What about lay counselors' experiences of task-shifting mental health interventions? Example from a family-based intervention in Kenya.

Background:A key focus of health systems strengthening in low- and middle-income countries is increasing reach and access through task-shifting. As such models become more common, it is critical to understand the experiences of lay providers because they are on the forefront for delivering care services. A greater understanding would improve lay provider support and help them provide high-quality care. This is especially the case for those providing mental health services, as providing psychological care may pose unique stressors. We sought to understand experiences of lay counselors, focusing on identity, motivation, self-efficacy, stress, and burnout. The goal was to understand how taking on a new provider role influences their lives beyond simply assuming a new task, which would in turn help identify actionable steps to improve interventions with task-shifting components. Methods:Semi-structured interviews (n = 20) and focus group discussions (n = 3) were conducted with three lay counselor groups with varying levels of experience delivering a community-based family therapy intervention in Eldoret, Kenya. Thematic analysis was conducted, including intercoder reliability checks. A Stress Map was created to visualize stress profiles using free-listing and pile-sorting data collected during interviews and focus group discussions. Results:Counselors described high intrinsic motivation to become counselors and high self-efficacy after training. They reported positive experiences in the counselor role, with new skills improving their counseling and personal lives. As challenges arose, including client engagement difficulties and balancing many responsibilities, stress and burnout increased, dampening motivation and self-efficacy. In response, counselors described coping strategies, including seeking peer and supervisor support, that restored their motivation to persevere. At case completion, they again experienced high self-efficacy and a desire to continue. Conclusions:Findings informed suggestions for ways to incorporate support for lay providers into task-shifting interventions at initiation, during training, and throughout implementation. These include acknowledging and preparing counselors for challenges during training, increasing explicit attention to counselor stress in supervision, fostering peer support among lay providers, and ensuring a fair balance between workload and compensation. Improving and building an evidence base around practices for supporting lay providers will improve the effectiveness and sustainability of lay provider-delivered interventions

Women's perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: Consequences and unexpected opportunities

Background The aim of this paper is to explore women's perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war. Methods The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N-=-20). Results Women perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship. Conclusions IPV was found to be a significant problem for women in Sierra Leone and Liberia. The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.sch_iih8 [12]pub3561pu

Mapping complex systems: Responses to intimate partner violence against women in three refugee camps

From Frontiers via Jisc Publications RouterHistory: received 2020-10-03, collection 2021, accepted 2021-01-05, epub 2021-02-05Publication status: PublishedArmed conflict and forced migration are associated with an increase in intimate partner violence (IPV) against women. Yet as risks of IPV intensify, familiar options for seeking help dissipate as families and communities disperse and seek refuge in a foreign country. The reconfiguration of family and community systems, coupled with the presence of local and international humanitarian actors, introduces significant changes to IPV response pathways. Drawing from intensive fieldwork, this article examines response options available to women seeking help for IPV in refugee camps against the backdrop of efforts to localize humanitarian assistance. This study employed a qualitative approach to study responses to IPV in three refugee camps: Ajuong Thok (South Sudan), Dadaab (Kenya), and Domiz (Iraqi Kurdistan). In each location, data collection activities were conducted with women survivors of IPV, members of the general refugee community, refugee leaders, and service providers. The sample included 284 individuals. Employing visual mapping techniques, analysis of data from these varied sources described help seeking and response pathways in the three camps, and the ways in which women engaged with various systems. The analysis revealed distinct pathways for seeking help in the camps, with several similarities across contexts. Women in all three locations often “persevered” in an abusive partnership for extended periods before seeking help. When women did seek help, it was predominantly with family members initially, and then community-based mechanisms. Across camps, participants typically viewed engaging formal IPV responses as a last resort. Differences between camp settings highlighted the importance of understanding complex informal systems, and the availability of organizational responses, which influenced the sequence and speed with which formal systems were engaged. The findings indicate that key factors in bridging formal and community-based systems in responding to IPV in refugee camps include listening to women and understanding their priorities, recognizing the importance of women in camps maintaining life-sustaining connections with their families and communities, engaging communities in transformative change, and shifting power and resources to local women-led organizations.The research was funded by the U.S. Department of State’s Bureau of Population, Refugees and Migration (S-PRMCO-13-CA-1209).3pubpu

Drivers of intimate partner violence against women in three refugee camps

This qualitative study examined the drivers- of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq (N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men's substance use, women's separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women's risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.sch_iih24pub4838pub

Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda.

OBJECTIVES: This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. METHODS: Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their childrens mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. RESULTS: Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. CONCLUSIONS: Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families

Psychological and Social Suffering of Another Generation of Palestinian Children Living Under Occupation: An Urgent Call to Advocate [Viewpoint]

Alastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563https://www.hhrjournal.org/2024/05/psychological-and-social-suffering-of-another-generation-of-palestinian-children-living-under-occupation-an-urgent-call-to-advocate/26pubpub

Flexible protocols and paused audio recorders: The limitations and possibilities for technologies of care in two global mental health interventions.

Lay-counselors have become a key human resource in the field of global mental health, aiming to address the estimated one-million-person shortage of mental healthcare providers. However, the role of lay-counselors is ambiguous and in tension: their role is quasi-professional, with specific training and skills that set them apart within communities, yet their role is also defined in contrast to professional mental healthcare providers. We explore how these tensions manifest through the material technologies for protocolizing and evaluating lay-counselor roles. We draw on our ethnographic fieldwork within two global mental health interventions that represent different ends of the spectrum of lay-counselor involvement, in order to explore the possibilities and limitations of such material technologies. Thinking Healthy Program-Peer delivered is a cognitive behavioral therapy-based intervention for women with perinatal depression delivered in Goa, India, and Tuko Pamoja (Swahili: We are Together) is a family therapy intervention to improve mental health and family functioning in Eldoret, Kenya. First, we explore how intervention manuals - the step-by-step protocols that guide therapy delivery - can both constrain counselors to a script and enable their novel contributions to therapeutic encounters. Then, we examine assessment tools used to evaluate interventions writ large and lay-counselors specifically. We describe how, even where lay-counselors are encouraged to bring their own expertise into therapy delivery, this expertise is not often reflected in evaluation tools. Instead, the focus tends toward fidelity checklists, which require adherence to the manualized intervention and can penalize counselors for going off book. Even though lay-counselors are often recruited specifically because of their existing roles and local expertise, we argue that the material technologies of interventions can at times limit how their expertise is enabled and valued. We offer recommendations for global mental health programs to facilitate greater recognition and valuing of lay-counselor expertise

'I don't need an eye for an eye': Women's responses to intimate partner violence in Sierra Leone and Liberia

This paper explores the possibilities for agency in intimate partner violence (IPV) situations from the perspective of women in Sierra Leone and Liberia using focus group discussions (N groups = 14, N participants = 110) and individual interviews (N = 20). Findings identify multiple interrelated factors influencing the decisionmaking of women experiencing IPV. At the individual level, emotional factors and women's knowledge of their rights and options influence their decision-making. At the relational level, the role of neighbours, family and friends is crucial, both for emotional support and practical assistance. At the community level, more formal structures play a role, such as chiefs and women's groups, though their effectiveness varies. At the structural level are barriers to effective responses, including a poorly functioning criminal justice system and a social system in which children often stay with fathers following separation or divorce. Strong cultural beliefs operate to keep women in abusive relationships. We identify implications for prevention and response services and make practice recommendations. Since the desire of most women experiencing IPV was to live in peace with their husbands, interventions should respect women's priorities by focusing more on prevention and interventions to end the violence, rather than solely assisting women to leave violent relationships.sch_iih11pub3966pub1-

The ecology of resilience: Predictors of psychological health in youth in Lebanon

Protective processes across levels of an individual’s life influence the likelihood of positive adaptation following adversity. Indicators of resilience are attributes and resources of an individual and the environment that predict positive adjustment. The purpose of this study was to examine the presence of resilience indicators across three ecological levels (individual, familial, environmental) among disadvantaged youth living in Lebanon and to examine whether indicators were associated with psychological well-being and psychological distress. A sample of 187 adolescents ages 15 to 23 completed surveys, and hierarchical multiple linear regressions were conducted to identify variables associated with psychological outcomes. Higher self-efficacy, curiosity, social support, and the availability/involvement with spiritual, cultural, and educational opportunities were related to greater psychological wellbeing. Low self-efficacy was the only indicator that was associated with psychological distress independently above and beyond demographic characteristics. Results support the potential importance of considering resilience indicators across ecological levels for interventions seeking to promote positive psychological outcomes for adolescents in highly stressful contexts