Potential treatment mechanisms of counseling for children in Burundi: A series of n = 1 studies.

Abstract

Little is known about the impact and treatment processes of psychosocial counseling in low-income countries. This study aimed to generate hypotheses on key working mechanisms of counseling in Burundi. The authors carried out 11 empirically grounded n=1 studies with children (11-14years) screened for depression and anxiety who received counseling. The authors used quantitative (symptom scales) and qualitative instruments (treatment content and perceptions). Weekly measurements were taken preintervention (4 time points), during the intervention period (8-10 time points), and postintervention (4 time points). Five treatment mechanisms continua appeared associated with outcome trajectories: client centeredness, therapeutic alliance, active problem solving, trauma-focused exposure, and family involvement. Higher levels appeared associated with better outcomes. Contrarily, cases that demonstrated no change were characterized by a heavy focus on counselors' norms, containment and self-control, unstructured retelling and explicit avoidance, advice-oriented problem solving, and noninclusion of family members, respectively. The authors found a distinct clustering of outcome trends per therapist. The findings suggest that integrative counseling, which combines universal therapist variables with active use of specific therapeutic techniques and a systemic perspective, may be an adequate strategy to treat mental health symptoms of children in Burundi.

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single‐case experimental design series

“…Interrater reliability for visual inspection (κ = 0.981) indicated a high level of agreement. Similar procedures have been utilized in evaluations of novel interventions in resource‐strained, global mental health settings (e.g., Jordans et al., ; Jordans, Komproe, Tol, Nsereko, & De Jong, ).…”

“…(a) change in trend or symptom level across phases A, B, and follow-up; (b) the degree of change (slope of the graph) between phases; and (c) changes in variability of the data that capture stability of symptom change within phases.Interrater reliability for visual inspection ( = 0.981) indicated a high level of agreement. Similar procedures have been utilized in evaluations of novel interventions in resource-strained, global mental health settings (e.g.,Jordans et al, 2012;Jordans, Komproe, Tol, Nsereko, & De Jong, 2013).…”

Implementation of a Mental Health Care Package for Children in Areas of Armed Conflict: A Case Study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan

“…We learned that counselor performance was highly stable (i.e., there were counselors with consistently positive results and counselors with consistently negative results), which reemphasized the importance of our clinical supervision and evaluation mechanisms, for example, for early identification of counselors performing poorly. Furthermore, results showed that the combination of universal treatment variables (therapeutic alliance and trust, and a non-moralistic and non-normative counselor) with specific treatment components (active problem-solving, narrative exposure, and cognitive restructuring) was associated with positive client trajectories [21]. These findings resulted in changes in the training curricula and led to the exploration of a components-based intervention approach.…”

“…We conclude with recommendations to improve future uptake of psychosocial and mental health care. While several articles have been published on separate studies of the program [13],[16]–[21], we have thus far not provided an integrated overview of the overarching lessons learned through research and practice reflections.…”

Designing mental health interventions informed by child development and human biology theory: A social ecology intervention for child soldiers inNepal

“…A good example of this is N = 1 single case studies in which outcome variables are measured at various points in a lead‐up to an intervention, during, and after. This helps determine when changes occur and what the active ingredients in an intervention are (Jordans et al, ).…”