Zambia
AU - Murray, Laura K.
AU - Dorsey, Shannon
AU - Skavenski, Stephanie
AU - Kasoma, Margaret
AU - Imasiku, Mwiya
AU - Bolton, Paul
AU - Bass, Judith
AU - Cohen, Judith A.
N1 - Funding Information:
The authors wish to thank our local collaborators at the University Teaching Hospital and the University of Zambia. We particularly appreciate Dr. Elwyn Chomba’s dedication to developing a multi-disciplinary center specifically for sexually abused children. We thank Mr. John Mayeya of the Ministry of Health in Zambia, whose tireless efforts to improve the mental health for all Zambians are valiant and should not go un-noticed. We are also grateful for Dr. Donald Thea’s help beginning these projects in Zambia. His long-standing local experience and wisdom were invaluable. Finally, we extend sincere thanks to the local counselors who worked with us and taught us so much about Zambian children and families. The preparation of this article was supported primarily by a NIMH K23 Grant (MH077532; LM). Additional support came from the 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 & SD).
PY - 2013/10/23
Y1 - 2013/10/23
N2 - Background: The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Methods: Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Results: Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Conclusions: Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
AB - Background: The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Methods: Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Results: Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Conclusions: Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
KW - Child trauma, Evidence-based treatment, Implementation
KW - International, Low-resource setting
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U2 - 10.1186/1752-4458-7-24
DO - 10.1186/1752-4458-7-24
M3 - Article
C2 - 24148551
AN - SCOPUS:84886741976
SN - 1752-4458
VL - 7
JO - International Journal of Mental Health Systems
JF - International Journal of Mental Health Systems
IS - 1
M1 - 24
ER -