Process and outcome of child psychotherapies offered in Kenya: a mixed-methods study into what works in improving child mental health

Although mental health disorders account for almost half of the disease burden among young people globally, child and adolescent mental health (CAMH) continues to take a backseat in the global and local mental health agenda. Closing of the treatment gap is hindered by a lack of relevant policy, as well as a lack of human and economic resources coupled with stigma and limited mental health literacy. CAMH disorders are responsive to psychological interventions, with local literature showing a positive impact on mental health symptoms. Despite establishing psychological interventions for managing mental illnesses in young people, little is understood about how they work and if they are effective, especially in culture-rich contexts such as ours. Therefore, this thesis aims to evaluate the process and outcomes of psychological interventions offered to young people in the Kenyan context. In Chapter 2, we assessed the relationship between adolescent attachment security and emotional and behavioral problems, with an interest in how socioeconomic differences impact. The findings showed that those with increased attachment insecurity had more emotional/behavioral issues, with those from lower economic backgrounds showing more significant difficulties than their counterparts. Chapter 3 presents the methodology adopted for this study. A mixed method, naturalistic observational approach, was utilized. This study design was deemed appropriate for this work as we wanted each phase to expand and strengthen an understanding of the delivery and outcomes of psychotherapies offered to adolescents in Kenya, where there is limited information. Chapter 4 presents data from validating the Health of the Nations Scale for Children and Adolescents (HoNOSCA). The results demonstrated good internal reliability, with Cronbach’s α = .77. It was also found to be sensitive to change and easy to use in routine practice. Chapter 5 highlights the findings from a naturalistic observational study where the participants had high levels of impairment, with the majority having a sub-clinical diagnosis. The participants attended an average of three sessions and showed improvement by the third session. Despite the literature suggesting otherwise, we also found that therapeutic alliance did not influence treatment outcomes in our sample. In Chapter 6, we explored clinicians’ perspectives on offering psychological services to adolescents using a qualitative approach. Our findings from this inquiry highlighted four interconnected themes that highlighted barriers and facilitators to treatment. Of note was the limited awareness of mental health literacy and available services that impacted service uptake by the stakeholders. In conclusion, this thesis describes the process and outcomes associated with psychotherapies delivered to adolescents at a national referral hospital in Nairobi, Kenya. There is an increased need for appropriate interventions to meet the mental health needs of adolescents and young people. The offered interventions show utility in alleviating distress in this group.