Providing Mental Health Care For Trauma Survivors Using Technology-enabled Solutions: TC4A Advisory Services

The Challenge
Housing more than 350,000 people, Dadaab refugee complex in northeast Kenya is the world’s largest. People at Dadaab have fled deeply traumatic situations, including war and personal persecution. Many suffer psychological effects, ranging from depression to panic attacks, but mental health care can help.  The Center for Victims of Torture (CVT), an international nonprofit, works extensively with displaced people, including those in locations like Dadaab across Kenya as well as in Ethiopia, Jordan and Uganda. 

CVT offers counseling that traditionally is done in person, but Covid-19 made in-person services too risky. CVT approached Tech Care for All to advise them in their search for new solutions that would enable them to provide mental health services remotely using telemedicine. Also, CVT sought a suitable replacement for software they were using to gather initial patient assessment details, a costly product that no longer met their needs.

Tech Care for All Approach
In this assignment, Tech Care for All Kenya began by understanding the population to be served with mental health care. Equally critical was developing a detailed knowledge of the coverage of internet and mobile phone signals in each area (assets that would be necessary to deliver remote counseling), the barriers to mobile and internet access (such as SIM card cost and data costs), and the current patterns in mobile device ownership—considering age, gender and other individual characteristics. Having done a scan across all the countries, the team classified different solutions from the simplest to the most sophisticated. Each option was assessed for local applicability and practicality. 

From phone to WhatsApp to video, even looking at pre-recorded sessions—TC4A and its partner Savannah Informatics applied key criteria like chat/voice features, simplicity of use, and value-add features like recording. The team assessed dozens of products to find those that most fully met the criteria for successful use by CVT for the people it serves.

Realizing that CVT was using paper records, the team further examined each potential solution for its ability to integrate with electronic medical record (EMR) systems and maintain longitudinal patient records. Our resulting report went beyond telemedicine solutions to recommend that CVT add capability to create and store digital records. 

The Result
CVT now offers “tele-mental health”: safe remote counseling services using products designed for each of the specific settings where trauma survivors live. The recommended solutions are ideally suited for  the conditions at hand: phone-based counseling for conflict zones with low broadband connectivity or government surveillance of the internet, for example, and internet-based apps in urban zones. Telehealth has become a normal component of CVT operations in Kenya and elsewhere. This has allowed CVT to reach clients safely during COVID or disturbances due to insecurity.

Going beyond the original scope proposed by CVT, Tech Care for All presented our client with an EMR strategy and recommendations for a simple, safe, secure, interoperable EMR product. Our selection, CommCare by Dimagi, can work with any of the selected telemedicine techs. On the team’s recommendation, CVT engaged Dimagi to pilot CommCare in one of its program locations. Now, CVT is closer to digital patient records across its global programs. Digitalization has been a crucial step in improving efficiency and data protection. 

This assignment yielded a powerful “bonus”:  Telemedicine, beyond its benefits during the pandemic, unlocks access to a far bigger pool of therapists. And the remote treatment may be more comfortable for some clients, as it creates a sense of greater privacy and safety.