Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

15897 Development of a Lay Mental Health Worker Intervention In Post-Earthquake Haiti: Addressing Controversies In Cross-Cultural Disaster Response

Friday, January 13, 2012: 8:00 AM
Roosevelt (Grand Hyatt Washington)
* noted as presenting author
Leah E. James, MS, MSW, Doctoral Candidate, University of Michigan-Ann Arbor, Ann Arbor, MI
John Roger Noel, Project Manager, Soulaje Lespri Moun, Aristide Foundation for Democracy, Tabarre, Haiti
Jean Jacques Solon, Psychology Student, University of Haiti, Port-au-Prince, Haiti
Purpose: Recent disasters have fueled debate regarding if and how Western psychology can contribute to post-disaster intervention, in light of criticism associated with importing a Western perspective to other cultural contexts. Drawing from experience implementing a lay mental health worker intervention for displaced peoples in Port-au-Prince, Haiti, we propose that when a model is culturally-sensitive, people may benefit from both local and Western perspectives simultaneously; even if their ideas are not entirely congruent. We outline the methods by which this group intervention model, called Soulaje Lespri Moun (SLM; “Relief for the Spirit”), works to present empirically-informed psychological content in a culturally-sensitive way. Next, we present results of two assessments of intervention effectiveness, revealing decreased symptoms of posttraumatic distress among SLM participants.

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.

Previous Abstract | Next Abstract >>