title: An evaluation of trauma focused cognitive behavioral therapy for children in Zambia.
abstract: 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). 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. 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). 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.
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 North Broadway, Baltimore, MD 21205, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Murray
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 North Broadway, Baltimore, MD 21205, USA.
authors.forename: Itziar
authors.initials: I
authors.lastname: Familiar
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 North Broadway, Baltimore, MD 21205, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Skavenski
authors.affiliation: Catholic Relief Services, Zambia, Longolongo Road, Lusaka 10101, Zambia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jere
authors.affiliation: Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Cohen
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Mwiya
authors.initials: M
authors.lastname: Imasiku
authors.affiliation: Ministry of Health, City Airport Road, Lusaka, Zambia.
authors.forename: John
authors.initials: J
authors.lastname: Mayeya
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 North Broadway, Baltimore, MD 21205, USA.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Bass
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 8th Floor, Baltimore, MD 21205, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolton
mesh_terms: D000293:Adolescent; D002648:Child; D054540:Child, Orphaned / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D055317:Evidence-Based Practice; D005240:Feasibility Studies; D005260:Female; D006284:Health Plan Implementation / Q000379:methods; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D011203:Poverty; D012752:Shame; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D016896:Treatment Outcome; D035862:Vulnerable Populations; D014947:Wounds and Injuries / Q000628:therapy*; D015024:Zambia / Q000453:epidemiology
keywords: Child trauma; Evidence-based treatment; Implementation; International; Low-resource setting