Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model Eve S. Puffer 1,2 & Elsa A. Friis-Healy 1,2 & Ali Giusto 1,2 & Sofia Stafford 2 & David Ayuku 3 # Springer Nature Switzerland AG 2019 Abstract The large burden of mental health disorders among young people worldwide calls for scalable prevention and treatment models that reach children and families in low-resource settings. This paper describes the development of an evidence-informed family therapy intervention designed for lay counselor delivery in low-resource settings and presents findings on the feasibility and acceptability of implementation in Kenya. Qualitative data guided the development of a components-based family therapy that integrates multiple strategies from solution-focused and systems-based therapies, as well as those from parenting skills training and cognitive behavioral therapies. Eight lay counselors delivered the intervention, with 10 families completing treatment. Lay counselors demonstrated adequate fidelity and clinical competency when treating families with a wide range of presenting clinical problems. Unique elements of the implementation model proved feasible and acceptable, including recruiting Bnatural^ lay counselors from communities already engaged in informal counseling for families; participants indicated trust and respect in the counseling relationship that facilitated their participation. Both counselors and families reported positive perceptions of intervention content and strategies, including those least similar to local counseling practices. Results support the potential of this implementation strategy that aims to add evidence-based practices to local practices and routines rather than creating new cadres of lay counselors or health workers. Supervision, provided by psychology student trainees, also proved feasible and mutually beneficial, with phone-based supervision as acceptable as in-person meetings; this suggests the potential feasibility of this model for use in remote locations. Future directions include integrating these delivery approaches into existing social structures to develop and evaluate a comprehensive implementation model for scale-up. Keywords Global mental health . Family therapy . Task shifting . Africa . Low- and middle-income country Introduction With mental health and substance use disorders as the leading cause of disability for children and adolescents worldwide, the need for developing scalable models for prevention and treat- ment is clear (Erskine et al. 2015; Kieling et al. 2011). Within the broader field of global mental health, much progress has been made on adapting, developing, and testing innovative strategies for providing appropriate and evidence-based care in extremely low-resource settings. Systematic approaches for cultural adaptation of interventions (Bernal et al. 2009), feasible methods of measures validation (Bolton 2001), and successful models of task shifting to non-professionals (van Ginneken et al. 2013) are among the influential tools researchers and practitioners now have in order to develop and evaluate effec- tive treatments. In low- and middle-income countries (LMICs), the most progress in this endeavor has been for individual-level treatments for adults (Lund et al. 2012; World Health Organization 2010), though there also is a growing body of literature supporting prevention and treatment strategies for child and adolescent mental health problems in these settings. These include individual-level and some school-based interven- tions that have demonstrated efficacy in reducing symptoms of children’ s emotional and behavioral problems (Fazel et al. 2014; Klasen and Crombag 2013). * Eve S. Puffer eve.puffer@duke.edu 1 Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC 27708-0086, USA 2 Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA 3 College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya Global Social Welfare https://doi.org/10.1007/s40609-019-00151-6