Laura K Murray1, Stephanie Skavenski1, Jeremy C Kane1, John Mayeya2, Shannon Dorsey3, Judy A Cohen4, Lynn T M Michalopoulos5, Mwiya Imasiku6, Paul A Bolton7. 1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Ministry of Health, Lusaka, Zambia. 3. Department of Psychology, University of Washington, Seattle. 4. Allegheny General Hospital, Pittsburgh, Pennsylvania. 5. School of Social Work, Columbia University, New York, New York. 6. School of Medicine, University of Zambia, Lusaka. 7. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
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.
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.
Authors: Laura K Murray; Stephanie Skavenski; Lynn M Michalopoulos; Paul A Bolton; Judith K Bass; Itziar Familiar; Mwiya Imasiku; Judith Cohen Journal: J Clin Child Adolesc Psychol Date: 2014-01-08
Authors: Laura K Murray; Alan Haworth; Katherine Semrau; Mini Singh; Grace M Aldrovandi; Moses Sinkala; Donald M Thea; Paul A Bolton Journal: J Nerv Ment Dis Date: 2006-08 Impact factor: 2.254
Authors: Kathryn Whetten; Jan Ostermann; Rachel A Whetten; Brian W Pence; Karen O'Donnell; Lynne C Messer; Nathan M Thielman Journal: PLoS One Date: 2009-12-18 Impact factor: 3.240
Authors: Judith A Cohen; Esther Deblinger; Anthony P Mannarino; Robert A Steer Journal: J Am Acad Child Adolesc Psychiatry Date: 2004-04 Impact factor: 8.829
Authors: Judith K Bass; Jeannie Annan; Sarah McIvor Murray; Debra Kaysen; Shelly Griffiths; Talita Cetinoglu; Karin Wachter; Laura K Murray; Paul A Bolton Journal: N Engl J Med Date: 2013-06-06 Impact factor: 91.245
Authors: Jeremy C Kane; Sarah M Murray; Michael J Vinikoor; M Claire Greene; Shoshanna L Fine; Ravi Paul; Laura K Murray Journal: Alcohol Clin Exp Res Date: 2019-10-20 Impact factor: 3.455
Authors: Briana S Last; Brittany N Rudd; Courtney A Gregor; Hilary E Kratz; Kamilah Jackson; Steven Berkowitz; Arturo Zinny; Lauren P Cliggitt; Danielle R Adams; Lucia M Walsh; Rinad S Beidas Journal: J Community Psychol Date: 2019-12-24