Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia

Abstract

BackgroundSexual violence against children is a major global health and human rights problem. In order to address this issue there needs to be a better understanding of the issue and the consequences. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia.MethodsThe PTSD-RI was adapted through the addition of locally relevant items and validated using local responses to three cross-cultural criterion validity questions. Reliability of the symptoms scale was assessed using Cronbach alpha analyses. Discriminant validity was assessed comparing mean scale scores of cases and non-cases. Concurrent validity was assessed comparing mean scale scores to a traumatic experience index. Sensitivity and specificity analyses were run using receiver operating curves.ResultsAnalysis of data from 352 youth attending a clinic specializing in sexual abuse showed that this adapted PTSD-RI demonstrated good reliability, with Cronbach alpha scores greater than .90 on all the evaluated scales. The symptom scales were able to statistically significantly discriminate between locally identified cases and non-cases, and higher symptom scale scores were associated with increased numbers of trauma exposures which is an indication of concurrent validity. Sensitivity and specificity analyses resulted in an adequate area under the curve, indicating that this tool was appropriate for case definition.ConclusionsThis study has shown that validating mental health assessment tools in a low-resource country is feasible, and that by taking the time to adapt a measure to the local context, a useful and valid Zambian version of the PTSD-RI was developed to detect traumatic stress among youth. This valid tool can now be used to appropriately measure treatment effectiveness, and more effectively and efficiently triage youth to appropriate services.

The Body Can Change the Score: Empirical Support for Somatic Regulation in the Treatment of Traumatized Adolescents

“…The PTSD-RI is a commonly used test to help diagnose, treat, and monitor PTSD levels in youth (Murray et al 2011), yielding an Overall Severity score, which at certain levels corresponds to a PTSD diagnosis depending on the population being examined (clinical cut off for single incident trauma victims is 38 and for chronically traumatized children is 31). The three subscales correspond to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), PTSD symptom clusters of Re-experiencing, Avoidance, and Overarousal.…”

Task sharing in rural Haiti

“…However, important questions remain regarding the best approach to train non specialist healthcare workers to provide mental health services. Additionally, best practice for mental health training are still under-evaluated, as compared, for example, to guidance provided for task sharing in HIV/AIDS care (Murray et al, 2011; Perez-Sales, Fernandez-Liria, Baingana, & Ventevogel, 2011; WHO, 2008). …”

“…Murray and colleagues (2011) argue that existing guidelines are overly broad and limit replication efforts. Lack of adequate evidence results in brief, one time training approaches and a limited participatory framework.…”

“…instructing, feedback, modelling, observing) are key to effective supervision. Apprenticeship approaches, where training is reinforced through intensive supervision, coaching and feedback, may thus lead to increased fidelity and effectiveness of psychosocial interventions in LMICs and therefore warrant further consideration (Murray et al, 2011). …”

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.…”