Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model

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 “natural” 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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Acknowledgements

The authors acknowledge Wilter Rono and Katherine King for the project management; the local TP supervisors (Daisy Malinga, Valarie Kosgei, Mercy Korir, and Julius Barasa); the Tuko Pamoja lay counselors; the Tuko Pamoja survey enumerators; the participating families; Puja Patel for the qualitative data coding; and Bonnie Kaiser for the qualitative analysis consultation. This research was conducted in collaboration with the AMPATH consortium.

Funding

This study was funded by Grand Challenges Canada.

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Correspondence to Eve S. Puffer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. Caregivers also provided permission for their children to participate.

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Puffer, E.S., Friis-Healy, E.A., Giusto, A. et al. Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model. Glob Soc Welf 8, 11–28 (2021). https://doi.org/10.1007/s40609-019-00151-6

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Keywords

  • Global mental health
  • Family therapy
  • Task shifting
  • Africa
  • Low- and middle-income country