Efficacy of bi-modal psychosocial interventions among adolescents in residential care in Kenya
Introduction: The United Nations Children's Fund (UNICEF) had estimated that by 2010, 106 million children <15 years of age will have lost one or both parents because of illness, violence, or injury. Orphans and other vulnerable , children are often left unprotected after loss of their parents, placement in temporary shelters, or loss of contact with primary caregivers. The situation of children in Kenya remains critical due to social, economic and political challenges which include conflict, violence and family breakups. In times of family or societal conflict, these children experience increased risk of exposure to violence, physical and sexual abuse, exploitation and emotional neglect, along with an increased risk for death. Nationally, nine percent of children have lost their father, four percent have lost their mother and two percent have lost both parents. They are often left unprotected, end up in temporary shelters with the eventual loss of contact with caregivers. They become more vulnerable to becoming victims of violence, exploitation, human trafficking, discrimination, and other forms of abuse. In times of family/societal conflict, these children experience increased risk of exposure to violence, physical and sexual abuse, exploitation and emotional neglect, along with an increased risk for death. Main Objective: To evaluate the efficacy of bi-modal psychosocial interventions on the prevalence and severity of mental disorders among orphans and vulnerable adolescents in residential care. Inclusion Criteria: Adolescents in residential care aged between 10-18 years old, those whose institutional cave consent, adolescents who gave assent to participate in the study. Exclusion Criteria: Respondents who did not fall within the age bracket of 10-18 years; those who did riot give assent to participate in the study; those whose institutional heads (guardians) did not give consent; respondents identified by the teachers as having mental retardation to the extent that they could not benefit from normal evaluation. Design: A population-based quasi-experimental design. Study sites: Four institutions providing residential care in a rural setting in Eastern Province, Kenya were selected through purposive sampling. Experimental group I received the bi- modal intervention (Life skills (psychoeducation) and Team building activities, Experimental group II received the single component intervention - Life skills (psychoeducation) only; while the control groups I & II did not receive any interventions. Four assessments were done with an interval of 3 months apart. Subjects: All respondents in the selected institutions within the 10-18 years age bracket. Results: Adolescents who met the criteria for full Post Traumatic Stress Disorder (PTSD) had significantly high mean scores on Somatic problems, length of stay at the institution revealed a statistically significant difference between sites (p<0.001). There was a significant difference in distribution of respondents by gender, age, length of stay at the institution, living arrangements during the holidays and orphanhood status I (p<O.05). I Conclusion: The development and implementation of a combination of knowledge (psychoeducation) and skills acquisition intervention is effective iru I the amelioration of mental health problems in orphans and vulnerable -''',IQ~r.ents in residential care. Recommendations: By virtue of the fev the prevention and treatment of mental health problems, there is room for further research into other alternatives to assess the efficacy of simpler interventions, such as the ones used in this study, which can be delivered by non-mental health specialists.