Culturally Adapted Spiritually Oriented Trauma-Focused Cognitive-Behavioral Therapy for Child Survivors of Restavek

Restavek is a form of modern-day slavery that is estimated to affect 300,000 (i.e., approximately 1 in 10) children in Haiti. It typically involves a child from a poor rural family being sent to work as an indentured domestic servant for an affluent urban family. Restavek children experience a high rate of trauma, as well as other mental health concerns.The present study explored the effectiveness of a culturally adapted form of Spiritually Oriented Trauma-Focused Cognitive-Behavioral Therapy (SO-TF-CBT), a treatment model for assessing and treating religious and spiritual issues within the standard TF-CBT protocol (an evidence-based treatment for childhood trauma). This study involved 20 control participants and 38 treatment participants assigned to a 12-session protocol. The primary research question of the present study is whether a culturally adapted SO-TFCBT intervention, relative to a control, would lead to a reduction in posttraumatic stress symptoms among child survivors of Restavek in Haiti. Because SO-TF-CBT also targets potential religious and spiritual issues related to trauma, a secondary research question examined the effects of this intervention on participants' tendencies to experience spiritual struggles. In the interests of better addressing the mental health treatment gap among this population in Haiti, our study also investigated, as a secondary goal, whether this treatment could be effectively delivered by people with less formal mental health training. Specifically, we examined three distinct delivery methods: (a) community- based lay counselors, (b) NGO staff volunteers, and (c) undergraduate students from a local university.

Data File

Cases: 58
Variables: 121
Weight Variable: None

Data Collection

Date Collected: 2015

Funded By

This survey is part of a larger grant from the John Templeton Foundation entitled "Earth as a School: Finding Meaning, Relating to God, and Experiencing Growth After a Natural Disaster" (#44040).

Collection Procedures

All participants received pretreatment assessments and those designated to receive treatment were assigned to one of three treatment groups-led by lay counselors, NGO staff volunteers or student volunteers. Initially, treatment started with 28 counselors and 58 children; at the end of the 12-week treatment, 24 counselors and 38 children remained. Several children could not complete the treatment because of external factors such as displacement. Two of the four counselors did not complete the program because of their children dropping out of the program; the two other counselors dropped out because of life situations not related to the program. Because of many interruptions that occurred throughout the delivery of the program (e.g., national holidays, teacher strikes, national exams, a Chikungunya mosquito-borne viral epidemic), some participants required up to six months to complete the treatment program, at times receiving more than one session per week.

Sampling Procedures

The children who received treatment in our study were recruited from the Restavek Freedom Foundation residential program, the local community (these children were assisted by RFF staff), and elementary schools (in conjunction with a school program led by an RFF collaborator) in Port-au-Prince, Haiti. The control group consisted of children recruited from the same elementary schools as those represented in the treatment group; they had been specifically identified by schoolteachers and/or school administrators as having experienced some form of trauma (physical or sexual). For the treatment group, participants' age ranged from 6 to 20 years old, gender was predominantly female (68 percent), and self-reported religious affiliation was predominantly Catholic (29 percent) and Protestant (68 percent). For the control group, participants' age ranged from 10 to 17 years old, gender was also predominantly female (60 percent), and self-reported religious affiliation was again predominantly Catholic (35 percent) and Protestant (45 percent).

Principal Investigators

David C. Wang, Rosemead School of Psychology, Biola University; Jamie D. Aten and David Boan, Graduate School and Humanitarian Disaster Institute, Wheaton College; Wismick Jean-Charles and Kathylynn Pierre Griff, Centre de Spiritualité et de Santé Mentale (CESSA), the Université Notre-Dame d'Haiti; Viola C. Valcin, Graduate School and Humanitarian Disaster Institute, Wheaton College; Edward B. Davis, Graduate School, Wheaton College; Joshua N. Hook, Department of Psychology, University of North Texas; Don E. Davis, College of Education, Georgia State University; Daryl R. Van Tongeren, Department of Psychology, Hope College; Tania Abouezzeddine, Quyen Sklar, and Anna Wang, Rosemead School of Psychology, Biola University.

Related Publications

Wang, David C., Aten, Jamie D., Boan, David,Jean-Charles, Wismick, Griff, Kathylynn Pierre, Valcin, Viola C.,Davis, Edward B., Hook, Joshua N., Davis, Don E., Van Tongeren, Daryl R., Abouezzeddine, Tania, Sklar, Quyen, Wang, Anna. 2016. "Culturally adapted spiritually oriented trauma-focused cognitive-behavioral therapy for child survivors of restavek." Spirituality in Clinical Practice. 3(4):224-236.