1. Multi-sectoral Stakeholder Team Approach to Scale-up Community Mental Health in Kenya: Building on Locally-generated Evidence and Lessons Learned (TEAM) (Please use the content in the brief for this project provided)

 

  1. The computer-basedDrug and Alcohol Training Assessment in Kenya (e-DATA K)

 

Funded by: Grand Challenges Canada

 

Collaborators: University of British Columbia, Canada and NextGenU.org

 

Introduction

The burden of substance use disorders (SUDs) is heavy and growing, with alcohol being the fourth-highest cause of years lost-to-disability in low- and middle-income countries (LMICs). This burden could be substantially lightened by delivering high-quality, accessible, integrated SUD services at the primary care level. In Kenya and many other LMICs, there is little attention paid to SUDs during training or for continuing education due to challenges such as limited human and financial resources. This creates a primary care workforce ill-prepared to identify and treat those with SUDs. Our goal is to massively increase the accessibility of high-quality SUD training, and to evaluate the impact of this educational intervention. This is a first step in building capacity to address other mental health conditions all over the world, for any trainee with a computer and a willing mentor.

This project tests NextGenU.org’s model of free, high-quality, computer-based learning with online and in-person mentored and peer activities to train Kenyan primary care workers about SUD.

 

 

 

Project Goal

To train large numbers of primary health care workers to successfully identify and treat substance use disorders in their practices through high-quality, globally-available, free-to-use, and low-cost to assemble, computer-, peer-, and mentor-supported learning.

 

Objectives

  1. Train professional and lay health workers on alcohol, tobacco, and other substance use disorders to increase access to SUD services in primary care in several districts in Kenya
  2. Train clinical leaders in quality improvement and practice change to support the institutionalization of the interventions in practice in one district in Kenya
  3. Provide the trainings worldwide for free
  4. In public and private educational institutions and healthcare settings, evaluate the feasibility and impact of the SUD training (with and without the practice support training) on health care worker stigma, the availability and sustainability of the intervention, and patient outcomes

 

Research Methods

This is a developmental evaluation, with a pilot study and a randomized control trial (RCT) using qualitative methods (focus group discussions, key informant discussions, direct observation, and trainee journaling) and quantitative methods (comparison of trainees’ pre- and post-training levels of stigma, self-efficacy, knowledge, attitude, and practices); post-training online and in-person competency assessment.  We also compared controls vs. brief intervention subjects for alcohol and other substance use, to assess impact of the intervention on consumption level, quality of life, and health services utilization.

 

The Trainings

Like all NextGenU courses, these courses are competency-based, with competencies adapted from the WHO Mental Health Gap Action Programme (mhGAP) and the WHO ASSIST manuals.  Course resources come from world-class academic and governmental organizations such as the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA), National Institute on Drug AbuseWorld Health Organization, and the World Medical Association. The aim of the courses are to enable health workers to:

  1. Identify those with substance use disorders;
  2. Provide care to those with substance use disorders with appropriate and ethical care and non-judgmental attitude and communication;
  3. Use clinical brief intervention techniques;
  4. Assist in identifying and managing co-morbidities;
  5. Provide basic psychological and pharmaceutical treatment;
  6. Assist patients and families with self-help strategies;
  7. Determine the need for, and feasibility of referral and follow-up; and
  8. Support primary care sites to implement those interventions in practice in a sustainable and scalable manner.

This course is cosponsored by the Africa Mental Health Foundation, the Annenberg Physician Training Program in Addiction Medicine, and the University of Florida.

 

 

  1. The Kenya Integrated Intervention Model for Dialogue and Screening to Promote Children’s Mental Wellbeing (KIDS)

 

Funded by: Grand Challenges Canada

 

Collaborators: University of Toronto

 

Introduction

One of the seven Grand Challenges is to improve child access to evidence-based care by trained health providers.   Three of the other Grand Challenges can also be addressed in child and adolescent mental health.   These are: (i) To integrate screening and core packages of services into routine primary health care; (ii) To provide effective and affordable community-based care and rehabilitation; (iii) To develop effective treatments for use by non-specialists, including lay health workers with minimal training.

The aim of this approach is to promote mental well-being and support positive cognitive development to break the vicious cycle of mental illness from continuing through adulthood and having a detrimental effect on the quality of life of the individual.  Kenya has no country-specific operational model that addresses this matter at scale.    The World Health Organization (WHO) has put together a multi-stakeholder model for a primary school intervention that has been successfully piloted in 24 secondary schools in Australia.  The Africa Mental Health Foundation (AMHF) has piloted the same model in one rural school in Kenya. The Kenya Integrated Intervention Model for Dialogue and Screening to Promote Children’s Mental Well-being (KIDS) will bring this pilot to two administrative districts in Kenya with the potential for further scale up.

KIDS will demonstrate the feasibility of a multi-stakeholder service model that will maximize the potential of children by promoting mental well-being, preventing mental illness, and treating existing mental illness.

 

Project Goal:

To test the efficacy and feasibility for scale-up of a multi-stakeholder model for primary schools that seeks to promote mental well-being, prevent mental illness and reduce the treatment gap for children.

 

Objectives:

1: To promote mental well being and prevent mental illness in 5,740 primary school children (6-13 years) in 18 primary schools in two rural districts in Eastern Kenya

 

2: To facilitate intervention for children with mental illnesses identified from the 5,740 primary school children

 

3: To evaluate the efficacy of KIDS.

 

Study design

 

KIDS will conduct a randomized wait-listed control study.  Given the life of KIDS, the intervention will run for 12 months in each of the districts with a 6-months overlap.  The district that becomes the experimental or the waitlisted control group will be determined by balloting.

 

Sample size: The study will screen a total of 5,740 children

 

 

Description of instruments:  The instruments were chosen on the basis of known psychometric properties, worldwide use and brevity.  We have the necessary authorizations where needed.

 

  1. The WHO mhGAP-IG for psycho education and assessment on the various symptoms of mental illnesses in children
  2. The NOK on the culture specific physical symptoms associated with mild psychiatric disorders. It was developed by among others, the PI of this project. This tool’s psychometric properties have been tested in Kenya where it was shown to have a reliability coefficient of 0.9733
  • ASEBA (a) for screening to identify children at risk of developing mental illness (b) to assess changing means of symptoms as reported by parents and teachers.
  1. MINI KID-Version for 6-14 years to provide Diagnostic Statistical Manual Version IV/International Classification of Diseases Version 10 (DSM-IV/ICD-10) equivalent diagnoses
  2. Stigma ToolKit to evaluate changing patterns of community and individual stigma to mental illnesses (S)
  3. MIMH Scale for evaluating functional outcomes. The MIMH was chosen because it is specific for measuring school related functional outcomes on mental health psycho education and interventions in school and has the following domains from the perspective of the school children concerning the school: (a) Teacher/student relationships – six questions (b) School performance – three questions (c) School/parent relationship – one question (d) School attachment – 7 questions. It has a total of 17 questions and one specific question for the different types of substance use.
  • Resilience scale to evaluate the general wellbeing. It tests the children’s coping mechanism with adversities (that cannot be eliminated by this program in the short term).
  • Researcher designed tools will be used to assess (a) Social demographic characteristics of study participants, (b)school records, (c) Clinic records, (d) case management records, (e) capture instruments for any emerging issues

 

 

 

 

  1. Using Mobile Phones to Empower the Frontline Healthcare Workers to Manage Depression at the Point of Care in Kenya using the WHO Mental Health Treatment Gap Intervention Guidelines” ( mHealth)

 

Funded by: Grand Challenges Canada (GCC Rising Star grant)

 

Introduction

 

Project Goal

To evaluate the applicability of a model that seeks to utilize mobile technology to train, supervise, support and monitor application of mhGAP-IG depression module on non-mental health workers.

 

Objectives

  1. To develop a software matrix on mhGAP-IG that can be uploaded on a smart phone.

 

  1. To train health care workers on mhGAP-IG and how to use the software.

 

  1. To determine the applicability of the technology among the health care workers through FDGs.

 

End date: April 2015

 

  1. Dialogue to Empower, Supervise, Support and Include the Informal Traditional and Faith Healers to Deliver Evidence-Based mhGAP-IG Adapted Psychosocial Interventions to Reduce Treatment Gap in Kenya (DIALOGUE)

 

Funded by: Grand Challenges Canada (GCC Rising Star grant)

 

Project Goal:

To empower, supervise, support and include the informal traditional and faith healers to deliver evidence based mhGAP-IG adapted psychosocial interventions to reduce treatment gap in Kenya

 

Objectives:

  1. To facilitate dialogue between the two sectors; formal (conventional health care workers) and informal (traditional and faith healers) sectors towards synergy in the provision of mental health services.

 

  1. To train the informal sector on the use of mhGAP-IG to provide psychosocial services for depression and the need to refer cases not responding to treatment to formal sector.

 

  1. To determine accuracy of depression diagnosis made by the informal sector after training on mhGAP-IG for depression.

 

  1. Identification of Psychosis-Risk Traits in Africa

 

Funded by: National Institutes of Health (NIH – R21 grant)

 

Collaborator: University of Washington, USA.

 

Introduction

The lifetime prevalence of schizophrenia and related psychotic disorders exceeds 3% and these are among the most disabling illnesses worldwide. Treatment of schizophrenia early in the course of the illness is linked to better outcomes, and accurately identifying individuals before the onset of psychotic illness holds promise for developing preventative interventions and minimizing the burden of schizophrenia. This has particular relevance in sub-Saharan Africa, where financial and health care resources for managing psychotic disorders are extremely limited.

The introduction of the ultra-high risk (UHR) criteria has significantly advanced the possibility of indicated prevention of a full-blown psychotic disorder. UHR criteria include 3 different syndromes: attenuated positive symptoms, brief limited intermittent psychotic symptoms, or a combination of genetic risk indicators and recent functional deterioration. Supporting their conceptualization as criteria of an imminent risk of psychosis, studies report transition rates to psychosis of 16% to 54% within 1-2.5 years.  There have, however, not been prior published references investigating the prevalence of ultra-high-risk symptomatology in Africa.

 

Project Goal

To evaluate factors influencing the development of psychotic disorders, without the influence of psychotropic medication, which is a limitation in doing similar studies in developed countries.

 

Objectives

  1. To Assess Cognitive, Athropometric and Dyskinesia traits in Kenyan Youth. – Rates of abnormalities will be compared in 120 UHR+ and 60 matched-control youth aged 14-25 years, in Machakos, Kenya.

 

  1. To Longitudinally Evaluate Symptom Change and Identify Psychosis Predictors.120 UHR+ youth will be assessed at baseline (month 0), and months 1, 6, 12 and 18.

 

Research Design

A team of AMHF staff and 12 nurses will be trained on the use of the assessment tools. Then,120 UHR and 60 control participants will be recruited through house-to-house visits. 3,000 youths will be screened to pick suitable study participants in Machakos District. For initial screening, the Prime-Screen and WERCAP screen will be given to willing participants within the age range (14 to 25 yrs). The text in the Prime-Screen had been slightly culturally modified following extensive discussions between PI and AMHF research staff in March 2010. Written consent will be obtained from all participants and in the case of minors (aged less than 18 yrs) from parents.

Inclusion criteria for UHR+ participants will be initially made using the Prime-Screen and WERCAP screen, and requiring a score of 5 or more on at least three items. Participants that screen positive will be assessed for UHR criteria by the Structured Interview of Psychosis-Risk Syndromes (SIPS) version 5.0. Control participants will be randomly selected among those that screen negative (i.e. 0-1 in all 12 questions on the Prime-Screen, then validated by the SIPS). UHR participants will be matched as close as possible with controls (2:1) based on gender, age (+ or – 2 years) and town of recruitment. The SIPS had been slightly modified following feedback obtained through six targeted focus groups involving youth and mental health professionals, conducted by Dr. Linda Cottler (consultant), the PI, and other key AMHF and Washington University staff (July, 2010). The rationale for the minor alterations in the SIPS text was to ensure that the questions are in context with Kenyan culture.

 

Instruments and measures

  1. Neurocognition will be measured using specific modules from the Penn Computerized Neurocognitive Battery (P-CNP)
  2. Trained research assistants will assess six quantitative head/face measures
  3. Trained research assistants will assess facial and upper body movement abnormality
  4. Psychosis-risk symptoms will be assessed using the SIPS at all time points. Neurocognitive symptoms assessed using the P-CNP will be assessed at months 0 and 18. Motor abnormalities will be assessed at months 0 and 18.
  5. DSM-IV-TR criteria for non-affective (schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder) and affective (bipolar disorder, major depressive disorder) psychosis will be assessed using the Computerized Diagnostic Interview Schedule (C-DIS) at months 0 and 18, or if psychotic disorder is suggested by the SIPS at any time point.
  6. Baseline SIPS, cognitive, anthropometric and neurologic profiles will be compared in UHR+ that transition to psychotic disorders (and/or progress in symptoms) and those that do not transition (or that do not progress in symptoms).

 

 

 

  1. Sustainable and Adapted Treatment Strategies to Restore Psychological Functioning and Mental Health among Displaced Somalis: Preparation of a Multicenter Treatment Study

 

Funded by: The German Federal Ministry of Education and Research (BMBF)

 

 

Collaborator: University of Konstanz, Germany.

 

Project Goal:

 

A pilot measure that aims at the development and evaluation of new concepts of integrated community-based mental health services for Somalia and for Somali refugees in neighboring countries.

 

Objectives:

  1. Be able to apply for funds for a randomized controlled trial on adapted community-based care for patients with severe mental illnesses and their carers.

 

  1. Essential information for designing a randomized controlled trial on adapted community-based treatment is available:
  • the expected effect sizes (pre-post) of treatment components for the calculation of power and sample size
  • the reliable and culturally valid measurement instruments to evaluate intervention effects

 

  1. In-depth knowledge on key variables is available that will be important for planning and implementing the randomized controlled trial on adapted community-based treatment:
  • the prevalence of severe mental disorders in urban Somali refugee settlements
  • the burden of caretakers of people with severe mental disorders
  • the prevalence of other mental disorders, problematic behaviours such as excessive substance use, substance use disorders and trauma experiences
  • the use of the different existing mental health treatment services and their effects
  • the attitudes and expectations of Somali refugees against different forms of mental health services, including medical services, traditional healers and self-help.
  • the use of psychotropic substances and their effects

 

  1. First evidence for a community-based treatment tool for khat addiction exists.

 

  1. The network of African partners is extended. On the level of investigators, partnerships for a multi-center study have been established.

 

 

  1. Mobile Substance Use Intervention for HIV Prevention

 

Funded by: The National Institutes of Health (NIH – R21 grant)

 

Collaborator: University of Vermont

 

Project Goal

To adapt an evidence-based intervention (motivational interviewing; MI) to be used over the mobile phone by trained clinicians to treat substance abuse.

 

Objectives

  1. Assess feasibility, acceptability, and efficacy of using mobile phones to provide MI to substance abusing adults

 

  1. Quantify the varying response to MI treatment for participants with psychiatric problems and identify areas for future intervention

 

 

  1. Alcohol and Substance use in Kenyan Schools

 

Funded by: AMHF

 

A cross sectional survey on the prevalence and determinants of alcohol and substance use among primary and high schools students. This project, will not only look at patterns and prevalence of substance use in urban primary and secondary schools, but will also identify factors that encourage alcohol intake by adolescents include parenting, cultural factors and the home environment.

This project was informed by the fact that drug use and abuse remain a critical problem in our country and is associated with adverse social and economic consequences. The World Health Organization (WHO) points out that many school children experiment with alcohol before the age of 12 and that pre-teen alcohol initiation, which continues into adolescence and worsens, leads to adverse health outcomes among the youth. A high prevalence of drinking at an early age bodes ill for the psychosocial development of the youth because of the increased risk for alcohol–related problems like poor school performance, more substance–use and other co–occurring problems, tobacco use, sexual activity, violence, drunk driving, suicide, delinquency, unintended pregnancies, and sexually transmitted diseases.

We believe that students who increase their drinking from adolescence to early adulthood and who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g., marriage, educational attainment, employment, and financial independence).

This study will also look to the common trends of alcohol and substance use among school going children in Nairobi to establish if there are new and emerging trends. It also targets to establish factors that may be facilitative or prohibitive of alcohol and substance use among students with the aim of establishing interventions that can be developed to mitigate use of substances among the youth. This study will also identify the students’ perceptions on the use of these substances.

This study will allow us to determine what influences specific youth drinking patterns, that we can use in designing potential interventions. It will help us identify and modify high-risk behavior to alcohol and substance use in order to be successful in prevention of alcohol problems instead of solely trying to prevent the initiation of drinking.

 

Objectives:

  1. To determine the prevalence of alcohol and substance use and any differences if any between primary and secondary schools

 

  1. To determine whether a difference in prevalence exists between boys and girls studying in secondary schools

 

  1. To identify which substances are mostly abused by Kenyan school youth

 

  1. To establish whether a relationship exists between the students’ psychological, living conditions and socio-economic factors and alcohol and substance use

 

  1. To assess factors possibly predictive of alcohol and substance use in Kenyan youth in schools

 

Study design

We will involve public schools only, both primary and secondary. We will involve classes seven to eight in primary schools and forms one and two in high schools. The schools will be mixed day schools (boys and girls). Day schools were selected because it will be easy to get parental consent as the students normally go home every evening.

These schools will be randomly selected from four divisions of Nairobi. Nairobi County will be divided into four geographical divisions, Nairobi East, Nairobi North, Nairobi West and Westlands districts. From each division, a primary and a secondary school will be randomly picked from the list of schools in each category. A list of these schools will be obtained from the County Education Office. Once in the schools, all the students in target classes will be involved. This is because selecting some students and leaving others would bring stigma among the students.

The data collection tools will consist of three self-administered questionnaires, administered primarily to students 12-16 years of age. We will use a standardized scientific sample selection process, commonly used school-based methodology and a combination of core questionnaire modules, core-expanded questions, and specific questions.

The socio-demographic data will be collected on all students; their hierarchy of values, family relations, adjustment to school, relationships with peers, high-risk and delinquent behavior

  1. Social demographic – 10 minutes
  2. Youth questionnaire on alcohol and substance use – a collaboration questionnaire but adapted for Kenyan use- 20 minutes
  3. Khat questionnaire

 

 

  1. Prevalence and Treatment Course of Diabetes and Depression in Kenya: An International Collaborative Study

 

Funded by: AMHF

 

Project goal

1.To estimate the prevalence of depression in patients on follow up with type 2 diabetes mellitus and determine the incidence within a year.

 

  1. To determine the clinical course of treated and untreated depression on diabetes: complications and metabolic control over a one year follow-up period

 

Objectives

  1. Estimate the prevalence and incidence (over 12 months) of depressive disorders and diabetes related distress in adults currently receiving care for type 2 diabetes

 

  1. Examine the course and treatment of type 2 diabetes in people with and without depressive disorders over a 12 month follow-up period.

 

  1. Examine the relationships between depression, diabetes-related distress, diabetes complications and metabolic control in the following in people with and without other co morbid mental or physical illness.

 

  1. Assess the impact of appropriate treatment of depression (both previously diagnosed as well as unrecognized) on the course of diabetes, and on patients’ emotional well-being.

 

  1. To assess the specificity and sensitivity of two depression screening instruments (the PHQ-9 and the WHO-5) when used in people with type 2 diabetes

 

  1. To compare the collected data among countries applying the same protocol.

 

 

 

 

  1. The Kenya Integrated Intervention Model for Dialogue and Screening to Promote Children’s Mental Wellbeing (KIDS) – Telomere length sub-study

 

Funded by: AMHF

 

Project Goal

To determine the change, over treatment in DNA telomere length  in the intervention versus the control arm of the study

 

Objectives

  1. To determine the change in DNA telomere length over 18 months

 

  1. To determine the correlation between the change in DNA telomere length and the clinical treatment outcomes in the study participants in both the intervention and control arms of the study.

 

  1. The Prevalence of Post-Partum Depression, its Effect on Neurological Development of Children and Validation of the Edinburgh Post-Natal Depression Scale in Kenya

 

Funded by: AMHF

 

Project Goal:

To determine the prevalence and factors affecting peri-partum depression in rural Kenya and determine the psychometric validity of the Edinburgh Post-Natal Depression scale in Kenya.

 

Objectives:

  1. To determine the prevalence of depression among women in the 1st, 2nd and 3rd trimester as well as in the first 5years after birth.

 

  1. To determine the correlations between children’s neuro-developmental aspects and mothers’ depressive status using ASEBA, DC: 0-3R, MINI PLUS and routine MCH data.

 

  1. To determine the prevalence of alcohol consumption among pregnant and postpartum women respondents, using AUDIT questionnaire.

 

  1. To determine the prevalence of intimate partner violence among pregnant and postpartum women respondents.

 

  1. To determine the reliability and validity of EPDS as a screening tool for peri-partum depression compared to a gold standard (MINI PLUS) in Kenya.

 

  1. The Community REcovery Achieved Through Entrepreneurism (CREATE) Project (The link to this project should redirect to the website http://www.createkenya.com/