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Al Sager A, Goodman SH, Jeong J, Bain PA, Ahun MN. Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:656-669. [PMID: 39142740 DOI: 10.1016/s2352-4642(24)00134-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social-emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848. FINDINGS We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social-emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (-0·18 [-0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results. INTERPRETATION Multi-component parenting and mental health interventions had a positive effect on child cognitive and social-emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Alya Al Sager
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Social and Behavioural Sciences, College of Public Health, Kuwait University, Kuwait City, Kuwait
| | | | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA USA
| | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
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2
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Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Mulushoa A, Demissie M, Deyessa N, Howard LM, Hanlon C. Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia. Psychother Res 2024; 34:538-554. [PMID: 37384929 DOI: 10.1080/10503307.2023.2222899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. METHOD We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model". RESULTS Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. CONCLUSION Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.
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Affiliation(s)
- Roxanne C Keynejad
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Education and Behavioural Sciences, Injibara University
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia
- Mental health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Adiyam Mulushoa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Buitrago DCC, Rattner M, James LE, García JFB. Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300032. [PMID: 38253391 PMCID: PMC10906549 DOI: 10.9745/ghsp-d-23-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024]
Abstract
Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.
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Affiliation(s)
- Diana Carolina Chaparro Buitrago
- Department of Global Health, McMaster University, Hamilton, Canada.
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Michel Rattner
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
- Palo Alto University, Department of Psychology, Palo Alto, California, USA
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Pedersen GA, Elnasseh A, Bhattacharya B, Moran L, Neupane V, Galea JT, Contreras C, Pfeffer KA, Brown A, Sangraula M, Luitel N, Kohrt BA. Practitioners' perspectives on preparing for and delivering remote psychological support in Nepal, Perú and the United States during COVID-19. Psychol Psychother 2023; 96:849-867. [PMID: 37294035 PMCID: PMC10709530 DOI: 10.1111/papt.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has propelled a global paradigm shift in how psychological support is delivered. Remote delivery, through phone and video calls, is now commonplace around the world. However, most adoption of remote delivery methods is occurring without any formal training to ensure safe and effective care. OBJECTIVE The purpose of this applied qualitative study was to determine practitioners' experiences of rapidly adapting to deliver psychological support remotely during COVID-19. DESIGN We used a pragmatic paradigm and applied approach to gain perspectives related to the feasibility and perceived usefulness of synchronous remote psychological support, including views on how practitioners can be prepared. METHODS Key informant interviews were conducted remotely with 27 specialist and non-specialist practitioners in Nepal, Perú and the USA. Interviewees were identified through purposeful sampling. Data were analysed using framework analysis. RESULTS Respondents revealed three key themes: (i) Remote delivery of psychological support raises unique safety concerns and interference with care, (ii) Remote delivery enhances skills and expands opportunities for delivery of psychological support to new populations, and (iii) New training approaches are needed to prepare specialist and non-specialist practitioners to deliver psychological support remotely. CONCLUSIONS Remote psychological support is feasible and useful for practitioners, including non-specialists, in diverse global settings. Simulated remote role plays may be a scalable method for ensuring competency in safe and effective remotely-delivered care.
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Affiliation(s)
- Gloria A. Pedersen
- The Center for Global Mental Health Equity, The George Washington University
| | - Abdelrhman Elnasseh
- The Center for Global Mental Health Equity, The George Washington University
| | - Bani Bhattacharya
- Milken Institute School of Public Health, The George Washington University
| | | | | | - Jerome T. Galea
- School of Social Work, University of South Florida
- Department of Global Health and Social Medicine, Harvard Medical School
| | - Carmen Contreras
- Socios En Salud Sucursal Perú
- Harvard Global Health Institute, Harvard University
| | | | - Adam Brown
- Department of Psychology, The New School for Social Research
- Department of Psychiatry, New York University School of Medicine
| | | | | | - Brandon A. Kohrt
- The Center for Global Mental Health Equity, The George Washington University
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Rahman A, Malik A, Atif N, Nazir H, Zaidi A, Nisar A, Waqas A, Sharif M, Chen T, Wang D, Sikander S. Technology-assisted cognitive-behavior therapy delivered by peers versus standard cognitive behavior therapy delivered by community health workers for perinatal depression: study protocol of a cluster randomized controlled non-inferiority trial. Trials 2023; 24:555. [PMID: 37626428 PMCID: PMC10463295 DOI: 10.1186/s13063-023-07581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The lack of trained mental health professionals is a key barrier to scale-up of evidence-based psychological interventions in low and middle-income countries. We have developed an app that allows a peer with no prior experience of health-care delivery to deliver the cognitive therapy-based intervention for perinatal depression, the Thinking Healthy Programme (THP). This trial aims to assess the effectiveness and cost-effectiveness of this Technology-assisted peer-delivered THP versus standard face-to-face Thinking Healthy Programme delivered by trained health workers. METHODS We will employ a non-inferiority stratified cluster randomized controlled trial design comparing the two formats of intervention delivery. A total of 980 women in the second or third trimester of pregnancy with a diagnosis of Major Depressive Episode, evaluated with the Structured Clinical Interview for DSM-V Disorders (SCID), will be recruited into the trial. The unit of randomization will be 70 village clusters randomly allocated in a 1:1 ratio to the intervention and control arms. The primary outcome is defined as remission from major depressive episode at 3 months postnatal measured with the SCID. Data will also be collected on symptoms of anxiety, disability, quality of life, service use and costs, and infant-related outcomes such as exclusive breastfeeding and immunization rates. Data will be collected on the primary outcome and selected secondary outcomes (depression and anxiety scores, exclusive breastfeeding) at 6 months postnatal to evaluate if the improvements are sustained in the longer-term. We are especially interested in sustained improvement (recovery) from major depressive episode. DISCUSSION This trial will evaluate the effectiveness and cost-effectiveness of a technology-assisted peer-delivered cognitive behavioral therapy-based intervention in rural Pakistan. If shown to be effective, the novel delivery format could play a role in reducing the treatment gap for perinatal depression and other common mental disorders in LMIC. TRIAL REGISTRATION The trial was registered at Clinicaltrials.gov (NCT05353491) on 29 April 2022.
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Affiliation(s)
- Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Waterhouse Building, Block B First Floor, 1-5 Dover Street, Liverpool, L69 3GL, UK.
| | - Abid Malik
- Health Services Academy, Islamabad, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - Ahmed Zaidi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Anum Nisar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Ahmed Waqas
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Waterhouse Building, Block B First Floor, 1-5 Dover Street, Liverpool, L69 3GL, UK
| | - Maria Sharif
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Siham Sikander
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Waterhouse Building, Block B First Floor, 1-5 Dover Street, Liverpool, L69 3GL, UK
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Pedersen GA, Shrestha P, Akellot J, Sepulveda A, Luitel NP, Kasujja R, Contreras C, Galea JT, Moran L, Neupane V, Rimal D, Schafer A, Kohrt BA. A mixed methods evaluation of a World Health Organization competency-based training package for foundational helping skills among pre-service and in-service health workers in Nepal, Peru and Uganda. Glob Ment Health (Camb) 2023; 10:e55. [PMID: 37854401 PMCID: PMC10579647 DOI: 10.1017/gmh.2023.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/09/2023] [Accepted: 08/04/2023] [Indexed: 10/20/2023] Open
Abstract
Health systems globally demand more competent workers but lack competency-based training programs to reach their goals. This study evaluates the effectiveness of a competency-based curriculum (EQUIP-FHS) for trainers and supervisors to teach foundational helping knowledge, attitudes and skills, guided by the WHO/UNICEF EQUIP platform, to improve the competency of in-service and pre-service workers from various health and other service sectors. A mixed-methods, uncontrolled before-and-after trial was conducted in Nepal, Peru, and Uganda from 2020 to 2021. Trainees' (N = 150) competency data were collected during 13 FHS trainings. Paired t-tests assessed pre- to post-change in ENACT competency measures (e.g., harmful, helpful). Qualitative data was analyzed using thematic analysis. EQUIP-FHS trainings, on average, were 20 h in duration. Harmful behaviors significantly decreased, and helpful behaviors significantly increased, across and within sites from pre-to post-training. Qualitatively, trainees and trainers promoted the training and highlighted difficult competencies and areas for scaling the training. A brief competency-based curriculum on foundational helping delivered through pre-service or in-service training can reduce the risk that healthcare workers and other service providers display harmful behaviors. We recommend governmental and nongovernmental organizations implement competency-based approaches to enhance the quality of their existing workforce programming and be one step closer to achieving the goal of quality healthcare around the globe.
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Affiliation(s)
- Gloria A. Pedersen
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
| | - Pragya Shrestha
- Program Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Josephine Akellot
- Uganda Country Office, Programs Department, HealthRight International, Kampala, Uganda
| | | | - Nagendra P. Luitel
- Program Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Rosco Kasujja
- School of Psychology, Department of Mental Health, Makerere University, Kampala, Uganda
| | - Carmen Contreras
- Socios En Salud Sucursal Perú, Lima, Peru
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Jerome T. Galea
- School of Social Work, University of South Florida, Tampa, FL, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Vibha Neupane
- Program Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Damodar Rimal
- Program Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Alison Schafer
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
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Barnett ML, Puffer ES, Ng LC, Jaguga F. Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States. Glob Ment Health (Camb) 2023; 10:e26. [PMID: 37854408 PMCID: PMC10579690 DOI: 10.1017/gmh.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/06/2023] [Accepted: 04/29/2023] [Indexed: 10/20/2023] Open
Abstract
Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.
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Affiliation(s)
- Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Eve S. Puffer
- Department of Psychology and Neuroscience, Global Health Institute, Duke University, Durham, NC, USA
| | - Lauren C. Ng
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
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Pedersen GA, Pfeffer KA, Brown AD, Carswell K, Willhoite A, Schafer A, Kohrt BA. Identifying Core Competencies for Remote Delivery of Psychological Interventions: A Rapid Review. Psychiatr Serv 2023; 74:292-304. [PMID: 36475826 PMCID: PMC9988705 DOI: 10.1176/appi.ps.202100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The COVID-19 pandemic led to a rapid shift toward remote delivery of psychological interventions and transition to voice-only and video communication platforms. However, agreement is lacking on key competencies that are aligned with equitable approaches for standardized training and supervision of remote psychological intervention delivery. A rapid review was conducted to identify and describe competencies that could inform best practices of remote services delivery during and after the COVID-19 pandemic. METHODS Scopus, MEDLINE, and PsycINFO were searched for literature published in English (2015-2021) on competencies for synchronous, remote psychological interventions that can be measured through observation. RESULTS Of 135 articles identified, 12 met inclusion criteria. Studies targeted populations in high-income countries (11 in the United States and Canada, one in Saudi Arabia) and focused on specialist practitioners, professionals, or trainees in professional or prelicensure programs working with adult populations. Ten skill categories were identified: emergency and safety protocols for remote services, facilitating communication over remote platforms, remote consent procedures, technological literacy, practitioner-client identification for remote services, confidentiality during remote services, communication skills during remote services, engagement and interpersonal skills for remote services, establishing professional boundaries during remote services, and encouraging continuity of care during remote services. CONCLUSIONS These 10 skills domains can offer a foundation for refinement of discrete, individual-level competencies that can be aligned with global initiatives promoting use of observational competency assessment during training and supervision programs for psychological interventions. More research is needed on identification of and agreement on remote competencies and on their evaluation.
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Affiliation(s)
- Gloria A. Pedersen
- Division of Global Mental Health, Department of Psychiatry
and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600,
Washington, D.C. 20037, USA
| | - Kendall A. Pfeffer
- Department of Psychology, The New School for Social
Research, 80 5 Avenue, 6 Floor, New York, NY10003,
USA
| | - Adam D. Brown
- Department of Psychology, The New School for Social
Research, 80 5 Avenue, 6 Floor, New York, NY10003,
USA
- Department of Psychiatry, New York University School of
Medicine, 1 Park Avenue, New York, NY 10016, USA
| | - Kenneth Carswell
- World Health Organization, Department of Mental Health and
Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ann Willhoite
- UNICEF Headquarters, Child Protection in Emergencies; Child
Protection, Programme Division, 3 UN Plaza New York, NY 10017, USA
| | - Alison Schafer
- World Health Organization, Department of Mental Health and
Substance Use, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry
and Behavioral Sciences, George Washington University, 2120 L St NW, Suite 600,
Washington, D.C. 20037, USA
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Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, Felton JW. Behavioral Activation Disseminated by Non-Mental Health Professionals, Paraprofessionals, and Peers: A Systematic Review. Behav Ther 2022; 54:524-538. [PMID: 37088508 DOI: 10.1016/j.beth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
There is a striking disparity between the number of individuals with significant mental health concerns and those who are able to access care globally. One promising solution to expanding the mental health taskforce is task-sharing, or employing nonspecialists in the delivery of evidence-based interventions. Behavioral activation (BA), a brief intervention that focuses on scheduling rewarding activities into one's daily life, may have promise for delivery using task-sharing approaches due to its straightforward, flexible nature. The aim of this systematic review was to examine the current state of the literature on non-specialist-delivered BA and evaluate the evidence base of this approach. Three databases (Pubmed, PsycInfo, and Cochrane) were searched, and all articles were screened for inclusion criteria by two research assistants, included the review of titles, abstracts, and full-text. The final dataset consisted of 13 research studies, represented through 15 articles. A meta-analysis was conducted to examine the overall pooled effects of peer-delivered BA on depressive symptoms (the most widely examined clinical outcome). Studies reported on effectiveness and implementation outcomes of non-specialist-delivered BA for depression, substance use, loneliness, trauma survivors, and individuals with comorbid physical health conditions. Results provide initial support for the effectiveness of BA utilizing a task-sharing approach, and highlight the feasibility and acceptability of using nonspecialists to deliver BA in a variety of contexts, including low-resource settings.
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Affiliation(s)
| | - Tessa Hampton
- Center for Health Policy & Health Services Research, Henry Ford Health
| | | | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health
| | - Justin D Triemstra
- Spectrum Health, Helen DeVos Children's Hospital; College of Medicine, Michigan State University
| | | | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit
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Alipanga B, Kohrt BA. Competency-based pre-service education for clinical psychology training in low- and middle-income countries: Case study of Makerere University in Uganda. Front Psychol 2022; 13:924683. [PMID: 36300077 PMCID: PMC9589034 DOI: 10.3389/fpsyg.2022.924683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
Reducing the global treatment gap for mental health conditions in low- and middle-income countries (LMICs) requires not only an expansion of clinical psychology training but also assuring that graduates of these programs have the competency to effectively and safely deliver psychological interventions. Clinical psychology training programs in LMICs require standardized tools and guidance to evaluate competency. The World Health Organization (WHO) and UNICEF developed the “Ensuring Quality in Psychological Support” (EQUIP) platform to facilitate competency-based training in psychosocial support, psychological treatments, and foundational helping skills, with an initial focus on in-service training for non-specialists. Our goal was to design the first application of EQUIP to implement competency-based training into pre-service education for clinical psychology trainees. With Makerere University in Uganda as a case study, we outline an approach to develop, implement, and evaluate a competency-based curriculum that includes seven steps: (1) Identify core clinical psychology competencies; (2) Identify evaluation methods appropriate to each competency; (3) Determine when competency evaluations will be integrated in the curriculum, who will evaluate competency, and how results will be used; (4) Train faculty in competency-based education including conducting competency assessments and giving competency-based feedback; (5) Pilot test and evaluate the competency-based education strategy with faculty and students; (6) Modify and implement the competency-based education strategy based on pilot results; and (7) Implement ongoing evaluation of the competency-based curriculum with continuous quality improvement. This approach will be formally evaluated and established as a foundation for pre-service training in other low-resource settings.
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Affiliation(s)
- Benjamin Alipanga
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
- *Correspondence: Benjamin Alipanga,
| | - Brandon A. Kohrt
- Division of Global Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, United States
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Kohrt BK, Saltiel MM, Rosen EL, Cholotio M. The use of formative research to culturally adapt a psychosocial support program for perinatal Mayan women in Guatemala. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Competency-based mental health supervision: evidence-based tool needs for the humanitarian context. Glob Ment Health (Camb) 2022; 9:221-222. [PMID: 36618752 PMCID: PMC9806983 DOI: 10.1017/gmh.2022.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 01/11/2023] Open
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What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development. Glob Ment Health (Camb) 2022; 9:491-498. [PMID: 36618724 PMCID: PMC9807002 DOI: 10.1017/gmh.2022.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide. METHODS A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions. RESULTS Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for 'psychological/counselling' and another for 'psychiatric/mhGAP' practitioners. Each grid features 22-26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality. CONCLUSIONS Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.
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Watts S, Hall J, Pedersen GA, Ottman K, Carswell K, van‘t Hof E, Kohrt BA, Schafer A. The WHO EQUIP Foundational Helping Skills Trainer's Curriculum. World Psychiatry 2021; 20:449-450. [PMID: 34505376 PMCID: PMC8429346 DOI: 10.1002/wps.20880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Jen Hall
- World Health OrganizationGenevaSwitzerland
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Tay AK, Miah MAA, Khan S, Mohsin M, Alam AM, Ozen S, Mahmuda M, Ahmed HU, Silove D, Ventevogel P. A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh. EClinicalMedicine 2021; 38:100999. [PMID: 34505027 PMCID: PMC8413262 DOI: 10.1016/j.eclinm.2021.100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh. Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience. Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17). Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency. Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.
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Affiliation(s)
- Alvin Kuowei Tay
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
- Correspondence: Alvin Kuowei Tay, : School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.
| | | | - Sanjida Khan
- Independent Researcher, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - A.N.M. Mahmudul Alam
- Mental Health and Psychosocial Support Subunit, Public Health & Nutrition Unit, United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh
| | - Sanem Ozen
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
| | | | - Helal U. Ahmed
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor, Malaysia
- Department of Psychology, Jagannath University, Dhaka, Bangladesh
| | - Derrick Silove
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Peter Ventevogel
- National Institute of Mental Health, Dhaka, Bangladesh
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Kohrt BA, Ottman K, Panter-Brick C, Konner M, Patel V. Why we heal: The evolution of psychological healing and implications for global mental health. Clin Psychol Rev 2020; 82:101920. [PMID: 33126037 DOI: 10.1016/j.cpr.2020.101920] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
Why do humans heal one another? Evolutionary psychology has advanced our understanding of why humans suffer psychological distress and mental illness. However, to date, the evolutionary origins of what drives humans to alleviate the suffering of others has received limited attention. Therefore, we draw upon evolutionary theory to assess why humans psychologically support one another, focusing on the interpersonal regulation of emotions that shapes how humans heal and console one another when in psychosocial distress. To understand why we engage in psychological healing, we review the evolution of cooperation among social species and the roles of emotional contagion, empathy, and self-regulation. We discuss key aspects of human biocultural evolution that have contributed to healing behaviors: symbolic logic including language, complex social networks, and the long period of childhood that necessitates identifying and responding to others in distress. However, both biological and cultural evolution also have led to social context when empathy and consoling are impeded. Ultimately, by understanding the evolutionary processes shaping why humans psychologically do or do not heal one another, we can improve our current approaches in global mental health and uncover new opportunities to improve the treatment of mental illness across cultures and context around the world.
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Affiliation(s)
- Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
| | - Katherine Ottman
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Catherine Panter-Brick
- Jackson Institute of Global Affairs, Yale University, New Haven, and Department of Anthropology, Yale University, New Haven, USA
| | - Melvin Konner
- Department of Anthropology, Emory University, Atlanta, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, and Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA
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