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

Abstract

Objectives 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). Methods 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. Results 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). Conclusions 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.

Differences in the Association Between Childhood Trauma and BMI in Black and White South African Women

“…Given the inconsistent results across settings, however, it may be better to start with World Health Organization recommendations for treatment of PTSD in children and adolescents. A remaining key research question here is how existing evidence-based interventions, often tested in more highly resourced research settings, can be effectively disseminated and implemented in real-world health-care settings [46][47][48].…”

Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia

“…10 We have conducted studies in Zambia to understand local mental and behavioral health problems, validate mental and behavioral assessment instruments, and examine the cross-cultural feasibility of evidence-based treatment. [11][12][13][14][15] These studies culminated in the randomized clinical trial reported in this article, which tests the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT; http://tfcbt.musc.edu/) 16 for OVC compared with treatment as usual (TAU) provided by lay counselors without previous mental health care training. This trial was a collaboration with Serenity Harm Reduction Programme Zambia, a local nongovernmental organization.…”

Trauma-focused cognitive behavioral therapy for youth: Effectiveness in a community setting.

“…It is also important to note that the dropout rate was high (39.5%) and that post-treatment data were estimated for more than a third of the sample. Finally, several other TF-CBT effectiveness trials have been completed, with preliminary findings presented but not yet published: preliminary findings with children in foster care (Dorsey, Cox, Conover, & Berliner, 2010; Lyons, Weiner, & Scheider, 2006) and several cross-cultural studies (Cinamon, Zorzella, Thornback, Konanur, & Muller, 2011; Dorsey, Murray, Balusubramanian, & Skavenski, 2011; Murray et al, manuscript submitted). …”