Thesis advisor: Theresa Betancourt / Families in low- and middle-income countries (LMICs) face significant mental health and psychosocial care gaps. In recent years, researchers and practitioners have addressed these gaps by task-sharing evidence-based mental health and psychosocial support (MHPSS) interventions to nonspecialist community providers. Task-shared interventions have demonstrated effectiveness (improvements in MHPSS outcomes of intervention participants); however, quality of delivery (fidelity and competence) has rarely been examined as a factor associated with effectiveness despite implementation science models suggesting a causal link between quality of delivery and effectiveness. In this study, I apply a mixed methods approach to examine the quality of delivery by nonspecialists who are facilitating an evidence-based, early childhood development and family violence prevention program, known as Sugira Muryango, in Rwanda. Currently, Sugira Muryango is being expanded and implemented through the Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) Collaborative, which scales up Sugira Muryango to 10,000 households living in extreme poverty in Ngoma, Nyanza, and Rubavu districts. The program has strong ties to the Rwanda National Government and their social protection and policy goals. I find that nonspecialist age is significantly associated with higher initial fidelity and competence scores and smaller improvements in fidelity and competence over time. In addition, nonspecialists in Nyanza district were more likely to have higher initial fidelity and competence scores but also see smaller changes over time. Fidelity and competence were found to significantly co-vary. Multi-level growth models revealed that fidelity was not a significant predictor of changes in any child discipline outcomes or of any responsive caregiving outcomes. However, competence significantly predicted changes in some responsive caregiving practices, specifically acceptance and learning materials, and it predicted decreases in physical punishment. In semi-structured interviews, the nonspecialists provided examples of using skills such as rapport-building, empathy, and active listening to deliver Sugira Muryango effectively. Nonspecialists also provided examples of barriers to quality of delivery, including compensation and technology issues. Overall, this dissertation contributes empirical evidence to what we understand theoretically and moves towards development of best practices for monitoring and supervising nonspecialists in task-shared MHPSS interventions. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Since the start of the Syrian war, Jordan has received many Syrian refugees with around 650,000 Syrians now residing in the country. As the state has received a lot of help from the international community, funding refugee camps and providing basic necessities, a lot of international humanitarian practitioners have come to Jordan to work alongside Jordanian and Middle Eastern practitioners. The situation therefore has brought practitioners from different academic, professional and geographical backgrounds together to work with people of a different cultural background than their own. Syrians represent a vast diversity in terms of ethnic, religious, linguistic and socio-economic backgrounds. Research have addressed that practitioners’ sensitivity to how cultural complexities may influence social problems can facilitate a better understanding of the client’s path to recovery. The purpose of our study was to increase the knowledge of mental health and psychosocial support practitioners’ understanding and experience of a culturally sensitive social work in Amman, Jordan and discuss how this affects their practice with Syrian refugees. Through qualitative interviews we found that the practitioners’ perception of Arab culture as one and the same makes culture a non-issue in terms of cultural diversity, and that this perception influence the practice with Syrian refugees in a number of ways.

Mental Health and Psychosocial Support is a growing field of intervention in humanitarian assistance worldwide. The influence of culture and faith in individual and collective coping mechanisms and recovery processes has brought scholars to emphasize the need for MHPSS programming to adopt a cultural and faith sensitive approach to increase the cultural relevance and efficacity of interventions. However, despite official guidelines for humanitarian agencies to integrate cultural and faith sensitivity in their operations, there is an information gap on designing such an approach and its effects on the implementation and success of interventions. This qualitative study explores the opportunities and challenges encountered when adopting a cultural and faith sensitive approach within MHPSS interventions in the context of the Red Cross in Zambia, Ghana, Niger, and South Africa. Based on in-depth interviews with key informants from the Red Cross, the results provide insights into the strengths and opportunities of adapting to local cultural norms and practices and cooperating with faith-based and traditional community leaders during the implementation of MHPSS. The study concludes on the potential of such an approach to strengthen the local capacities of faith-based actors and reduce the stigmatization of mental illness.