Contextualization and Adaptation of the Child and Adolescent Mental and Behavioural Disorders Module of the mhGAP-IG in Kilifi and Nairobi Counties in Kenya

The Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was developed by the World Health Organization as a key technical tool for delivering evidence-based mental healthcare in non-specialized settings around the world. It requires contextualization and adaptation for local relevance, considering healthcare and resource contexts. However, evidence on adapting the Child and Adolescent Mental Disorders module of the mhGAP-IG is limited. This study involved contextualizing and adapting the Child and Adolescent Mental Disorders module of the 2016 mhGAP-IG through two workshops with local mental health experts and stakeholders. Prior to the workshops, six in-depth interviews were conducted with mental health stakeholders to explore the child and adolescent mental health system contexts in Nairobi and Kilifi. Data were analysed using thematic analysis in NVivo-Lumivero© software. Interviews with mental health stakeholders revealed significant challenges in both counties, including a shortage of mental health specialists, frequent medication stockouts, stigma, and inadequate resources. Key adaptations to the module included using locally acceptable terms such as changing ‘failure to thrive’ to ‘sub-optimal growth’; expanding the training to five days; inclusion of the mhGAP-IG Essential Care and Practice module to address culturally sensitive communication in care provision; streamlining referral pathways; and incorporating aspects of self-harm, suicide, and substance use linked to the child and adolescent mental and behavioural disorders module. Contextualizing the child and adolescent mental disorders module is crucial for effective implementation. However, sustaining its impact will require addressing systemic barriers beyond the capacity-building efforts.