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Institute for International Programs

Testing Mental Health Treatment

Development and Testing of Evidence-based Mental Health Treatment for Affected Zambian Youth (Zambia)

Many children in sub-Saharan Africa experience traumatic events such as loss of family members, severe poverty, and chronic illness. These events frequently affect mental health and ability to function, including the ability to learn and engage in healthy practices and to avoid risky or negative behaviors.

Research Brief

Zambia RCT TF-CBT Research Brief for Dissemination

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This study is a community-based randomized controlled trial to explore the effectiveness of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in addressing psychological and behavioral problems of Zambian youth resulting from trauma.  TF-CBT is an evidence-based treatment for youth who have experienced trauma and/or grief, and includes eight treatment components for children ages 5-18 and their primary caregivers when available. Through a prior feasibility study and pilot project (2009-2010) TF-CBT was adapted for use in Zambia and found it to be feasible with lay practitioners. Preliminary data from our pilot study suggested that it reduced trauma and shame-related symptoms.

Faculty from the Applied Mental Health Research Group at Johns Hopkins University (AMHR) trained the local staff of service providers in both assessment and treatment of children, using the assessment tools and TF-CBT manuals developed and validated during aforementioned pilot study. These assessment tools were used by staff to screen children in populations being served by our partner organizations in Lusaka, Zambia. Triage into the study was done on the basis of symptom and function scores, and those who agreed to be in the study were allocated at random either to receive TF-CBT immediately or to a treatment as usual (TAU) control group.

Results of the study indicated that TF-CBT was a powerful intervention for treating trauma-related symptoms among youth. Children in the study receiving TF-CBT had a clinically and statistically significantly greater reduction in both trauma symptoms and functional impairment as compared to children receiving treatment as usual. The full primary study results were published in JAMA Pediatrics in 2015. Overall, given the effectiveness of TF-CBT, we recommend that it be scaled up and integrated into services. Zambia would benefit from future evaluations on implementation variables such as who are the providers best served to deliver TF-CBT, what infrastructures could integrate TF-CBT, and the sustainability within different delivery systems.  

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