Establishing Context to Build Capacity: A Qualitative Study to Determine the Feasibility, Utility, and Acceptability of
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ORIGINAL PAPER
Establishing Context to Build Capacity: A Qualitative Study to Determine the Feasibility, Utility, and Acceptability of a Complex Trauma Training for Psychologists Working in Urban Migrant Communities in Northern Peru Brieanne K. Kohrt1 · Maxwell P. Murray1 · Lourdes Cabel Salinas2 Received: 3 May 2019 / Accepted: 29 February 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Across Latin America, increasing access to mental health care has become a priority. Management of common mental disorders is shifting to primary care, and community mental health centers (CMHCs) are being established to treat severe needs. In urban migrant communities on the outskirts of Trujillo, Peru, five new CMHCs have been built to treat complex mental health concerns, partially in response to high rates of domestic violence and child maltreatment. However, psychologists have no training in the treatment of interpersonal trauma. This study sought to determine the utility of such a training and identify areas for cultural adaptation. Six focus groups were conducted with CMHC psychologists. Findings revealed that, while a culturally-adapted training in trauma-focused treatment is desired, sociocultural barriers to ensuring the physical and psychological safety of the service user must be considered, as well as provider barriers including short treatment packages, insufficient physical infrastructure, and unstable work conditions. Keywords Capacity building · Peru · Complex trauma · Community mental health · Urban migrants · Global mental health
Introduction Recent global mental health initiatives seeking to increase access to services in low-and-middle income countries (LMICs) have centered on shifting the identification and management of mild to moderate mental health problems to the primary health care (PHC) system, while communitybased psychologists take on a more supervisory and capacity building role. Simultaneously, the care of people with more complex and severe mental health problems is moving out of institutionalized settings and into community mental health * Brieanne K. Kohrt [email protected] Maxwell P. Murray [email protected] Lourdes Cabel Salinas [email protected] 1
The University of Denver, 2450 S Vine St, Denver, CO 80210, USA
Sayariy Resurgiendo, Urb Covicorti Condominio Tierra Verde, Bloque C 1102, Trujillo 13011, Peru
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as part of the deinstitutionalization of mental health care (Eaton et al. 2011; Kakuma et al. 2011; Patel et al. 2018). One such region making significant advances over the last decade in increasing access to mental health care is Andean South America (Pan American Health Organization 2013). Peru, for example, passed Law 29,889 in 2012, which sought to close the existing treatment gap (estimated at 70–85% countrywide) by reducing psychiatric hospital beds, increasing the capacity of the PHC system to screen and treat common mental disorders, and establishing a community mental health center (CMHC) system. However, nearly 90% of
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