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Koly KN, Saba J, Christopher E, Hossain ANN, Akter T, Rahman Z, Ahmed HU, Eaton J. Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders' perspectives in Bangladesh. BMC Health Serv Res 2024; 24:270. [PMID: 38433239 PMCID: PMC10910748 DOI: 10.1186/s12913-024-10742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Bangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services. METHODS Four stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised. RESULT Stakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery. CONCLUSION The peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Enryka Christopher
- Trauma and Community Resilience Center, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anan Nisat Nabela Hossain
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Taslima Akter
- Centre for Disability in Development, Dhaka, Bangladesh
| | - Zakia Rahman
- CBM Bangladesh Country Office (CBMBCO), Dhaka, Bangladesh
| | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- CBM Global Disability and Inclusion, Laudenbach, Germany
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Rabie S, Poudyal A, King A, Ndwandwa ES, Marais A, Andersen L, Joska J, Sikkema K. A Supervision Framework for Task-Shared Mental Health Workers: Implications for Clinical Trials and Beyond. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300092. [PMID: 38050095 PMCID: PMC10749652 DOI: 10.9745/ghsp-d-23-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
The rise in task-shared interventions that address the mental health treatment gap in low- and middle-income countries (LMICs) has highlighted the need for additional support and supervision of nonspecialist mental health workers (NHWs). The supervision of NHWs in most resource-limited settings is still primarily disorganized, without clear guidelines that provide the necessary structure for supervision. The need for supervision is even greater for NHWs working in the context of trauma, not only to provide training and ensure adequate delivery of care but also to provide support to minimize the psychological impact of their work. In South Africa, women face intersecting epidemics of HIV, intimate partner violence, and sexual trauma. This syndemic highlights the importance of integrating mental health treatment in HIV care, especially in settings like South Africa, where mental health services are limited. In this context, our group developed and is evaluating the effectiveness of ImpACT+, a task-shared coping intervention to improve clinical and mental health outcomes among HIV-infected women with sexual trauma in South Africa. We describe the ImpACT+ supervision model that is currently being implemented in the context of a hybrid effectiveness-implementation clinical trial. Combining experiences from clinical psychology, task-shared interventions, and trauma-informed care, the supervision model integrates formal elements of clinical supervision into categories that are suitable for use in task-shared trauma interventions in low-resource settings. To the best of our knowledge, such a trauma-informed supervision approach has not been widely documented in the literature, particularly in task-shared interventions in LMICs. In this article, we describe the ImpACT+ intervention, provide an overview of the supervision model, and provide illustrative examples of how the supervision model has been implemented.
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Affiliation(s)
- Stephan Rabie
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Aisha King
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Community Health and Health Policy, School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Esona-Sethu Ndwandwa
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Adele Marais
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lena Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kathleen Sikkema
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, 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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Draper CE, Mabena G, Motlhatlhedi M, Thwala N, Lawrence W, Weller S, Klingberg S, Ware LJ, Lye SJ, Norris SA. Implementation of Healthy Conversation Skills to support behaviour change in the Bukhali trial in Soweto, South Africa: A process evaluation. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Bunn M, Zolman N, Smith CP, Khanna D, Hanneke R, Betancourt TS, Weine S. Family-based mental health interventions for refugees across the migration continuum: A systematic review. SSM - MENTAL HEALTH 2022. [PMID: 37529116 PMCID: PMC10392776 DOI: 10.1016/j.ssmmh.2022.100153] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study reviewed the literature on family-based mental health interventions for refugees across migration contexts and settings to identify types of interventions and intervention components, implementation approaches and to assess effectiveness. The review used a systematic approach, and ten intervention studies were retained for analysis. The findings identified three primary types of family-based mental health interventions used with diverse refugee communities in settings in the Global North and South-parenting groups, multiple family groups and home visiting interventions. Findings indicated that non-specialized or peer providers were frequently utilized to deliver the interventions though additional details on the workforce and workforce development strategies are needed to better understand how to sustain and support such providers. The findings suggest that family-based mental health interventions are potentially effective for improving a range of child and caregiver mental health outcomes and improving family processes and functioning among refugee families. However, the empirical evidence is quite limited to date, with a need for additional rigorous studies, especially with refugee families in humanitarian settings, to further build the evidence base.
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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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Faisal-Cury A, Ziebold C, Rodrigues DMDO, Matijasevich A. Depression underdiagnosis: Prevalence and associated factors. A population-based study. J Psychiatr Res 2022; 151:157-165. [PMID: 35486997 DOI: 10.1016/j.jpsychires.2022.04.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil. METHOD We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors. RESULTS The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%). CONCLUSION(S) depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Peng M, Xiao T, Carter B, Chen P, Shearer J. Evaluation of the effectiveness and cost-effectiveness of psychological first aid (PFA) system based training for frontline health workers in emergency health services in China a study protocol of a cluster randomized controlled trial. Front Psychiatry 2022; 13:1044594. [PMID: 36590637 PMCID: PMC9800601 DOI: 10.3389/fpsyt.2022.1044594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is insufficient evidence on the effectiveness and cost-effectiveness of psychological interventions to enhance frontline responders' mental health proficiency and competence in emergency settings. This paper describes the methods for the evaluation of the effectiveness and cost-effectiveness of Psychological First Aid training, to determine whether the intervention is effective and cost-effective as a mental health intervention in public health emergencies. A pilot to evaluate the acceptability of the PFA training found participants were either satisfied (55.6%) or extremely satisfied (44.4%) with the training program. METHOD This paper describes the protocol for a cluster randomized two-arm controlled trial. A total of 1,399 non-specialist health care workers will be recruited in 42 hospitals and health care centers across six provinces in China. Participants will be assigned according to hospital or health care center site to one of two groups (n = 699 for intervention group and 709 for control group) to receive system based PFA training or PFA training as usual. Both groups will receive one-day of training, comprising six modules including PFA core concepts, knowledge, skills and practice. Their knowledge, skills, competency, self-efficacy, resilience, and professional quality of life will be assessed immediately after the training; and reassessed after 1 and 2 months. ANALYSIS For effectiveness outcomes, repeated measures will be used in a multi-level linear mixed model. The pooled standard deviations will be used to calculate the effect sizes (Cohen's d) within and between groups. Appropriate statistical tests will be used to explore differences between intervention and control groups. For economic outcomes, a health service sector perspective will be adopted, with intervention costs and outcomes collected prospectively. Within-trial cost-effectiveness analysis (CEA) will quantify the incremental costs and PFA proficiency gains of the intervention compared with training as usual at 2 months post training. CEA will present results as cost per unit of mental health proficiency gained. A cost-utility analysis (CUA) model will extend the population to emergency health service users.in order to identify potential for incremental cost offsets attributable to mental health improvement arising from intervention. Intervention costs and effects will be extrapolated to the population of patients who receive the emergency health service in clinical wards and will be modeled over the cohort's lifetime. Modeled CUA results will be calculated as quality-adjusted life-years saved and healthcare cost savings in preventing mental disorders. ETHICS AND DISSEMINATION Ethics approval was obtained from the Second Xiangya Hospital, Central South University Clinical Research Ethics Committee (2021) Ethical Review [Clinical Research] #067). Data about the economic evaluation of the intervention will be stored in the KCL OneDrive at King's College London, UK. The trial protocol was registered with the China Clinical Trials Registry: ChiCTR2200060464. Study findings will be disseminated through peer-reviewed academic papers, and participating hospitals.
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Affiliation(s)
- Min Peng
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Psychological Rescue Branch of China Association for Disaster and Emergency Rescue Medicine, Changsha, China
| | - Tao Xiao
- Psychological Rescue Branch of China Association for Disaster and Emergency Rescue Medicine, Changsha, China.,Department of Social Affair, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ben Carter
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pan Chen
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - James Shearer
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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