The Ladder to Family Communication

If there's one thing that is straightforward in psychology, it's treatment for phobias. If a child (or adult) is scared of a dog, we help them create a hierarchy of anxiety-provoking stimuli related to dogs: 1) picture of a dog, 2) looking at a dog in a cage, 3) petting a dog....etc. They can then climb the "bravery ladder" to conquering their fear of dogs. This process of exposure usually works because the individual gradually habituates to the feared stimuli such that they no longer need to worry about or to avoid the feared experience (or animal).

It's the subtle frightening tasks in life that are a bit more difficult to conquer - a shy adolescent boy asking someone out on a date, a people pleaser saying no when she's feeling overwhelmed. It's often the difficult aspects of communication that are most frightening in our relationships.

Exposure is one central intervention strategy in READY. We are attempting to guide participants to climb a "bravery ladder" towards more open, effective family communication about topics that are often avoided - finances, emotions, and sexuality (including issues related to HIV/AIDS). We begin with very brief family communication exercises that emphasize expressing positive thoughts and feelings about family relationships. We then progress to more difficult conversations throughout the intervention.

Jessica Pian, our research coordinator, taught our intervention team about exposure therapy and its relationship to the READY intervention.

 This week we had our first READY session that emphasizes the importance of family communication and begins discussion of financial issues in families. Here are some families beginning to climb the ladder.

Reflective Listening...Does it translate?

In my clinical psychology training, I spent hours learning how to listen and how to show others I am listening. My classmates and I role played, we were videotaped with clients, we received detailed feedback on tone of voice, posture, and word choice.

In our READY intervention, we teach listening and communication, largely through our facilitators modeling reflective listening when instructing families together and when facilitating the youth and caregiver support group components. So our first week of facilitator training looks a bit like my first year of graduate school – listening instruction, practice, feedback…repeat.

This is a video of two facilitators practicing restatement, reflection of feelings, and validation of feelings.

There’s only one catch. I train them in English – but the intervention occurs in Luo (the local language).  How easy is it to apply newly learned clinical skills in another language? Do direct translations work? What are the best Luo phrases for letting someone know you understand and empathize? What is it like to discuss sex and HIV risk in Luo? I typically ask the team to practice first in English and then in Luo. Afterwards, I asked them some of these questions. 

These are a few of their comments about aspects that are easier in their own language, but words related to sex and HIV that are sometimes a bit too strong in their native tongue. 

HIV prevention in churches?!

When I describe the READY program to colleagues, they are often surprised that we chose churches as our site for the intervention, especially when they learn that READY promotes condom use. "Will they let you talk about that?!" Yes.

We chose churches for several reasons: (1) Our formative surveys showed that most adolescents attend church regularly, (2) Churches are the most organized social structures we identified in Muhuru that include women and youth (e.g., community meetings held by Chiefs and other social gatherings are often attended by men only), and (3) Pastors and other church leaders are widely respected as role models and sources of social support in the community. 

When we piloted the program in February, churches showed willingness and openness to HIV prevention education in their churches. We allowed the church leaders to decide whether or not we could include information about condom use. To facilitate conversations about this and other issues where religious beliefs could conflict with the content of READY, READY includes church leader discussion groups each week before the session. These discussions relate to the topics planned for the week, and leaders are encouraged to debate and think through the issues and to decide what can be presented to their church. These discussion groups are led by a pastor from the community who is also a trained READY facilitator. 

Many leaders were reluctant to talk about condoms at first, but all came to the conclusion that they wanted to face the reality that many youths are not remaining abstinent - and that condoms were a good option in order to save their lives. After pastors decided to allow teaching about condoms, we also asked them to be the ones to introduce the topics to their churches. We are hopeful that church leaders will reach the same conclusions in the full intervention trial we are starting now. 

We completed recruitment in the 4 randomly selected churches this week. All of the churches welcomed us, and we spent a lot of time singing and dancing with them in addition to registering families into the program. Spending time with these congregations made me excited about starting the intervention in a couple weeks! Here are a few pictures from our visit to a church this weekend. 

Giving the Luo translation of what READY means

Scheduling survey times

Zilpa and Jessica scheduling

Beautiful view on our walk back to the car