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Background: The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care., Aims: For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children's Fund., Method: Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions ( N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes., Results: Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision., Conclusions: A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.

This study describes an alternative to face-to-face training method for community health volunteers (CHVs) as used by a collaborative group from the University of Nairobi, University of Washington and the Nairobi Metropolitan Mental Health Team during the COVID-19 lockdown in Kenya. This qualitative study describes the experiences of 17 CHVs enrolled in a training study, required to utilize different digital platforms (Google Meet or Jitsi) as a training forum for the first time. Verbatim extracts of the participants' daily experiences are extracted from a series of write-ups in the group WhatsApp just before the training. Daily failures and success experiences in joining a Google meet or Jitsi are recorded. Then, 17 participants, 10 women and 7 men, aged between 21 and 51 years (mean = 33), owning a smartphone, were enrolled in the study. None had used Jitsi or Google meet before. Different challenges were reported in login to either and a final decision to use Jitsi, which became the training platform. Training CHVs to deliver a psychosocial intervention using smartphones is possible. However, the trainer must establish appropriate and affordable methods when resources are constrained., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2024.)

Introduction: This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them., Method: The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes., Results: Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems., Conclusion: Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems., Competing Interests: Conflict of Interest: On behalf of all authors, the corresponding author states that there is no conflict of interest

Introduction: Studies have shown that a child's learning in school is affected by several factors, some related to the school environment, others to the home and community while others are as a result of the individual characteristics of the child. This study sought to explore parents' and teachers' perceptions of factors that affect learning of children in primary schools in a rural County in Kenya., Methods: This was a qualitative study that adopted the phenomenological approach. It was conducted with parents and teachers of 7 primary schools in rural and semi-rural areas of Kiambu County in Kenya. Using a researcher developed guide, data was collected using focus group discussion with parents and teachers. The discussions were conducted as follows-four were conducted in English language, two in Kiswahili language, and three were conducted in the local language and all were audio taped. Research assistants also took notes during the discussions. Results were transcribed verbatim and those that needed to be translated into English were translated. In analysis, MA, MM and MT read the transcripts and coded the major themes., Results: Four themes perceived by both parents and teachers to affect a child's learning emerged. These were; school environment, home, community and factors within the child., Conclusion: There is need for both teachers and parents to come together and discuss perceived factors that interfere with learning of the children. Those that form a consensus for both groups, means to address them be found for better academic success of the child., Competing Interests: Conflict of Interest: On behalf of all authors, the corresponding author states that there is no conflict of interest

Anxiety in children with Autism Spectrum Disorder (ASD) contributes to their functional impairment. We evaluated a cognitive-behavioral program for anxiety and social deficits in children with ASD in two schools in Nairobi City, Kenya. Parents and teachers of 40 children and adolescents with ASD (5-21 years) participated, randomized by school. The two schools were randomly assigned to either intervention (n = 20) or control (n = 20). There was a significant improvement in ASD severity as well as anxiety within the treatment group, which was not seen in the control group. These findings support the expansion of treatments for ASD core deficits and secondary problems in youth with ASD in developing countries.

This study estimated the prevalence and correlates of PTSD in Kenyan school children during a period of widespread post-election violence. The UCLA PTSD Reaction Index was administered to 2482 primary and secondary school students ages 11-17 from rural and urban communities. A high proportion of school children had witnessed people being shot at, beat up or killed (46.9%) or had heard about the violent death or serious injury of a loved one (42.0%). Over one quarter (26.8%, 95% CI = 25.1% - 28.7%) met criteria for PTSD. Correlates of PTSD included living in a rural (vs urban) area (AOR = 1.72, 95% CI = 1.41-2.11), attending primary (vs secondary) school (AOR = 2.25, 95% CI = 1.67-3.04) and being a girl (with girl as referent AOR = .70, 95% CI = .57-.86). We recommend training Kenyan teachers to recognize signs of emotional distress in school children and psychosocial counselors to adapt empirically-supported mental health interventions for delivery in primary and secondary school settings., Competing Interests: Disclosure of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© Springer Nature Switzerland AG 2019.)

Background: The PRIME screen is a self-administered questionnaire designed to quickly assess individuals at risk for developing a psychotic disorder. It is shorter in both length and administration time compared to the Structured Interview for Psychosis-Risk Syndromes (SIPS)-a standard instrument for psychosis prodromal risk assessment. Validation of the PRIME against the SIPS has not been reported in large non-clinical populations., Methods: A culturally modified version of the PRIME screen (mPRIME) was administered to Kenyan youth between the ages of 14 and 29. 182 completed both the SIPS and mPRIME. Validation measures (sensitivity, specificity, positive predictive value, negative predictive value) were calculated and the study sample was then broken down into true positives, false positives, and false negatives for comparison on different quantitative measures., Results: Using previously suggested thresholds for a positive screen, the mPRIME had a sensitivity of 40% and a specificity of 64.8% for our entire sample. Positive predictive value (PPV) and negative predictive value (NPV) were 12.3% and 89.7%, respectively. Breaking the sample down by questionnaire outcome showed that true-positive individuals scored higher on average rate and intensity of endorsement of mPRIME items compared to false-positive and false-negatives, while false-negatives on average registered disagreement on all mPRIME questionnaire items., Conclusions: The mPRIME does not appear to be an effective screener of at-risk individuals for psychosis in our non-clinical sample. Further validation efforts in other general populations are warranted., (© 2014.)

Psychiatric disorders and symptoms are common worldwide. However, cultural differences in symptom manifestation and knowledge of psychiatric terms and concepts represent a challenge to accurate clinical assessment. Our previous youth surveys revealed higher rates of psychotic experiences in Kenya compared to several other countries, suggesting culture may influence psychosis risk assessment survey results. The goal of the present investigation is to evaluate understanding of general mental health related terms and concepts and specific items from the Structured Interview for Psychosis-Risk Symptoms (SIPS), a commonly used psychosis risk assessment instrument. Six focus groups were conducted in Nairobi, Kenya and surrounding areas with young adults from the community, university and secondary school students, and mental health professionals. Analysis of the information obtained from participants indicated that adolescents and young adults in Kenya were aware of mental illness in their communities, but had very limited knowledge of the meaning of specific psychiatric disorders and symptoms. Many believed that the cause of mental illness was spiritual in nature. These results suggest that in order to obtain accurate reported rates of psychiatric symptoms, assessment of Kenyan adolescents and young adults requires elaboration of assessment questions and use of simplified terms.

Psychotic-like experiences (PLEs) have been observed worldwide in both adults and children outside the context of a clinical disorder. In the current study, we investigate the prevalence and patterns of PLEs among children and adolescents in Kenya. Among 1,971 students from primary and secondary schools around Nairobi (aged 8-19), 22.1 % reported a lifetime history of a psychotic experience, and 16.3 % reported this unrelated to sleep or drugs. Psychotic experiences were more common in males compared to females. LCA resulted in a three-class model comprised of a normative class (83.3 %), a predominately hallucinatory class (Type 1 psychosis: 9.6 %), and a pan-psychotic class (Type 2 psychosis: 7.2 %). These results indicate that PLEs are prevalent in children and adolescents, and the distributions of symptom clusters are similar to that found in adulthood. The relationship of specific PLEs to the future development of psychotic disorder, functional impairment or distress will require further study.

Current evidence suggests that there may be significant differences in psychotic symptom prevalence in Africa compared with other cultures. However, there have been few studies evaluating these symptoms in the continent. We conducted a cross-sectional survey of psychotic-like experiences (PLEs) in 2963 Kenyan students from seven tertiary academic institutions spread across Kenya, using a self-administered psychosis questionnaire evaluating psychotic experiences and demographic variables. Logistic regression was used to evaluate relationship between PLEs and demographic variables. Latent class analysis (LCA) was used to determine specific classes of psychotic experiences. Twenty-three percent of respondents reported having at least one PLE, and 19% reported this unrelated to drug use or sleep. Compared to students identifying as Protestant Christians, Catholics had a lower likelihood of having any PLE or visual hallucinations. Other demographic variables were not significantly associated with PLEs. LCA of PLEs resulted in a three-class model that comprised 1) a non-psychotic class (83.8%), 2) a predominantly hallucinatory class ("type I PLE"; 12.7%), and 3) a multiple symptom class ("type II PLE"; 3.5%). Both psychotic classes had a predominance of male students. Further studies are required to clarify functionality and clinical progression associated with observed patterns of psychosis, as well as the generalizability of our findings., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Aim: To document Beck Depression Inventory (BDI) II suicidal symptoms among patients admitted to Kenyan non-psychiatric general medical facilities, Methods: All consenting adults admitted within a period of 4 weeks at 10 general medical facilities in Kenya were interviewed for suicidal symptoms and depression using the BDI-II., Results: In all, 2,780 patients responded to item 9 (suicidal symptoms of the BDI-II). The prevalence of all BDI-II suicidal symptoms combined was 10.5%. Thoughts of 'killing oneself but have not carried them out' accounted for 9% of the suicidal symptoms. The younger age group had the highest prevalence of suicidal symptoms and the oldest age group had the least prevalence of suicidal symptoms. The more depressed the patients were on the overall BDI-II score, the higher the prevalence of suicidal symptoms., Conclusion: On average 1 out of 10 of the patients had suicidal symptoms, more so in younger than the older people and in the more depressed. These symptoms had not been clinically recognised and therefore not managed. This calls for clinical practice that routinely enquires for suicidal symptoms in general medical wards.

There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.

Background: Physical disorders are commonly comorbid with depression in children attending general medical facilities. However, the depression component is rarely recognised., Methods: A questionnaire on sociodemographics and history of presenting medical conditions was administered together with the Children's Depression Inventory (CDI) to all 11-year-old to 17-year-old children attending at nine medical facilities., Results: In all, 408 children were recruited from 9 health facilities. Whereas the clinicians diagnosed a mental disorder in only 2.5% of the sample studied, 41.3% had CDI scores that suggested mild to moderate depression. The highest proportion of children with depressive symptomatology was found at the Kenyatta National and Teaching Referral Hospital., Conclusion: Although prevalence rate for depression among children is high, detection rates remain low. This finding has clinical practice and policy implications within and outside Kenya.