title: The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya.
abstract: This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in a culturally responsive manner.
  
  
  
  Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data.
  
  
  
  Lay counselors described the importance of being responsive to TF-CBT participants' customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs.
  
  
  
  The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. (PsycINFO Database Record
authors.affiliation: Children's Mercy Hospital.
authors.forename: Briana A
authors.initials: BA
authors.lastname: Woods-Jaeger
authors.affiliation: Department of Community and Behavioral Health, University of Iowa College of Public Health.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Kava
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Akiba
authors.affiliation: Department of Psychology, University of Washington.
authors.forename: Leah
authors.initials: L
authors.lastname: Lucid
authors.affiliation: Department of Psychology, University of Washington.
authors.forename: Shannon
authors.initials: S
authors.lastname: Dorsey
mesh_terms: D001601:Bereavement; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003150:Community Health Workers / Q000523:psychology; D065246:Culturally Competent Care / Q000191:economics / Q000379:methods*; D003469:Culture; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D019317:Evidence-Based Medicine / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008605:Mental Health Services; D010290:Parents; D010372:Pediatrics / Q000379:methods; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013636:Tanzania; D000068099:Trauma and Stressor Related Disorders / Q000191:economics / Q000208:ethnology* / Q000628:therapy*