Early findings from this feasibility study indicate promising viability of harnessing spiritual leaders as therapists to fill the mental health treatment gap in Haiti. All three research groups demonstrate significant improvement in knowledge related to mental health and CA-CBT, comparable trainer skills, and strong degrees of satisfaction with the therapeutic material presented.
By the numbers:
- 50 key informants for cultural adaptation of cognitive behaviour therapy (CBT)
- 30 spiritual leaders trained and enrolled
- 31 new spiritual leaders trained by main spiritual leaders
- 18 persons with depression treated in at least one CBT session
- 125 CBT sessions delivered (in total)
- 6.9 average number of CBT sessions completed in therapy
After an analysis of the reliability of the knowledge test, the 10 item version was found to be good and for the 5 items is reasonable. KR20 coefficient was calculated, which is the Cronbach Alpha coefficient for binary scales, for both the 10 and the 5 items scales. The total for 10-items = 0.73 and for 5-items = 0.59.
Knowledge scores indicate high improvement pre/post and strong retention for all groups, and in both phases. In general there is a time effect caused by the fact that the knowledge is higher at post as compared to baseline. A significant improvement was found in knowledge scores across all three spiritual groups from baseline (64% correct) to post-training assessment (90% correct) with strong retention at 4-month follow up (87% correct). Though Catholic and Protestant groups received significantly higher overall scores than the Vodou group, the Vodou group showed greatest improvement in score of 42% between baseline and post-training assessment as compared to Catholic and Protestant groups (20% and 16%, respectively).
Exceptionally strong levels of satisfaction from the participants at the 5-day training led by mental health professionals. Among the 41 spiritual leaders and 11 stakeholders participating in the 5-day training, 71% (n=37) reported overall satisfaction as “Excellent”, 98% (n=51) agreed that the training met expectations, and 96% (n=50) agreed that they would be able to apply the lessons learned in practice.
Of 37 community members referred by spiritual leaders for depression screening, 26 were deemed eligible to participate (70.3%) and 18 of those eligible proceeded with treatment sessions. For the total 18 persons, 125 therapy sessions were completed in each spiritual group (Catholic: 38; Protestants: 66; Vodou: 21). There were a total of 6 persons that completed the suggested 12 session treatment period and an additional 5 persons that completed at least 6 sessions.