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Child Abuse Negl. 2013 Dec;37(12):1175-85. doi: 10.1016/j.chiabu.2013.04.017. Epub 2013 Jun 12.

An evaluation of trauma focused cognitive behavioral therapy for children in Zambia.

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Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 North Broadway, Baltimore, MD 21205, USA.
Catholic Relief Services, Zambia, Longolongo Road, Lusaka 10101, Zambia.
Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA.
University Teaching Hospital, Lusaka, Zambia.
Ministry of Health, City Airport Road, Lusaka, Zambia.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 8th Floor, Baltimore, MD 21205, USA.


To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5-18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.


Child trauma; Evidence-based treatment; Implementation; International; Low-resource setting

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