Impact of social risk factors on TF-CBT engagement and strategies to mitigate the impact: A qualitative analysis.

Social risk factors, or adverse conditions in which people are born, grow, live, and age (1), contribute to greater mental health problems (2,3) and lower treatment engagement worldwide (4). The prevalence and impact of social risk factors (SRFs) are particularly pronounced in low-to-middle income countries (LMICs); however, strategies to address SRFs alongside mental health treatments have not been systematically studied. Building on an NIMH-funded project (BASIC; 5), we invited participants ranging from children and guardians who received and lay counselors that delivered an adapted form of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; 6) in western Kenya to complete qualitative interviews. In these interviews, we examined both the experience of SRFs and how lay counselors address SRFs within TF-CBT. Results from the qualitative analysis reveal that in the face of SRFs, counselors were already addressing SRFs, though typically by using their own personal resources. Participants also identified a variety of strategies that do not require extensive financial support. Overall, the experience of SRFs and strategies to address SRFs reported in this paper may support the engagement in and effectiveness of evidence-based practices in Kenya and globally.