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Integrating Mental Health Services into the Haitian Educational System to Provide Care to At-Risk Youth: An NIMH R 21 Pilot Study in Haiti’s Central Plateau.

TITLE OF PRESENTATION:

Integrating Mental Health Services into the Haitian Educational System to Provide Care to At-Risk Youth: An NIMH R 21 Pilot Study in Haiti’s Central Plateau

PRESENTERS:
Eddy Eustache, MA; Georges Erick Alexis; Yoldie Alcindor

PRESENTER NAME AND TITLE: Father Eddy Eustache, MA 

Professional Title: Director, Mental Health

Organization: Zanmi Lasante (Haiti)

Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti

Email Address: Eeustache@pih.org

Phone Number:

Haiti: +509-37017431

US: 617-835-1892

Brief Presenter Biography:

Father Eddy Eustache is a psychologist and priest who has worked at Zanmi Lasante since 2005. He is Director of Mental Health for Zanmi Lasante. While training to become a priest, Pere Eddy became very interested in becoming a physician.  However, under his bishop’s request, he decided to hold off and complete his theological and philosophical studies, and upon completion of his studies Pere Eddy took a job as a high school chaplain. During his time at the school, it became very clear to him that the many issues facing the students could not be addressed by the existing school counseling system. He realized that in the youth’s issues could not solely be addressed with his spiritual skills, but also required a sophisticated psychological skill set. Pere Eddy soon thereafter received a scholarship from the Sisters of the Holy Cross to study in Canada, where he received his Master in Counseling Psychology. After his studies, he was hired at Holy Cross School in Haiti as a school psychologist.  He then left in 2005 to work for Catholic Relief Services (CRS), providing psychological support to staff exposed to violence following the coup d’état in Haiti in 2004.  While at CRS, Pere Eddy met Fernet Leandre, who told him about Zanmi Lasante’s work to provide health care to the poor.  Pere Eddy joined ZL, where he was exposed to the vulnerability and mental health issues of those living in poverty.  Pere Eddy wished to provide care with the utmost dignity, and his work was driven by the goal to instill hope in the populations with whom he worked.  He provided psychological support to those with depression, individuals affected by HIV, and those who felt their well-being was put in danger due to their poor circumstances. Pere Eddy’s passion lies in combining the provision of social services with mental health services, and empowering those who are vulnerable and suffering from mental disorders to be able to recover and reclaim their lives. Pere Eddy is, along with Anne Becker, MD PhD MS, of Harvard Medical School, Principal Investigator for the R 21 research project entitled, “Developing research capacity for mental health interventions for youth in Haiti”, Brain Disorders in the Developing World, National Institutes of Mental Health (NIMH). This work develops local institutional capacity for mental health implementation research in Haiti within the Zanmi Lasante health care system, while also implementing and evaluating a school-based pilot program to promote access to care for Haitian youth with mental disorders. 

ADDITIONAL PRESENTERS:

2) Georges Erick Alexis

Professional Title: Program Coordinator, NIMH R 21 Project

Organization:Zanmi Lasante

Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti

Email Address:eryl281@hotmail.com

Phone Number:

Haiti: +509-37172340

Brief presenter biography:

Georges Erick Alexisis the research coordinator for NIMH R 21 project entitled Developing research capacity for mental health interventions for youth in Haiti.

3) Yoldie Alcindor

Professional Title: Psychologist, Cange, Haiti

Organization:Zanmi Lasante

Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti

Email Address: yoldie@gmail.com

Phone Number:

Haiti: +509-38549331

Brief presenter biography:

Yoldie Alcindor is a Psychologist serving at Cange, Haiti.

Background: Many people, particularly the youth of Haiti, suffer from problems related to mental health but often do not have access to mental health services. Many emotional and behavioral problems have been observed among the youth of Haiti after the earthquake such as: high risk behavior, rape, and the inability to get along well with their peers. Neither parents nor teachers know how to appropriately manage or address mental health behavior problems in youth. Many times teachers and parents resort to more harsh methods including beatings and more severe punishments. These students then perform worse, are marginalized due to low performance and have a negative impact in the community. Zanmi Lasante (ZL) has worked in collaboration with Harvard Medical School to develop a program that aims to target teenage youth and provide adequate mental health care services at schools. This program seeks to 1) develop local institutional mental health research capacity at the Haiti-based organization, ZL, through community-based needs assessments, didactic seminar based training, and a practicum that encompasses design, implementation, and evaluation of a novel school-based youth mental health pilot intervention in central Haiti; 2) assist teachers to approprately manage situations among students who have behavioral and emotional difficulties; and 3) integrate mental health services into the school system.

Methods: To date, we have conducted focus group discussion (FGD) interviews with fivegroups of respondents comprised of Haitian educators and parents of students (n=33). The FGDs were co-facilitated by two Haitian mental health professionals in the local language, Haitian Kreyol, with an open-ended, semi-structured interview guide. Probe questions were designed to engage local knowledge and experience regarding the burden and impact of mental illness in school-going Haitian youth. The interview questions also sought responses to inform the development of a planned pilot school-based task sharing intervention designed to promote youth access to mental health supports and services when needed. Our systematic evaluation of thematic content prioritizes understanding educator observations of behavioral and emotional problems as well as perceived causal attributions and impact. In addition, we have identified perceived solutions and suggestions for locally feasible, desirable, and effective approaches to training teachers.

Results: Our work to date has augmented mental health research capacity at ZL, collaborative research capacity between Harvard Medical School (HMS) faculty and ZL, and a research culture at ZL. Specifically, the HMS and ZL/PIH teams have collaborated in developing a curriculum for mental health research study design, methods, analyses, data management, the ethical conduct of health research, and important cross-cultural issues in mental health assessment and interview data collection. We delivered intensive didactic training to 33 Haitian health and educational professionals in January 2012. A mental health research curriculum was subsequently distributed among these trainees, as an enduring resource, and is suitable for future use by other health professional trainees in Haiti. Moreover, the engagement of six trainees–Haitian health professionals–in mentored research will further strengthen the infrastructure, resident expertise, and culture for mental health research at ZL. The team has begun to develop curriculum materials to train Haitian educators in recognizing, responding to, and referring students with mental health needs which will be used in the implementation phase of this study.

Conclusions: Preliminary analysis from this work has (1) identified how educators perceive and understand emotional distress among school-going youth; (2) confirmed enthusiasm by educators to participate in a proposed intervention that includes specific training to equip them with skills to understand and respond to youth at-risk for depression and PTSD; and (3) collated specific suggestions for shaping an effective intervention. Future work will focus on completion of focus groups and piloting of a teacher mental health curriculum.

BRIEF DESCRIPTION OF SESSION

Zanmi Lasante (ZL) has worked to develop a program that aims to target teenage youth and provide adequate mental health care services at schools, by developing local institutional mental health research capacity at the Haiti-based organization, ZL, assisting teachers to approprately manage situations among students who have behavioral and emotional difficulties, and integrating mental health services into the school system.

Learning Objectives

  1. Learn about the particular challenges faced by adolescents with mental disorders in secondary school
  2. Learn about the three R’s: an approach to help teachers to Recognize, Respond, and Refer to care, school-going adolescents with mental disorders
  3. Understand how a collaborative research approach benefits the development of interventions for youth in Haiti, and the development or research capacity within a local organization

MODE OF PRESENTATION

Panel Presentation:  Friday June 07, 2013 (45- to 50-minute long)

TARGET AUDIENCE

Mental Health Providers
Medical Providers
Educators/School Administrators
Paraprofessionals
Policymakers/Legislators

Legal/Juvenile Justice Personnel
Administrators
Students
Faith-Based Organizations
Community Leaders
General Public

Other

KNOWLEDGE LEVEL: Introductory (useful for professionals/students new to this field, or non-mental health professionals)

AUDIO VISUAL EQUIPMENT: LCD Projector/Computer

 

ACCOMMODATION REQUEST: None