Community Norms and Human Rights: Supervising Haitian Colleagues on Interpersonal Psychotherapy (IPT) With a Depressed and Abused Pregnant Woman

Abstract

After the 2010 Haiti earthquake, Zanmi Lasante, a local health care organization, implemented a collaborative stepped-care model to address depression in community and primary care settings in rural Haiti. Specialized community health workers, the ajans santé, collaborate with local psychologists and primary care doctors to offer home-based evaluation, support, and follow-up. The services include brief interpersonal psychotherapy (IPT) and/or medication to persons who met locally defined criteria for depression. A cross-national (Haiti-United States) expert mental health team has been overseeing the program. The present IPT supervision case of a severely depressed, physically abused, and pregnant young woman illustrates the U.S.-based supervisor's internal struggle to reconcile awareness of and respect for local norms while maintaining a human rights-based framework. It also highlights the critical role of community health workers in addressing the mental health treatment gap in regions plagued by extreme poverty and adversity.

Supervision of Task-Shared Mental Health Care in Low-Resource Settings: A Commentary on Programmatic Experience

“…To ensure feasibility at scale, locally available competent trainers are required. To date, trainers of programs using the apprenticeship model have often been specialists from universities in high-income countries 48 . In the context of limited specialists in LMICs, peer-based supervision using standardized measures of task-shared provider competence may be a highly acceptable and valid complement to expert supervision, and it would help mitigate the bottleneck of limited specialists in these contexts 66 , 67 .…”

“…It is relatively time and resource intensive: new counselors may shadow and observe supervisors for several weeks or months, after which supervisors perform direct clinical observation of counselor service delivery, incorporating periods of reflection and debriefing. Trainers have tended to be specialists or academics from high-resource settings 48 . Nonetheless, investigators have successfully applied the apprenticeship model across numerous settings, including the Democratic Republic of the Congo, Haiti, Iraq, Thailand, and Zambia 48 – 53 …”

“…Trainers have tended to be specialists or academics from high-resource settings 48 . Nonetheless, investigators have successfully applied the apprenticeship model across numerous settings, including the Democratic Republic of the Congo, Haiti, Iraq, Thailand, and Zambia 48 – 53 …”

A mobile clinic approach to the delivery of community-based mental health services in rural Haiti

“…Psychologists and social workers, who had bachelors-level training, were trained and supported to perform tasks typical of masters- or doctorate-level clinicians. They conducted evaluations and follow-ups, provided patient and family psychoeducation, and delivered a manualized psychotherapeutic intervention for patients with depression that was based on interpersonal therapy (IPT) and adapted to the Haitian context [ 34 ]. After a locally-developed screening tool (the Zanmi Lasante Depression Symptom Inventory (ZLDSI)) was introduced at the mobile clinic by psychologists in October 2012, the CHWs screened patients for depression symptoms [ 35 ].…”

Development of a comprehensive, sustained community mental health system in post-earthquake Haiti, 2010–2019

“…The World Health Organization mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings, new in 2011, was used as a reference guide for the inclusion in that pathway of interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) as accepted, evidence-based interventions that could potentially be adapted to the Haitian context (World Health Organization mhGAP, 2011). Both the Haitian and the U.S.-based management teams agreed on the selection of IPT as a potential scalable psychological intervention because of its effectiveness in treating depression and posttraumatic stress-related pathology in high- and low-income settings, as well as its emphasis on the social and interpersonal approach, which was perceived by the local team as critical in Haitian collective society (Verdeli et al ., 2016).…”