Feasibility of psychosocial intervention for children exposed to ethnic violence in Kenya

Background: There is limited evidence on the cultural acceptability and feasibility of psychosocial interventions for children in post-conflict settings in low-income countries. Aim: To establish the feasibility of a psychosocial intervention for children exposed to ethnic violence and who experience mental health problems. Methods: A mixed methods two-phase design was adopted. In phase I, four focus groups were conducted with community stakeholders (children, parents, teachers and other professionals) in Nakuru, Kenya. In phase II, children were screened on trauma exposure (SLES), post-traumatic stress (CRIES-13), anxiety (RMCAS), and depressive symptoms (DSRS). Fifty-four children subsequently randomly allocated to a psychoeducational and trauma-focused intervention (Writing for Recovery) or wait-list control group. The same measures, as well as free text and attendance data were collected to evaluate five feasibility criteria. Results: Emerging themes from phase I indicated that socioeconomic constraints, limited mental health knowledge, stigma, impaired parenting and engagement, and lack of culturally appropriate interventions and inter-agency collaborations as key challenges. In phase II, 85% participants completed the study, of whom 95.8% suggested that Writing for Recovery was acceptable and suitable, with a similar proportion (95%) finding it useful in controlling emotional symptoms. Effect size for outcome measures ranged from small to high with time/group analysis, showing reduction in PTSD symptoms (d=0691). Conclusions: Community stakeholders‘ views are important in informing the planning, delivery and evaluation of psychosocial interventions in post-conflict settings. Brief psychoeducational approaches such as Writing for Recovery are feasible, culturally acceptable and resource-effective in being delivered by non-specialist facilitators. These are indicated as first-line intervention in a stepped model. Implications: Findings contribute to the literature of evidence-based psychosocial interventions for children in post-conflict settings. These are useful for policy makers and other stakeholders involved in child care, by providing an additional low-cost resource to help traumatized children in similar communities and socio-cultural contexts.