(PS5-C67) Strategies to Address Social Risk Factors Alongside an Evidence-based Therapy: A Rapid Qualitative Analysis

Social risk factors (SRFs), or adverse conditions in which people are born, grow, live, work, and age, contribute to higher psychological impairment and lower treatment engagement in many settings (WHO, 2008; Bender et al., 2015; Fleury et al., 2014; Martin et al., 2016). SRFs (e.g., food insecurity, the experience of discrimination, social isolation) often co-occur and contribute to mental health problems in low-to-middle income countries (Smith et al., 2021), yet there has been limited effort to identify strategies that mitigate SRFs in the context of evidence-based psychotherapies. To address this gap, trained interviewers conducted qualitative interviews with 20 children and 20 guardians who received a culturally adapted form of trauma-focused cognitive behavioral therapy (TF-CBT) as a part of a Hybrid Type II Implementation-Effectiveness trial in western Kenya (Dorsey et al., 2020). The qualitative interviews included questions regarding the impact of SRFs on TF-CBT engagement and effectiveness, strategies that TF-CBT counselors used to address and mitigate SRFs, and other strategies that could be used to help future children and guardians receiving TF-CBT and experiencing SRFs. We utilized rapid qualitative analysis (Hamilton & Finley, 2019) with our US- and Kenya-based research team to identify common SRFs experienced by children and guardians enrolled in the broader BASIC study and strategies to address and mitigate the SRFs within TF-CBT. Preliminary analyses indicate that the majority of guardians knew at least one child in their TF-CBT group who lacked sufficient food, school fees, and shoes. The majority of children that were interviewed identified strategies that their counselors used to mitigate the impact of SRFs (e.g., providing encouragement, paying school fees, buying uniforms, and providing food for the children). Providing school fees and uniforms were among the most common strategies that children wanted counselors to use to help future recipients of TF-CBT. The results from this study will guide a workshop with lay TF-CBT counselors to further develop strategies and the implementation plan to enact each strategy alongside TF-CBT. Further, these strategies can inform efforts made by counselors in other low-resource settings to better mitigate the impact of SRFs among their clients.