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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00860

Lay counselor perspectives of providing a child-focused mental health intervention for children: Task-sharing in the education and health extension sectors in Kenya

 Shannon Dorsey1*, Rosemary D. Meza1,  Prerna Martin1, Christine L. Gray2,  Noah S. Triplett1,  Caroline Soi3,  Grace S. Woodard1,  Leah Lucid1,  Cyrilla Amanya4,  Augustine Wasonga4 and Kathryn Whetten2, 5
  • 1Department of Psychology, University of Washington, United States
  • 2Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, United States
  • 3Department of Global Health, University of Washington, United States
  • 4Ace Africa- Kenya, Kenya
  • 5Sanford School of Public Policy, Duke University, United States

The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors’ perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in specific government-supported sectors that might scale up and sustain mental health care for children and adolescents. In western Kenya, these sectors include Education and Health. Data come from a large hybrid effectiveness-implementation study examining implementation practices and policies in either or both sectors that support successful implementation of a child-focused intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT), for children and adolescents who had experienced parental death. We examined lay counselors’ self-report of acceptability, feasibility, and appropriateness of TF-CBT. Lay counselors were teachers (n = 30) from the Education sector and Community Health Volunteers (CHV; n = 30) from the Health sector, who were part of Sequence 1 of this large stepped-wedge, cluster randomized trial. Lay counselor self-report surveys included reflective and formative measurement of acceptability, feasibility, and appropriateness administered after lay counselors in both sectors had experience delivering the locally-adapted, group-based TF-CBT intervention. Descriptive statistics (means, standard deviations) were used to understand counselors’ perspectives on reflective and formative measures, stratified by sector. Both teachers and CHVs endorsed high acceptability, feasibility, and appropriateness of TF-CBT, with lay counselors’ responses on items from the formative measures providing some insight into specific aspects of acceptability, feasibility, and appropriateness that may be important to consider when planning for implementation support. These early findings suggest that both sectors may hold promise for task-shifting of mental health care for children and adolescents but also underline the importance of considering the multiple facets of these three implementation outcomes as well as lay counselor context (Education vs. Health ).

Keywords: task-sharing, Lay Counselors, low resource settings, trauma focused cognitive behavior therapy, Child and adolescence, Acceptability, feasibility, Appropriateness, implementation, implementation science, global mental health, Psychotherapy, Evidence based treatment, Low and Middle Income Countries (LMIC)

Received: 11 Jun 2019; Accepted: 01 Nov 2019.

Copyright: © 2019 Dorsey, Meza, Martin, Gray, Triplett, Soi, Woodard, Lucid, Amanya, Wasonga and Whetten. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Shannon Dorsey, Department of Psychology, University of Washington, Washington, 98195-1525, Maine, United States,