2

The developers of TF-CBT, Judy Cohen, Anthony Mannarino and Esther Deblinger

JHU, AMHR - Laura Murray, Paul Bolton, Stephanie Skavenski

University of Washington- Shannon Dorsey and all staff that made my trip to US possible

Serenity Harm Reduction Programme Zambia- Fr. Philip Baxter, Executive Director and all managers at the TF-CBT RCT sites

The counselors and assessors on all 3 projects I have been part of.

Varied backgrounds Training for different reasons Different literacy levels Full of “what ifs”

COUNSELOR TRAINING – Setting up Ground Rules

THEME: Implementation “bumps” easily solved:

Highly influenced by basic psycho-social counseling

Lay counselors require simpler language or better still translation into local language

Some TF-CBT material found to be culturally unacceptable Skeptical about how a young person can know how to solve child problems

Shying away from role-plays at first, but later appreciated

Modeling first by Trainer was found to be helpful by local counselors

Participation increased as days went on, appreciating praise from role

play.

DCOF -COUNSELOR TRAINING

Teaching Steps for parenting skill

Bonding during Training

A new idea for us…

SITE: Kabwe Pilot Project- Ranchod Hospice

Get to know each counselor at personal level

-They feel appreciated

-Become open to you

-Put in their best

-Time management an issue but….

Counselors had to commit time to do TF-CBT More time required for supervision to be

appreciated Fidelity following component steps

compromised sometimes Developmental stage of children often

overlooked Objective reporting found difficult Recommendation: ◦ Limit group to about 4 counselors

We were really the lead on modifications and adaptations. We suggested what would work well in Zambia e.g. meeting with parent before child

Mostly in how we say it, what activities we do…etc. ◦ Okra ◦ The story of the clever hare ◦ Analogies – cooking beans, Nshima,

harvesting a good crop, getting educated, ◦ Slow on introduction of sexual topics

The Cognitive Triangle Works GREAT here! Many of us use it personally! Kids seem to like it.

The child considered “OK” for so long, caregivers do not see problems Defilement/Rape Not infected with STI including HIV Not pregnant Able to get married Domestic Violence: The child is not victim but just watches The child does not tell other people

Implementation = explained the effects on children

Most parents think that: Praise will make children silly It’s the child’s duty to do chores A child who refuses to work has to be punished A child doesn’t need to be paid to do chores The child should all chores as instructed A child should obey and respect what adults say Parents too busy to spend time with child How we solved this: - Appreciating how hard it is to raise children - No one is trained on how to be a parent - Explaining how both children and parents can

benefit from the new skills

Children depend on parent/guardian views Implementation = praise children for trusting

parents/guardians Explain exceptions e.g. asked not report abuse

Parents/guardians suspicious at first Implementation = Find out what they are not certain about Explain program to their understanding

It is Satanism Implementation = Get to know why they say so Ask what they wouldn’t want to do

Mothers have to get permission from

husbands Implementation = Explain to them the implications of untreated trauma Offer that husbands can come in

Most men not involved Implementation = Still working on this one…. Appreciated when explained to them

We were really the lead on modifications and adaptations. We Zambainized TF-CBT, observed what was acceptable while maintaining all components.

Advantages and disadvantages Better counseling facilities Easy access to children Assessments not accurate if assessor is religious,

child withholding information Some religious judgmental Caregivers too conservative Some religious biased towards caregivers opinion Children feel things are not confidential

IMPLEMENTATION ◦ Still working on this one…

IMPLEMENTATION at FOUNTAIN OF HOPE CENTRE FOR STREET KIDS

•Population in need in Zambia •Difficult to hold these children •Importance of good partners that “know” these street children to find them •TF-CBT has helped children want to reunite with families

Many people don’t know about TF-CBT Getting parent/guardian involved Cultural interpretation of behaviors in children Some families expect to gain materially Myths, beliefs and cultural interpretations and

perceptions Therapies other than HIV/AIDS related, is

consider to be new phenomena in the Zambian context [associated mostly to Western culture]

Victim's inability to access help even when they

know where to get it. Inadequate advocacy in terms of information

dissemination, and service delivery. Few trained and skilled manpower to deal with child issues. The randomization brought a lot of anxiety in assessor if a child who scores highly is under wait list.

Integration into existing organizations dealing with children is feasible

Need for central location or treatment Centre, training and supervision of Mental Health

Integration can work if… ◦ There is proper trainee selection criteria ◦ Adequate resources are secured (e.g. allowances, transport,

talk time) ◦ Recognition of newly acquired skills ◦ assessments done by people that children are not familiar

with ◦ Incentives and motivations are appropriate for assessors,

counselors and others. ◦ Commitment by partner organizations ◦ Recognitions of trained TF-CBT therapist and mainstreaming

of TF-CBT in the relevant ministries

Training and use of local supervisors Counselors fulltime on TF-CBT Partner organizations selection Communication flow Rigorous monitoring and evaluation Cultural considerations

Children and parents are being helped Children and parents appreciate therapy Positive observable change evident in children Parents on program recommending TF-CBT to friends and

families Positive change evident to close family and friends Positive change evident in relationship between

parent/guardian and child Children doing well in school after, or while undergoing

TF-CBT Improved performance at school

The best thing that can be accorded a child who’s experienced trauma There is hope for a better future for traumatized children

Parents/guardians can develop better relationships with children Children can start trusting parents/guardians and others

Complete the ongoing impact evaluation on the effectiveness of TF-CBT in Zambia. (Murray: PI)

Train more counselors and assessors Conduct a national study to estimate the prevalence of

trauma experiences and trauma symptoms among Zambian children and youths.

Partner with more schools and residential Centers caring for children.

Actively involve the relevant Government ministries and other stakeholders in the implementation of TF-CBT service delivery