Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project

BACKGROUND

Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project.

METHOD

A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention.

DISCUSSION

There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.

Improvements in the purification of an antisteroid antiserum resistant to conventional immunoadsorption chromatography

Antibodies against dexamethasone, a synthetic steroid, have been induced in rabbits immunized with a 3-carboxymethyloxime dexamethasone derivative conjugated to bovine serum albumin. The antiserum displaying the highest affinity for dexamethasone (KD = 0.5 nM) appeared to be resistant to purification on an agarose matrix bearing the same 3-carboxy-methyloxime dexamethasone derivative. No desorption of active antibodies could be obtained whatever the eluting buffer used. Electrophoretic elution gave only poor results. However a very significant improvement in the purification of these antibodies was achieved by changing the connecting arm for steroid linkage to the agarose beads. A 17-fold purification and a 32% recovery of active specific antisteroid antibodies were obtained using a column bearing a 17 beta-carboxamide dexamethasone derivative. Moreover good results (23-fold purification and 30% recovery) were also obtained with a commercially available preactivated high-performance silica column derivatized with an aminated 3-carboxymethyloxime derivative of dexamethasone. In this case the more efficient diffusion of the eluting solution through the pores of a high performance stationary phase made of small diameter rigid beads probably explained the strikingly improved results, when compared to those obtained with agarose beads bearing the same dexamethasone derivative.

Rapid purification of antisteroid antibodies by high-performance liquid affinity chromatography

An adsorbent for the high-performance affinity chromatography of antisteroid antibodies was prepared, based on a commercial pre-packed column. The column contained activated microparticulate silica beads bearing epoxide functions, on which the steroid dexamethasone was covalently linked. The column was used successfully for the rapid and complete isolation of several hundred microgram amounts of specific antidexamethasone antibodies from rabbit antisera. The practical aspects of the purification procedure, especially the optimization of the washing and of the elution steps, are detailed. Despite non-biospecific elution with 20% acetonitrile in an acidic buffer, the purification yield was very satisfactory and the biological activity of the purified immunoglobulins appeared excellent.