Browsing by Author "Friis, Elsa"

The exposure to chronic interpersonal trauma during developmentally critical periods can have pervasive impacts on social, psychological, biological and cognitive functioning. Interpersonal trauma has been associated with a complex range of risk factors at the individual, family, community, and societal levels. However, little research has focused on the interplay between culture and trauma, especially in low- and middle-income countries. The current study is a qualitative investigation to develop a culturally grounded model of interpersonal trauma in Kenyan adolescents. Fourteen focus groups were conducted in three ethnically diverse communities surrounding Eldoret, Kenya with adolescents ages 12 to 18 (n=67) and caregivers (n=54). Focus Group participants identified community leaders and providers and three additional focus groups were conducted with these key informants (n=28). A grounded theory approach was used for data collection and analysis. A culturally grounded model of interpersonal trauma exploring both exposure and symptomatic presentation is proposed. From this investigation, it is apparent that adolescents who experience chronic interpersonal trauma in these communities experience dysregulation symptoms similar to those described in complex trauma theory. However, poverty, martial conflict, caregiver stress, caregiver substance abuse and favoritism emerged as risk factors for interpersonal trauma and indicate measures and interventions developed for the assessment and treatment of symptoms resulting from interpersonal trauma must be adapted for use in this population.

Psychological treatments delivered by lay counselors, individuals with little or no previous mental health training, have been shown to be effective in treating a range of mental health problems. However, in low resource settings, the dearth of available experts to train and supervise lay counselors is a key bottleneck in scaling up lay counselor delivered psychological treatments. Locally sustainable solutions that allow experts to train and supervise large volume of lay providers are needed. Two proposed solutions include the use of digital health strategies and peer supervision. In study one, we used a human-centered design approach to develop a web application to support asynchronous clinical supervision of lay counselors providing a family therapy program in Kenya. The development process engaged seven previously trained lay counselors and three prior supervisors in a phased design process which resulted in a final application prototype, “REACH”, that supported audio and text communication via a chat and a structured session report form. In study two, we conducted a feasibility study with 30 counselors with the aim of describing the capacity of REACH support supervision practices, exploring the feasibility and acceptability of REACH compared to peer group supervision, and describing the treatment fidelity and clinical competency of a small group of counselors using REACH. REACH was perceived as highly acceptable from both peers and supervisors and demonstrated promising impacts on counselor fidelity and clinical competency. Content analysis of correspondence between the counselors and the superior via the REACH indicated the supervisor was able to implement a wide range of evidence-based supervision strategies. Limitations of bi-directional communication on potential supervision effectiveness are discussed. Overall, this project suggests digital asynchronous clinical supervision holds promise as a scalable method of clinical supervision in low-resource contexts.