Fostering Resilience for Durham Families During a Stressful Time
December 2, 2021
By Milena Ozernova ’22
This story starts in Kenya, nearly eight thousand miles from Durham, North Carolina. For the last 13 years, Duke professor and licensed clinical psychologist Eve Puffer has been working to strengthen the well-being of Kenyan families who are struggling with unemployment, food insecurity and other challenges.
After more than a decade of research, Puffer and her colleagues launched Tuko Pamoja (“We’re together” in Swahili), a church-based intervention for families in rural Kenya that aims to improve family relationships and promote mental health among adolescents and caregivers.
“We know how powerful family influence can be on a child’s mental health,” Puffer explained. “By providing family-based interventions, we can improve family functioning and impact the mental health of the children and caregivers.”
Tuko Pamoja includes nine group sessions taught in a religious congregation (approximately 70 percent of Kenyans practice Christianity) focused on building communication skills as well as practicing emotional support and conflict resolution.
While the program was successful in improving family resilience and communication, Puffer and her team realized that their intervention didn’t meet the needs of families experiencing severe distress. The researchers set out to develop a family counseling model that provides home-based services for individual families.
“[The second intervention] combines family therapies and mental health therapies that are evidence-based but adapted for the context,” Puffer said. “Families receive the specific modules that they need to work on the relationships in which they are experiencing problems.”
Families that participated in the Tuko Pamoja pilot saw considerable improvement in their mental health, communication and caregiver-child relationships. However, before the team had a chance to combine both interventions and run a larger trial in Kenya to implement their program, the COVID-19 pandemic put this work on pause.
At the same time, the United States has been experiencing a mental health crisis of its own. Of the approximately 11 million Americans needing mental health services each year, 5.5 million do not receive access to any mental health service at all (based on 2016 figures). The pandemic, coupled with the ongoing legacies of social injustice and systemic racism, have exacerbated the crisis. Over the span of a few months in 2020, millions of people lost their loved ones and their financial security, all while having to care for their children or elderly parents.
“I have been home with my two children for nearly 250 days,” one parent wrote to the team. “My youngest has not had the first year of life that I imagined and my oldest is missing out on friends and school.”
Puffer and her team started researching whether the Tuko Pamoja model could be translated for families in the United States, starting with Durham. Rae Jean Proeschold-Bell then also joined the team. This was when the Coping Together project was born.
To adapt their Kenyan initiative to the realities of North Carolina, Puffer and her team collaborated with local partners Together for Resilient Youth (TRY) and West End Community Foundation, with Dr. Wanda Boone, director of TRY, co-leading the overall project. Puffer, Amber Rieder and Proeschold-Bell also led a Bass Connections team of undergraduate and graduate students who were a good fit for the new project.
Puffer, Boone and Rieder shared updates at a recent Wednesdays at the Center event, organized by the John Hope Franklin Center at Duke and the Duke Center for International and Global Studies, and cosponsored by Bass Connections and Duke Global Health Institute.
The team adapted Tuko Pamoja to meet the needs of Durham families, recruited community workers and designed an eight-session counseling program to improve families’ mental health and strengthen personal relationships. Bass Connections team members helped adapt Coping Together for virtual delivery, created multimedia content and assisted with the cultural and linguistic contextualization of the original model. Once the Coping Together pilot was complete, facilitators began their virtual counseling sessions with 16 Durham families in the summer of 2021.
Similar to the positive outcomes seen in Kenya, the initiative has been successful with families in Durham. Most participants experienced an increased level of communication and a newfound sense of closeness among family members. Couples improved their relationships, siblings became closer and caregivers began to feel more hopeful.
Bass Connections team member Savannah Johnson, a doctoral student in psychology, suggested that children could write a letter to their ‘before Coping Together self’ as an opportunity to reflect on the changes they experienced over the course of the program.
“[Children] were asked to think back to who they were before they started the program and write a letter in a way that explains to their past selves what they would learn along the way,” Rieder said. “The letters that they wrote were very reassuring.”
As Puffer and her team prepare to launch the next round of Coping Together in Durham, they are hopeful that they can continue to improve the mental health intervention so it can better serve communities in Kenya and North Carolina.
Duke University senior Milena Ozernova is a Bass Connections communications assistant majoring in Political Science. Milena loves to travel around the world, write articles on the issues that matter to her and the student community, and take photographs of street cats.