ViTAL Chats: Non-Profit Efforts on Mental Health

Welcome back to ViTAL Chats! My name is Jennifer He, the host for the September 2023 podcast. In today’s episode, we’re joined by Mrs. Kim Valente, the CFO of Strong Minds, a non-profit dedicated to revolutionizing mental health in Africa. Strong Minds offers cost-free group therapy to underprivileged women and young individuals in Uganda, Zambia, and Kenya. Since 2013, they’ve helped 230,000 individuals combat depression. Kim boasts two decades of finance industry expertise and joined Strong Minds in early 2015 after earning her MBA from the University of Connecticut and a BS in finance from Providence College. Our discussion today aims to shed light on non-profit careers and strategies to tackle the global mental health crisis.

Non-profit organizations play a crucial role in addressing the mental health epidemic in underprivileged countries. These entities operate with a focus on a social mission rather than generating profits for shareholders. In the context of mental health, non-profits often work to increase awareness, reduce stigma, and provide much-needed mental health services to vulnerable populations. This includes offering counseling, therapy, psychiatric care, and community support. Organizations like Strong Minds may also engage in advocacy and policy initiatives to influence systemic changes that improve mental health care accessibility, funding, and overall support for those struggling with mental health challenges in underserved regions. By leveraging their resources, expertise, and dedication to social impact, non-profits strive to alleviate the burden of mental health issues in disadvantaged communities.

You can listen to this ViTAL Chats episode on our Spotify and Soundcloud channels. If you prefer to read, here is the transcript below –

Keywords:

IPT-G: Interpersonal Therapy — Group; structured and time-limited psychotherapy approach that focuses on interpersonal relationships and communication skills. Main areas to be addressed are grief, interpersonal role disputes, role transitions, and interpersonal deficits.

PHQ-9: Patient Health Questionnaire-9; self-report tool for measuring the severity of depressive symptoms in individuals. Consists of 9 questions based on 9 criteria for major depressive disorder, as outlined in the DSM-5.

Burden Scale: a tool designed to measure perceived burden/distress experienced by individuals.

Jennifer: Welcome back to ViTAL chats, the podcast for ViTAL, Northeastern’s Health Care Innovation Core. I’m one of your hosts, Jennifer. Today, in our first episode from the Fall semester, we are speaking with Mrs. Kim Valente, the Chief Financial Officer at the non-profit, Strong Minds, an organization committed to transforming mental health in Africa. Strong Minds provides free group therapy to low-income women and adolescents in Uganda, Zambia, and Kenya, and since 2013, Strong Minds has treated 230,000 people suffering from depression. Kim has over 20 years of experience in the finance industry, and she joined Strong Minds in early 2015. Kim has an MBA from the University of Connecticut, and a BS in finance from Providence College. With our time today, we hope that this episode will give you guys an insight into a career in the non-profit world, as well as how the mental health epidemic that spans across the globe can be addressed.

Jennifer: Hi, Kim. Thank you for joining us here at ViTAL chats today. To start off, could you tell us a little bit about yourself?

Kim: Sure, Jennifer, my undergrad, as you mentioned, was in finance. I had always had an interest, though, in nonprofit. I started my career in banking, and after getting my MBA, I had a number of years spent in private equity and venture capital which was really interesting, and it gave me a lot of insight into startup ventures. Flash forward. A few years after that I had an opportunity when our family moved to switch careers. I had an interest in nonprofit for many years, and, in fact, when I was in graduate school I did an independent study in nonprofit management. So, taking my business experience and my startup experience, I shifted into the nonprofit industry, working for a small business enterprise center and managed a micro-loan program that was a part of usually those programs that are situated on college campuses. But this one was a little bit different, and that it was at a faith-based institution. But in any event, worked with a number of entrepreneurs on writing their business plans, getting their businesses up and going and helping them get loans for their businesses. Our family moved, and I had an opportunity to switch again, and I knew I wanted to do something international. My graduate degree was in finance and international business, and I wanted to try to marry both. With my business experience, my interest in nonprofit, and my interest in international business, I came upon Strong Minds. We’re in very early stages, and I won’t go into all the details about strong minds. But that was my path.

Jennifer: Hmm! It sounds like your academic background really led to your position and your experience. I’m curious. How did your interest in nonprofits begin?

Kim: I would say, when I was in my teens? As most teens, you’re encouraged to volunteer in your community, help others, kind of expand beyond yourself and in your school and work or sports. So I started to volunteer in my community, and I saw very directly the impact that you can have when you look kind of outside yourself, and how you can help others.

Jennifer: How did Strong Minds come about? Could you tell us a little bit more about that?

Kim: Sure. So the founder of strong minds, had been a career diplomat. Switched out of that, had been working for the State Department, switched out of that, and was working for a number of nonprofits in the leadership capacity. He had family members who were suffering from depression, and when he was doing his work in Africa, he saw that people were clearly suffering from depression, you know, is familiar with kind of what it looked like and what some of symptoms and so on.

He noticed that there was really no support for those folks, no resources. Especially the poorest of the poor folks in the slums, and so on. So he set about to find a solution to address that he knew it had to be something that would be effective in the context of the African culture. He spent a number of years researching, and he came across a study that was done jointly by some academics at Johns Hopkins and Columbia, that was published in 2,003 that talked about the use of group interpersonal psychotherapy in Uganda, and it showed that it was highly effective in helping people with their depression. So he realized, that one of the individuals who helped found Group Interpersonal Psychotherapy [JH1] (IPT-G) lives right in New York City, and as I mentioned was one of the authors of the paper from Columbia University, so he reached out to them and learned more about how Group Interpersonal Psychotherapy was used in Uganda and started to connect with some individuals who were involved in that study. Back in 2003 there were some people who had been trained by the researchers to run the therapy, and that’s how we started. We started in 2014 and still running. By then, we had 5 individuals who are running groups of therapy.

The amazing thing about group interpersonal psychotherapy is that it can be facilitated by normal people. You don’t need to have a psychology degree or anything like that. In fact, today we can train people who are illiterate to run groups, and I’ll get more into that later. But our initial team consisted of 5 mental health facilitators. So again, running groups, we collected the data from those groups and that was our work with those initial groups.

The results were, you know, people were coming out quote unquote, “depression free” in their depression scores. We’re highly favorable. So we use a tool called the PHQ-9[JH2] . There’s a number of different tools out there that have been approved by the World Health Organization, for example, diagnostic tools, and the PHQ-9 is one of them. That’s our primary tool, so we use that tool to assess people for depression.

We use it again when they start depression treatment, and then we use it at the end of their treatment. So baseline, and end line. We collect all that data, and we’re able to use that data to iterate our model and develop it further. And I’ll talk more about that, too.

Jennifer He: Sounds good. I’m curious. When finding your clientele, the recipients of these therapies, do you go into those communities to look for people who may need them, or do they sign up?

Kim: Right. So when we first started with those 5 mental health facilitators I mentioned, they used to go into the communities. When you go into the communities in a country like Uganda, you very much have to work with the local leaders in either the village or the district and help them understand what you’re trying to do and get them to support what you’re doing. So the mental health facilitators would go into the communities, talk with those officials, and then try to bring together a large group of people, and they would conduct some psycho-education, so provide some basic education on depression. You know what the triggers are, what the signs, and symptoms are. And from that people would be able to say, hey, you know. I think that might be me. I think I may have an issue with depression, or I may know somebody, a neighbor, a brother, a sister, somebody who may be suffering.

And that’s how they would get referred or come to the facilitators to get the full assessment. We’ve evolved over time and reach out to people in a number of different ways. Now, we have radio spots, our mental health facilitators, and we determined that that’s not really the highest and best use of their time, so we hire mobilizers to go into communities and do that initial psycho education.

Those are some of the primary ways. Now, it’s a little bit different in Uganda. You also have, you know, you can pay for trucks that go by with a bullhorn, and, you know announce our services to people or, you know, [put up] posters and signs in the community. There’s a variety of very grassroots initiatives that are taken to direct people to our services.

Jennifer: Wow! That’s very cool. I feel like that process is slightly different than the way we do things here. As you mentioned this earlier, I thought it was really interesting that you could get illiterate people to be group leaders. Seems like over here, you’d need a lot of training to do something like that. Could you expand on that?

Kim: Yes. So when we first started out, it was only our staff that were facilitating groups. Now, if we want to scale, we realize that that would not be cost effective, and that it would be a lot of work to train and employ an army of mental health facilitators. So the first thing we did the first iteration was, we realized that there were people who had [already] received the therapy. Coming out of that, they were so overjoyed with the experience that they had and the help that they were able to get, that they wanted to be able to help their peers.

So if you can imagine a woman, you know, who’s living in the slum of Uganda she receives our depression treatment. She comes out better she’s able to start earning some money. She’s able to start sending her children to pay school fees and send her children to school, and then she’s in the community and she wants to help her community, so we can train them to run groups. We have a number of visuals that we use in those communities. For example, there’s a thing, a tool we use called the Burden [JH3] Scale, which is an image of a person with a big sack of rocks. That they’re carrying over their shoulder. And so there’s a number of different pictures, essentially stages of this person with a sack of rocks and in one they’re standing up and they’re managing. And at the other end of the spectrum, they’re really hunched over. They really, you know, can’t move, you can tell they’re in pain. So that’s, for example, a tool that a group will use to kind of identify. Each individual in the group will go around and they’ll say where they are on the burden scale, and they’ll be able to point to that tool. There’s some other visual tools that we use, which helps the facilitators.

Another thing that’s different is that those communities are very song oriented so we can train them using song and they often will use that, and their groups will kind of sing about, you know, some of the triggers or some of the lessons that they’ve learned, so it helps them recall what they’ve learned.

Jennifer: Wow! That’s like, “the healing power of music”. That’s very cute. Our next question is, you know, lately we’ve been hearing a lot about how the COVID-19 pandemic has changed a lot of things changed a lot of companies, nonprofits, and the way things work. So I was wondering if that affected your work at all, and if so, how did you overcome them?

Kim: Hmm! It did. It did. So, as I mentioned, part of our focus is that Strong Mind is to be cost effective. Because the more cost effective we are, the more people we can treat. So just before the pandemic we base our costs on our cost per patient. So how much does it cost all in for us to treat one person? Our cost per patient before the pandemic was ~110. Depending on the program, we have a number of slight iterations in how we were delivering our services. And that was the full organization costs divided by the number of patients that were fully treated. When the pandemic hit, we had to pivot very quickly, and we moved to teletherapy. So it took a little bit of time to go through that and set up, and the best we could do is set up a closed user group, so it’d be a facilitator in 5 individuals.

As you might imagine, the poorest individuals in Uganda, they don’t have the latest iPhone. So they’re not doing zoom therapy on their phones. They have flip phones, and oftentimes they’ll share a phone amongst a couple of people and just swap out SIM Cards. We were able to treat people, but not as many people as we would have liked given some of those constraints, and even the people that we were able to reach sometimes as a challenge because they didn’t have access to their phone. They were sharing with others. They didn’t have airtime. Their airtime reception wasn’t cooperating where they were located. So, there were a lot of challenges in that.

We did take the learnings from that, and we were hoping to innovate further on that teletherapy and continue to develop it as one of our channels for delivering our services. But it just became apparent to us that given the current technology. And like, I said, where people in Uganda are with their cell phone, their personal cell phone technology, it just wasn’t cost effective. Our cost per patient delivering that way was about a hundred $48 a person. And you know, we’ve really iterated our program since the pandemic, so that $110 that I mentioned for in person therapy before the pandemic, we now have that down to about $60 per person. So when we compare $60 per person, and we have ambitions to drive that down even further compared to the $148 for teletherapy. Teletherapies are just not cost effective for us, so we’ve put it on the back burner for now, and hopefully, as technology improves and more individuals have access to cell phones and cell reception is better in the countries where we operate, that may be an option.

Jennifer: That’s very cool!

Most of our listeners are health science majors and other majors that are maybe not related to healthcare, but they’re also personally interested in the field. I was wondering, hearing about the rapid changes that are occurring in the mental health, the research field right now, the new developments, the new exploration into treatment types, what are your goals within the next few years or so? Or maybe in the next decade. I know you’re doing the IPT-G therapy. Are you exploring other methods perhaps?

Kim: No, great question. So, when we first started with IPT-G and what the study suggested that I mentioned from back in 2020- sorry, 2003, was that therapy would be 16 weeks long, and an hour and a half for each session. Now again, if you’re focusing on cost effectiveness, that’s a lot of time for a facilitator to be running a group.

So, as I mentioned, we’re very data driven. So one of the questions that we start to ask because we noticed, would notice, you know, people would drop off after a number of sessions. We said to ourselves- is 16 weeks really necessary? Maybe people are getting what they need from fewer sessions. So over time, we’ve brought that down to 12 weeks. We brought it down to 10 weeks. Then we brought it down to 8. This year we’re doing 6 weeks. and it’s still equally effective. There’s some other ways that we’re manipulating the therapy. There’s 4 main triggers for depression that can be treated through IPT-G. Now, if we organize people by their triggers, can we reduce that even further if you get a group of people together, and they’re all suffering from depression that’s been triggered by grief? You’re able to kind of address, with fewer sessions, to that particular trigger.

So that’s another innovation that we’re looking at. We’re also looking at single session therapy. There’s been some initial research done that shows that that can be effective as well. In fact, we launched an innovation lab last year, so you know, it’s had some fits and starts, I will say, but you know those are some of the early iterations to our model that we’ve had outside of just the therapy itself. We’re thinking creatively about how to scale our operations, so, as I mentioned before, you know, we started using peers, so people who were formally individuals that we treated former clients. We’re now working with the Ministries of Health and Education in Uganda and Zambia, so each country is a little different. But there’s generally what you may hear refer to is community health workers or village health teams. They may be volunteers, or they may be on stipend. Individuals who work with the health system, for example. and we’ll train them on how to run groups. And in the education setting, we’re training teachers and guidance counselors at schools on how to run groups.

So those are ways that we’re scaling, and that is proving highly effective. And we’re also working with partners, so other nonprofit organizations training either their staff or their program beneficiaries to run groups as well. We’re working on our plans for 2024, and we’re looking to treat 335,000 individuals next year, so that’s really exciting. As you mentioned, we’re in Uganda, we started in Zambia in 2019.

We’ve done a few programs, mostly through… I’m sorry. Not a few programs. We’ve worked with a number of partners in Kenya. That’s how we’ve been in Kenya. We don’t have an office there yet. But we’re looking to expand geographically, so possibly an office in Kenya next year. Ideally, an office in West Africa in 2024. We have partners that we’re working with in Nigeria, so that may lead to something there. And then we’ve we’re also doing a partnership up in Ethiopia. So those are other areas that we’re looking to expand in Africa, but we have greater visions. Beyond that, we want to be global. We’ve tried to launch in America. So at the beginning of 2022, we started Strong Minds America, that is proved very challenging. You know it’s a little bit disappointing, quite honestly, that our society here is so litigious.

We’re trying to form partnerships with academic institutions too, so that we can focus on adolescents and young adults. And the challenges that we’re running up against are just getting a basic memorandum of understanding to be able to treat adolescents and young adults for free. It’s proving very difficult. We’ve also seen some resistance amongst the adolescents and young adults. We’ve started to try to operate in Newark, New Jersey. Inner city youth. And it’s been a challenge to get them to show up: we can diagnose them with depression, but to actually have them embrace that they’re coming for group therapies is also pretty challenging. So we’ll see. You know, we’re hoping to continue in that our effort in America will be successful.

Jennifer: Yeah, that’s really interesting, to hear that the adolescents are resisting. Do you have any guesses as to why? Because I assume that going to a professional, you know, like established place right now would incur a lot of charges.

Kim: Right? Exactly. But I think they’re just hesitant to go in general. Particularly in in Newark, the demographics are such that they’re very distrustful of outsiders, if you know if people aren’t from their community, and I think it’s education. You know, we’re trying to do more more than we’ve had to do in Africa in terms of psychoeducation. We’re doing a lot of tabling events at health fairs. We’re trying to, you know, be a presence at some of the schools that we have partnered with already to have, you know, to be able to talk to the youth there and help them understand what we’re offering. So hopefully, we’ll make some progress when school’s back in session. Obviously. So, this is pushed over the next couple of months.

Jennifer: You mentioned earlier, going back to the Africa work that you do, the cost per patient and the training that you do, the money that you have to pour into that… I was wondering, if it’s appropriate for me to ask, where the funding comes from. Besides donations, do you get government funding?

Kim: Of course. Yeah. Good question. Just so everybody knows, all nonprofits have to file a tax return called a 9 90. And if you Google, any organization that you think you might be interested in. You can see their financial information on that form 990. So it’s a good resource to have. If you’re doing research on a nonprofit and want to know more about them. Oftentimes, nonprofits will also provide their audited financial statements on their websites. And that’s another great resource. We’re very transparent. We pride ourselves on being transparent.

Most of our funding does come from small to mid-sized foundations, probably about 70%. About 25% comes from individual donors, and then the rest is through partnership. So we have a broad spectrum of partners. Some partners pay us to come and help get programs set up at their organization. And sometimes you know, we’re going in and just offering and paying for our team to train staff at other nonprofits. So those are our main sources of funding, and it actually ties back to… you know what I talked about before about data? Donors today are very data focused and impact focus. They want to see that their dollars are producing impact, and they want to see the data that supports that impact.

So that’s one thing you know, we also focus on in addition to cost per patient making sure that our impact is solid. We’re looking to do a random control trial study next year to again demonstrate the effectiveness of what we’re doing in a more rigorous fashion.

Jennifer: It’s very cool. What you mentioned about the culture at Newark got me thinking about this in the context of Africa. I’m sure the women and the adolescents there they face a different set of cultural values, and changes that are happening to the world. Just a few weeks ago it was unbearably hot, so in terms of the climate change issues and how that affects them- I read an article on your website about how the floods have changed things and created environmental stress. Could you talk about that?

Kim: Yes, you know, we’ve seen that happen more recently with, you know, the terrible flooding that took place. You know Uganda is based right on the equator, so they don’t generally see a lot of variation in their climate. And the flooding that occurred, you know they do have a rainy season, but you know, that was probably that was definitely on the extreme end for them.

But to be honest, beyond that, I mean, it’s something that’s on our radar to look at. You know how climate might be affecting the people that we treat and it’s definitely an area that we’re gonna be looking to going forward. But to say that we’ve, you know, done very much in that area at the moment, we haven’t.

Jennifer: Many of our listeners are aspiring leaders, I would say, in health care in the mental health world. I know that you’re a leader at the nonprofit. So I was wondering if you had any advice to share to those of us?

Kim: I would definitely say keep your eyes open, be open to new opportunities. Even if you think it may not be so specifically related to what you’re doing at the moment. It may end up providing a benefit in the end, you know, the more you can expose yourself to different disciplines. You know I have my finance side of things, but I also took the time to take a Grant writing course, for example, so that I could understand that side of the business. So that’s just that’s just one example, you know. And you look at things like, how our CEO got this organization started. it’s interesting to see how this study was done in 2003, and it was an amazing opportunity for somebody to take and kind of run with that. But it basically sat on the shelf for 10 years until our CEO came along and found that and realized that something could be done with it.

So definitely, there’s things of the research that the students at Northeastern are doing, you know, something big could come up with that, you never know.

Jennifer: Okay. For our last question: say that there are listeners among us that are really interested in nonprofit as you started out, or somebody listened to this podcast and decided that nonprofit really excited them. What would you say you would recommend for them to get started? to get to know more about just the nonprofit industry specifically?

Kim: Well like I said, if there’s an organization, then volunteer if you have time here, or there, if you have a passion for something. I know when I first came across Strong Minds, and I saw what the organization was trying to do, it just made so much sense to me that there was such a void and such a need for these services. So, from that standpoint, it really struck a chord for me. And I think one thing that you’ll definitely find amongst people who work in nonprofit clique, is that they’re very passionate about the mission of their organization. So if there’s something that that you’re passionate about, I would say definitely, you know, lean into that and see where it may take you and like I said, there’s a number of ways to research various organizations and learn about what they’re doing.

So you know. There, there’s a lot of information out there.

Jennifer: Sounds good. That’s really helpful information for us, and I know this will be very inspirational for all of our listeners.

Jennifer: We really appreciate the work that you’re doing, and that you came here today to talk to us, so thank you again for joining us today!

Kim: Thank you, Jennifer.

Thank you for listening. To learn more about ViTAL and stay updated with our events, you can follow us on social media @vitalnortheastern, and check for updates on our website, www.northeastern.edu/vital.