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Effectiveness of Trauma-Focused Cognitive Behavioral Therapy Among Trauma-Affected Children in Lusaka, Zambia: A
Laura K Murray1, Stephanie Skavenski1, Jeremy C Kane1
1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Trauma-focused cognitive behavioral therapy (TF-CBT) significantly reduced trauma symptoms and improved functioning in orphans and vulnerable children (OVC) in Zambia. Lay counselors effectively delivered this evidence-based intervention in a low-resource setting.
Area of Science:
- Global Mental Health
- Child Psychology
- Public Health Interventions
Background:
- Orphans and vulnerable children (OVC) face high risks of trauma and psychosocial issues.
- Limited research exists on evidence-based treatments for OVC in low-resource settings.
- A significant gap in randomized clinical trials for OVC mental health interventions.
Purpose of the Study:
- To assess the effectiveness of lay counselor-delivered trauma-focused cognitive behavioral therapy (TF-CBT) for OVC in Lusaka, Zambia.
- To address trauma and stress-related symptoms in a vulnerable child population.
- To evaluate an adapted TF-CBT model in a resource-limited environment.
Main Methods:
- Randomized clinical trial comparing TF-CBT to treatment as usual (TAU).
- Involved 257 children (aged 5-18) with significant trauma symptoms in Lusaka, Zambia.
- Measured trauma symptoms and functional impairment using validated scales pre- and post-intervention.
Main Results:
- TF-CBT group showed an 81.9% reduction in trauma symptoms versus 21.1% in TAU.
- Functional impairment improved by 89.4% in the TF-CBT group compared to 68.3% in TAU.
- Statistically significant improvements for both outcomes (P < .001) with a large effect size for trauma symptoms (Cohen d = 2.39).
Conclusions:
- Adapted TF-CBT significantly reduced trauma and stress-related symptoms in Zambian OVC.
- The intervention demonstrated substantial benefits for functional impairment.
- Lay counselor delivery proved effective, supporting scalability in similar settings.
Importance:
Orphans and vulnerable children (OVC) are at high risk for experiencing trauma and related psychosocial problems. Despite this, no randomized clinical trials have studied evidence-based treatments for OVC in low-resource settings.
Objective:
To evaluate the effectiveness of lay counselor-provided trauma-focused cognitive behavioral therapy (TF-CBT) to address trauma and stress-related symptoms among OVC in Lusaka, Zambia.
Design, Setting, And Participants:
This randomized clinical trial compared TF-CBT and treatment as usual (TAU) (varying by site) for children recruited from August 1, 2012, through July 31, 2013, and treated until December 31, 2013, for trauma-related symptoms from 5 community sites within Lusaka, Zambia. Children were aged 5 through 18 years and had experienced at least one traumatic event and reported significant trauma-related symptoms. Analysis was with intent to treat.
Interventions:
The intervention group received 10 to 16 sessions of TF-CBT (n = 131). The TAU group (n = 126) received usual community services offered to OVC.
Main Outcomes And Measures:
The primary outcome was mean item change in trauma and stress-related symptoms using a locally validated version of the UCLA Posttraumatic Stress Disorder Reaction Index (range, 0-4) and functional impairment using a locally developed measure (range, 0-4). Outcomes were measured at baseline and within 1 month after treatment completion or after a waiting period of approximately 4.5 months after baseline for TAU.
Results:
At follow-up, the mean item change in trauma symptom score was -1.54 (95% CI, -1.81 to -1.27), a reduction of 81.9%, for the TF-CBT group and -0.37 (95% CI, -0.57 to -0.17), a reduction of 21.1%, for the TAU group. The mean item change for functioning was -0.76 (95% CI, -0.98 to -0.54), a reduction of 89.4%, and -0.54 (95% CI, -0.80 to -0.29), a reduction of 68.3%, for the TF-CBT and TAU groups, respectively. The difference in change between groups was statistically significant for both outcomes (P < .001). The effect size (Cohen d) was 2.39 for trauma symptoms and 0.34 for functioning. Lay counselors participated in supervision and assessed whether the intervention was provided with fidelity in all 5 community settings.
Conclusions And Relevance:
The TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma.
Trial Registration:
clinicaltrials.gov Identifier: NCT01624298.
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