a Department of Mental Health , Johns Hopkins University Bloomberg School of Public Health.
J Clin Child Adolesc Psychol. 2014;43(6):902-14. doi: 10.1080/15374416.2013.859079. Epub 2014 Jan 8.
This study examined Zambian counselors, children, and caregivers' perceptions of an evidence-based treatment (EBT) for trauma (Trauma-Focused Cognitive Behavioral Therapy [TF-CBT]) utilized in Zambia to address mental health problems in children. Semistructured interviews were conducted with local counselors trained in TF-CBT (N = 19; 90% of those trained; 12 female) and children/caregivers who had received TF-CBT in a small feasibility study (N = 18; 86% of the children and N = 16; 76% of the caregivers) who completed TF-CBT (total completed; N = 21). Each client was asked six open-ended questions, and domain analysis was used to explore the data. Counselors were positive about the program, liked the structure and flexibility, reported positive changes in their clients, and discussed the cultural adaptation around activities and language. Counselors stated the training was too short, and the supervision was necessary. Challenges included client engagement and attendance, availability of location, funding, and a lack of community understanding of "therapy." Children and caregivers stated multiple positive changes they attributed to TF-CBT, such as better family communication, reduction of problem behaviors, and ability to speak about the trauma. They recommended continuing the program. This study brings a critical examination of providers' and clients' perspectives of the implementation of an EBT for children in a low-resource setting. Clinical implications include changing implementation methods based on responses. Research implications include future study directions such as an effectiveness trial of TF-CBT and an examination of implementation factors.
本研究考察了赞比亚顾问、儿童和照顾者对创伤的循证治疗(创伤焦点认知行为疗法[TF-CBT])的看法,该治疗在赞比亚用于解决儿童的心理健康问题。对接受过 TF-CBT 培训的当地顾问(N=19;培训人数的 90%;12 名女性)和在小型可行性研究中接受过 TF-CBT 的儿童/照顾者(完成 TF-CBT 的儿童共 18 名,占儿童总数的 86%;照顾者共 16 名,占照顾者总数的 76%)进行了半结构化访谈。每位客户都被问到了六个开放式问题,并使用领域分析来探索数据。顾问对该计划持积极态度,喜欢其结构和灵活性,报告客户有积极变化,并讨论了活动和语言方面的文化适应。顾问表示培训时间太短,需要监督。面临的挑战包括客户参与和出勤率、地点可用性、资金以及社区对“治疗”的理解不足。儿童和照顾者表示他们经历了多种积极变化,归因于 TF-CBT,例如更好的家庭沟通、减少问题行为以及能够谈论创伤。他们建议继续该计划。本研究对提供者和客户在资源匮乏环境中实施儿童循证治疗的看法进行了批判性审查。临床意义包括根据反应改变实施方法。研究意义包括未来的研究方向,例如 TF-CBT 的有效性试验和对实施因素的检查。
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