For more than a decade, Eve Puffer has traveled to western Kenya to train church and community leaders to support neighbors who are struggling with family and relationship issues, a key part of her work to address yawning gaps in the availability of mental health care in sub-Saharan Africa.
But even as she made those trips, Puffer, an assistant professor of psychology, neuroscience and global health, imagined that the models might have some value in places like the United States. After all, even wealthy countries struggle to provide timely and equitable access to mental health services.
As it turns out, COVID-19 provided both the need and the opportunity for Puffer to bring her work closer to home.
A few months into the pandemic, with her work in Kenya stalled by travel restrictions, Puffer received an email from Wendy Prudhomme-O’Meara, DGHI’s associate director for research. “DGHI was interested in taking what faculty were learning in low- and middle-income countries and seeing what could be beneficial locally during the pandemic,” says Puffer. “Our work, which is designed to be very community-based and delivered with few resources, seemed like a good candidate.”
With funding from DGHI and Duke’s Bass Connections program, Puffer teamed with Rae Jean Proeschold-Bell, a global health professor who has strong partnerships in the local community, to create Coping Together, a peer-led therapy model aimed at helping families who are running on empty after more than a year of pandemic disruptions. Working with groups such as Durham’s Together for Resilient Youth and West End Community Foundation, the team has trained facilitators chosen from the community to lead an eight-week program for families to address stress, strengthen coping techniques and improve family communication. They hope to enroll up to 50 families from Durham and surrounding communities in the sessions, which started in May.
“COVID has put such a strain on families, and disparities in mental health care became even more prominent,” says Puffer. “We are seeing this as a way to help families reboot — to help them work together to get back to normal, maybe even a better new normal.”
From Kenya to Durham
Coping Together is built on the same core principles as Puffer’s work in Kenya, where only about 100 trained psychiatrists serve a population of 44 million people. Recognizing that very few Kenyans can access traditional family therapy, Puffer’s team drew on research showing that community members can be trained to provide therapeutic support. Working with Kenyan collaborators, her team has developed tools to teach community leaders how to counsel families struggling with conflict, violence and other relationship issues.
Although the U.S. has comparatively more mental health resources, the pandemic has exacerbated disparities in access to care, particularly among Black, Latino and rural populations. “Peer or lay provider models are a proven way to address the overwhelming demand for family support services, especially during this ongoing global crisis,” says Amber Rieder, a postdoctoral researcher on Puffer’s team.
But training community facilitators is more than just convenience. It’s about building trust and credibility with the families the program aims to serve.
“Usually, it’s an institution hiring people to come in and do this work, and I don’t know about the success of that,” says Wanda Boone, founder of Together for Resilient Youth, a Durham-based community coalition that will co-lead some of the Coping Together sessions. “With this, because it’s embedded within the community and has full community participation, I think that is really going to be what makes the difference.”
Boone says she was sold on the program after watching a video from an intervention in Kenya, in which a mother lays a large cloth on the ground to create a space for an open conversation with her daughter.
“I thought, this is what resilience in the community looks like,” she says. “I see this as setting down the fabric in a living room and learning how to come together.”
Weathering the Storm
Puffer’s team launched Coping Together after surveying parents in 17 southern states to learn how they were faring during the pandemic. Led by Rieder and graduate students Savannah Johnson, Justin Rasmussen and Kaitlin Quick, the study painted a despairing reality: More than 50 percent of parents reported symptoms consistent with depression, and three-quarters said they were worried about the deteriorating emotional states of their children.
The results did not surprise community partners such as Dosali Reed-Bandele, executive director of Durham’s West End Community Foundation. She relates a conversation she had with a man in her community who was struggling to keep his young grandchildren motivated in school and engaged in healthy activities.
“He told me, I just need help,” Reed-Bandele says. “Emotionally, our families are going through a lot. Everyone is at home, and so they don’t even necessarily have outlets to get away and relieve the stress.”
With such stories in mind, the team has built an emphasis on coping into the small-group meetings, which will teach healthy ways of dealing with stress and conflict. Proeschold-Bell, an expert on positive emotions, has designed family activities that elicit feelings of hope and gratitude, setting a tone for openness to growth and change. Facilitators will drive home the importance of family communication and mutual support during tough times.
“Just the phrase – Coping Together – really resonated with me,” says Reed-Bandele. “Togetherness is what we are all about here at West End.”
The need for those affirmative skills will of course outlive the pandemic, and Boone hopes the program will, as well. “I don’t see it ending at the end of eight weeks,” she says.
Puffer also has plans to bring the reciprocal innovation full circle. Two of her doctoral students have received a Bass Connections Student Research grant to incorporate aspects of the Coping Together program back into the Kenyan model that inspired it.
And, as the mother of two young children who has been juggling work and family demands herself, Puffer will also strive to model the program’s stress-management skills in her own life. “I’ve been using all the coping strategies we’re putting in the manual,” she says.