Strengthening Families Across Contexts: Multidirectional Learning (2024-2025)


Adverse mental health outcomes pose a significant risk to global populations, and inequitable access to treatment and affordable alternatives exacerbates this risk across countries and economic contexts. Low- and middle-income countries (LMICs) often have particularly limited access to treatment and prevention options given the cost of care and stigma associated with clinical treatments. Additionally, minoritized racial and ethnic groups in high-income countries (HICs) like the United States experience worse mental health status and treatment outcomes due to systemic oppression.

To address these significant health gaps, it is essential to have cross-country collaboration. While interventions must be culturally specific, innovations across contexts play a crucial role in enhancing mental health outcomes in both HICs and LMICs. Since clinical mental health care is often associated with high costs and stigma, family-based interventions delivered by trusted community health care workers have proven to be affordable and acceptable models for improving mental health.

Working closely with community partners in Eldoret Kenya, this multiyear team has developed and run a family-based mental health program in Kenya, Tuko Pamoja, that was subsequently adapted for communities in North Carolina during the COVID-19 pandemic. The Coping Together program, which is based in Durham, is now expanding to address the specific needs of Latinx community members in the Triangle.

Going forward, there is a continued need to evaluate and refine these programs and develop additional innovative, multidirectional interventions that can be adapted to different countries and contexts to further combat the global mental health crisis. 

Project Description

This project team will address global mental health inequalities through three family-based interventions: Coping Together-Latinx, Coping Together-Durham and Tuko Pamoja (Eldoret, Kenya). While each intervention is at a different phase of development and implementation, the team will work to generate community, multidirectional learning and mentorship across the programs and develop and disseminate information at the intersection of all interventions.

  1. Coping Together-Latinx (Adaptation Design, Development and Testing): This subteam will work on designing and adapting the Coping Together intervention for Latinx families. Team members will finalize the intervention and prototype it with community members to receive feedback. They will create an adapted manual and materials, gather and evaluate human-centered design and prototyping data, and develop manuscripts and presentations sharing their work.
  2. Coping Together-Durham (Planning and Measurement): This subteam will focus on improving recruitment and implementation strategies according to community partners’ recommendations. Team members will work on finalizing the implementation design, collecting feasibility study data and developing recommendations on equity-driven recruitment and implementation.
  3. Tuko Pamoja (Randomized Controlled Trial): This subteam will conduct a randomized controlled trial to determine intervention effectiveness and implementation outcomes. Team members will collect and assess baseline data, write up a results paper, and develop recommendations on supervising randomized controlled trials for family interventions.

Students across subteams will have the unique opportunity to explore and receive training in methods involved in each of these three stages. Ultimately, this team will formalize a multidirectional model between projects, with each subteam pushing each initiative forward in community with each other.  

Anticipated Outputs

Website to communicate progress and cross-project innovations; data for future grants; manuscripts and commentaries; local and national presentations

Student Opportunities

Ideally, this project team will include 3-4 graduate students and 6 undergraduate students from across disciplines that have prior experience or deep interest in mental health and the development of psychosocial interventions, health disparities in the Latinx community, community-engaged research, implementation science, qualitative or mixed-methods research, and/or experience with web design or other communication mediums. Fluent Spanish-speakers are strongly encouraged to apply. 

Undergraduate students will receive training in data collection and management, randomized controlled trials, intervention implementation and supervision, fostering community partnerships, parallel mixed-methods analysis, monitoring and evaluation, cultural adaptations to interventions and dissemination of findings (e.g., conference presentations and manuscripts). All undergraduate students will have opportunities to participate in all aspects of their subteam projects and will have the chance to learn about and be involved in other subteam activities as desired.

Graduate students will have opportunities to mentor undergraduates at earlier training stages. They will also lead data analysis and co-author manuscripts with support from other team members. All team members will meet weekly to develop group cohesion, instruction and planning. Subteams will also meet together to advance the individual goals of their projects.

In Fall 2024, the team will meet on Fridays from 10-11 a.m.

This project team has an optional component during summer 2024. Summer work will be flexible based on student availability. This component will span from May through August, and students will be invited to work up to 10 hours per week.


Summer 2024 – Spring 2025

  • Summer 2024 (optional): Analyze initial feedback data on Coping Together-Latinx intervention; seek IRB approval for prototyping the Coping Together-Latinx intervention; support grant writing; meet with community partners to determine Coping Together-Durham implementation plan; recruit participants for Tuko Pamoja
  • Fall 2024: Adapt Coping Together-Latinx materials according to feedback; recruit Latinx families for a prototyping study; support manuscript writing; compose an implementation plan for Coping Together-Durham; recruit families for Coping Together-Durham; continue participant recruitment for Tuko Pamoja
  • Spring 2025: Implement the prototyping study for Coping Together-Latinx; collect baseline data for Coping Together-Latinx, collect baseline data for Coping Together-Durham; collect baseline data for Tuko Pamoja; analyze baseline data across all three projects; support manuscript writing


Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Coping Together: Reducing Mental Health Disparities for Latinx Families (2022-2023).


Image: Latino Read 915, by US Department of Education, licensed under CC BY 2.0

Image: Latino Read 915, by US Department of Education, licensed under CC BY 2.0

Team Leaders

  • Eve Puffer, Arts & Sciences-Psychology and Neuroscience
  • Justin Rasmussen, Arts and Sciences–Psychology and Neuroscience–Ph.D. Student
  • Maeve Salm, Duke Global Health Institute

/yfaculty/staff Team Members

  • Irene Felsman, School of Nursing
  • Gabriela Nagy Carrasquel, School of Medicine-Psychiatry and Behavioral Sciences
  • Rae Jean Proeschold-Bell, Duke Global Health Institute
  • Allison Stafford, School of Nursing

/zcommunity Team Members

  • Together for Resilient Youth (TRY)
  • University of Wisconsin-Milwaukee, EQUITY Research Group
  • Florence Jaguga, Moi Teaching and Referral Hospital
  • Edith Kwobah, AMPATH
  • Wilter Rono, Laikipia University