(PS9-31) Insights from Lay Counselor Experiences with Delivering Trauma-focused Cognitive Behavioral Therapy in Western Kenya: Exploring the Role of Structural Factors

Background: Mental health providers who deliver trauma-focused services are at a relatively high risk for developing secondary traumatic stress (STS) and burnout; lay counselors without formal mental health training in low and middle-income countries (LMIC) are especially vulnerable. Much work has emphasized the importance of lay counselors in increasing access to trauma-focused interventions, but less is known about their experiences in this role across both personal (e.g., STS, burnout, compassion satisfaction) and structural (e.g., leadership support, workplace climate) domains. Prior research largely highlights workplace organizational factors such as high-quality supervision, strong and competent leadership, and respectful and collaborative work environments as key to STS and burnout mitigation and satisfaction promotion. The present study explored lay counselor experiences in western Kenya delivering a culturally modified version of Trauma-focused Cognitive Behavior Therapy (TF-CBT), specifically their levels of burnout, STS, and satisfaction as well as their perspectives on structural factors.



Methods: All data in the present study were collected for a stepped wedge, cluster randomized controlled trial evaluating the adapted TF-CBT for youth in two Kenyan government sectors: the education sector via teacher delivery and health sector via community health volunteer delivery. Lay counselors (N=240) completed surveys post-implementation, which included measures of STS, burnout, and compassion satisfaction on a 5-point scale and structural factors such as workplace climate (e.g., morale, communication) and leadership support for intervention implementation on a 4-point scale, and logistical support (e.g., transportation, equipment, resources) on a 5-point scale. We report means (M) and standard deviations (SD). 

Results: Descriptive analyses revealed low levels of STS (M = 1.40, SD = 0.54) and burnout (M = 1.53, SD = 0.52) and high compassion satisfaction (M = 4.59, SD = 0.48) among lay counselors in our sample. Counselors also reported positive evaluations of workplace climate (M = 2.93, SD = 0.47), implementation leadership support (M = 3.25, SD = 0.74), and logistical support (M = 4.27, SD = 0.41).



Discussion: These findings provide insight into the current landscape surrounding lay counselor experiences. On average, counselors reported that their organizations foster positive workplace culture, display strong leadership, and offer logistical support for service delivery. In line with prior work, these results support the idea that lay counselors have low rates of burnout and STS and high satisfaction when they feel that workplace structural factors cater toward their needs. Future research should explore which structural factors are most consistently and strongly related to counselor personal outcomes and how those factors can feasibly be improved in settings where various types of lay counselors deliver trauma-focused interventions both domestically and globally.