O2071: Evaluation of a Community Mental Health Program for Adolescent Girls in Western Kenya- an International Community Access to Child Health (ICATCH) Project

Background: Insufficient treatment and resources dedicated to adolescents suffering from mental health (MH) and substance use disorders lead to poor health and life outcomes. The World Health Organization recognizes this significant treatment gap of about 75% in Low- and Middle-Income Countries. Several factors contribute to these gaps including budgetary allocation for services falling below 1% of the national health budget. Work Her Dream Organization (WHDO), established in 2016, works with adolescent girls experiencing physical, emotional, and sexual abuse in Kamukunji slums in Eldoret Kenya. WHDO provides a safe space, sexual, reproductive and MH education, and links to education scholarships. In 2019 services were expanded focusing on social support, MH screening and care for the girls who attended our education sessions.

Methods: Free adolescent MH program offers psychological health empowerment to adolescent girls ages 10-24. Demographics, MH assessment scores and referral information were collected. WHDO offers 1) prevention-focused programming using sensitization 2) MH screening, adapting the PHQ9, GAD7, ASSIST questionnaires for depression, anxiety, substance use, suicidality, and PSQ is administered by a psychiatrist if questions for psychosis are positive 3) care including psychoeducation, individual, family and group therapy, and life skills training 4) psychiatry referral if needed. The program includes home visits, group education, and once monthly special events such as art therapy, sensitization, and community outreach. Education topics included life skills, MH, and self-care, facilitated by volunteers with expertise in these areas. Psychotherapy is offered on a volunteer basis by certified psychologists.

Results: A total of 5800 adolescent girls ages 13 to 20 were registered between 2020 and 2022. 4100 (70.6%) were screened for MH conditions. and linked to healthcare services specifically for medication treatment and/or management of withdrawal symptoms or psychosis. Of those screened, 22.3% were diagnosed with depression, 12.6% with active suicidal ideation, 15% with generalized anxiety disorder, 4.6% with substance use disorder and 10.3% with psychosis. 15% of participants had more than one diagnosis. Care offered included psychotherapy in the WHDO Safe Space and psychiatric and trauma support through our local government hospitals. Having supportive family and friends was associated with improved retention in the program; attendance was most adversely affected if parents had a substance use disorder or if girls had paid work that conflicted with program scheduling.

Conclusion: MH remains a significant health concern for adolescent girls in Kamukunji, including under-recognized substance use disorders. Our open, free, community-based program offers education, safe spaces, and linkages to MH services. Our community-based approach may improve health seeking behaviors for adolescent girls and raise awareness of the importance of MH. Adolescent friendly safe spaces encourage utilization of MH services in communities where stigma is high, and MH is deprioritized. Final program evaluation is ongoing to determine program effectiveness.