3 - (SYM 72) Organizational Determinants of Secondary Traumatic Stress Absence in Lay Counselors Delivering Culturally Adapted Trauma-focused Cognitive Behavioral Therapy in Kenya

Lay counselors are critical in expanding access to trauma-focused mental health care for youth in resource-limited settings. Without adequate organizational support, lay counselors face heightened risk of developing secondary traumatic stress (STS), which can compromise their own well-being and the quality of care they are able to provide. Prior research highlights organizational factors like strong leadership and supervision as protective against STS in traditional care settings, yet less is known about lay counselors. Understanding STS prevention in these contexts is key to sustaining lay counselors in delivering trauma-focused interventions.

            This study identified organizational factors that led to the absence of STS among lay counselors (N=155) delivering a culturally adapted version of trauma-focused cognitive behavioral therapy (TF-CBT) in Kenya. Data come from a NIMH-funded Hybrid Type II Implementation-Effectiveness trial, delivered by teachers and community health volunteers (CHV) in 40 primary schools in Bungoma, Kenya. Children ages 11–14 who experienced parental death, posttraumatic stress symptoms, and/or prolonged grief were randomized to receive TF-CBT by either teacher-counselors (N=81) or CHV-counselors (N=74).

            This study utilized a novel configurational comparative method called Coincidence Analysis that identifies the core components necessary for a desired outcome to occur. Preliminary findings show core combinations of organizational factors that were necessary in order for teacher and CHV counselors to report no symptoms of STS. For teacher-counselors, STS was absent when they had positive personal feelings at work (e.g., good morale, compensation) or when they had a combination of appreciation for delivering TF-CBT and leaders who were perseverant and motivational. For CHV-counselors, STS was absent when they perceived providing TF-CBT as highly feasible or they had leaders who employed both intrinsic and extrinsic motivators.

Findings emphasize the need to consider the specific context in which lay counselors are embedded when considering organization-level supports. Perspectives from community partners reveal that teachers may be more strongly impacted by workplace climate and appreciation given time spent at work and overwhelming demands. Since CHVs are less embedded in an organizational hierarchy, feasibility and leadership may be more impactful. This study highlights actions and considerations for organizations and leaders to better support lay counselors.