Methods: SLM has been implemented by Haitian lay mental health workers for residents of camps for internally displaced peoples in Port-au-Prince since April 2010. It was developed through US and Haitian collaboration with the aim of teaching western psychological concepts (e.g. fight or flight response) and coping skills (e.g. relaxation breathing) in a framework that acknowledges and validates other modes of understanding and experience. Several elements contribute to this objective: 1) use of local and lay developers and implementers, 2) discussion of diverse post-earthquake responses, explanations, and coping mechanisms, 3) provision of “compensatory social support” by tapping into therapeutic elements of disrupted community practices, and 4) promotion of community and collective efficacy building activity by training SLM graduates to disseminate skills learned in the seminars to other camp residents. Effectiveness of SLM participation was assessed using a Creole translation of the PTSD checklist portion of the Harvard Trauma Questionnaire (HTQ), a measure commonly used cross-culturally.
Results: Outcome data from a pre-post trial and a comparison of SLM participants and non-participants suggest significant decreases in PTSD symptoms following participation in SLM. First, a pre-post trial conducted in November 2010 revealed significant decrease in HTQ score, F(1,29) = 18.00, p<.001 among 30 SLM participants who completed one month of tri-weekly SLM seminars. Second, in January 2011, 84 randomly selected residents across 4 IDP camps completed interviews focused on mental health. Of these, 44 had participated in SLM seminars during the previous nine months, and these individuals displayed lower HTQ scores, F(1,67) = 4.63, p<.05, and reported more coping mechanisms, F(1,67) = 6.90, p<.01 than non-participants, controlling for demographics and disaster exposure.
Implications. These data suggest promising effects of participation in a coping-skills intervention implemented by Haitian lay people. By providing psychological content in a framework that values local perspectives, the development of this intervention aims to address controversies about intervention development prevalent within the field of cross-cultural post-disaster mental healthcare. Future work entails assessing intervention effects using a wait-list control-group design, as well as continued exploration of mechanisms of change and the extent to which participants continue to utilize locally-promoted spiritual and social coping strategies alongside newly acquired skills. Ultimately, we aim to create a set of guidelines for the development of culturally-tailored treatment models for use in diverse post-disaster settings.
