Buffering the Impact of Family Distress on Child Mental Health: A Pilot Study of a Community-Based Adapted Family Therapy in Kenya

Background: The family environment can be a powerful risk or protective factor for children’s mental health. In resource constrained settings, positive interactions may buffer negative effects of contextual stressors. Conversely, high conflict, emotional distance, and lack of effective discipline may compound risk. Addressing family-level risk factors before mental health problems manifest is a potential avenue for prevention.

Aims: (1) To adapt a family therapy approach for a resource-constrained setting; (2) To pilot the intervention in Kenya to assess indicators of change and the feasibility/quality of community-based implementation.

Methods: Best practices in family therapy were evaluated alongside results of a qualitative study of family functioning in Kenya. Therapies were chosen and adapted based on the best match with common negative family processes and cultural/contextual norms. The intervention was streamlined for lay providers and manualized. Nine lay counselors were trained, and a pilot trial was conducted with high-conflict families. Mixed-methods data included: (a) in-depth qualitative interviews with participants; (b) verbatim transcripts of sessions; and (c) a pre-post survey of family functioning, parent-child relationships, and mental health.

Results: Solution-focused family therapy was the best fit, which guided the 10 core strategies in the adapted in-home family therapy, Tuko Pamoja (“We are together” in Kiswahili). Tuko Pamoja includes 6 modules addressing domains of functioning (e.g., marital relationship, parent-child relationship); these are matched with needs of families. A mobile phone tool guided counselors during sessions and presented skills demonstrations. The pilot included 14 families (12 adolescents; 23 caregivers) who received a mean of 17 sessions. Analysis is ongoing, but preliminary results are promising. Lay counselors achieved a mean of 89% fidelity to the treatment. In qualitative interviews, participants reported changes in overall family functioning, parent-child communication/discipline, marital relationship quality, and mental health. Families described cascading effects, with marital improvements often leading to child-related improvements. Survey data suggest improved family functioning on a locally-derived scale, improved parent-child relationships, and reduced child mental health symptoms. Primary challenges included participant alcohol use, delays due to informal employment, and variability in counselors’ comfort using technology.

Discussion: The family therapy, delivered by lay counselors, was feasible in a low-resource setting for high-risk families. Preliminary results support the value of a controlled trial to evaluate the efficacy of the approach for mental health prevention.