Ali Giusto
Columbia University Medical Center

Targeting Families and Fathers to Improve Youth and Caregiver Mental Health in Low Resource Global Settings
Family violence and mental health are intertwined public health issues that impact youth and their caregivers. Male caregiver alcohol use can be particularly disruptive to youth and caregiver mental health and safety. Problem drinking disproportionally affects men with disabling consequences. In turn, men’s alcohol use has a cascade of negative effects on families with links to intimate partner violence, child maltreatment, and increased likelihood for youth mental health problems. These multi-level problems are often exacerbated where poverty rates are high, such as low and middle-income countries, and where strong patriarchal norms place men in positions of power. Family-focused interventions offer avenues for addressing such multi-level problems simultaneously in low resource settings. This presentation focuses on two such interventions in Kenya. First, I describe the development, evaluation, and implementation of Tuko Pamoja (Kiswahili for “We are Together”)— a family therapy intervention targeting family conflict and adolescent mental health. Tuko Pamoja was developed for the context and delivered by lay-providers in community-based settings. Pilot results suggest improved violence, relationships, and child and caregiver mental health. Second, I present a multiple baseline single case series pilot trial of an alcohol reduction and family engagement intervention for fathers with problem drinking examining implementation and effectiveness outcomes. Intervention development resulted in a brief family-focused intervention rooted in behavioral activation and motivational interviewing modified for the context and streamlined for lay providers. Both implementation and clinical outcomes were examined. Implementation outcomes demonstrated the intervention and its delivery was feasible and acceptable, including high participant satisfaction and high rates of counselor fidelity. On clinical outcomes, fathers showed significant reductions in alcohol use. Improvements were also seen in fathers’ family involvement and family-directed behaviors, as well as secondary outcomes of family functioning and mental health. Results suggest the promise of developing scalable, effective treatments that target family-level problems to improve child and adolescent mental health in low resource settings.

Ali Giusto is a candidate for the Population Health Initiative Joint Hire  position in Psychology and Global Health. This lecture is free. No registration needed.