ABSTRACT
There is a vast unmet need for mental health care and support in the United States and globally. Although expanding specialty services is needed, this is neither sufficient nor necessary to comprehensively address the current and future demand. Traditional models of care which have focused on mental disorders, while useful for many, remain out of reach, unaffordable, and not timely for helping the vast majority of individuals in need of mental health support. There is a growing movement of community-based networks and organizations which aim to fill this need by harnessing existing community resources to promote mental health and prevent mental and substance use disorders. This paper describes our effort to derive a blue-print for an approach, which we call "Community Initiated Care (CIC)", building on these real-world experiences and the growing science on lay person delivered brief psychosocial interventions in community settings. CIC serves as a back-bone for training lay persons to support the mental health and well-being of others in their communities. CIC is envisioned as an equitable, efficient, safe, and timely form of contextualized support to promote mental health and prevent selfharm, mental health and substance use problems. CIC is not intended to replace clinical interventions;instead, we envisage the supportive encounter to use a person-centered approach to bolster existing positive coping skills, promote positive social engagement, reduce risk of future mental health problems, and encourage other forms of help seeking when appropriate. This article explores how our thinking is aligned with and responsive to the strategies and tactics of the Contextual Behavioral Science Task Force to promote programs that are multidimensional, process-based, prosocial, practical, and multi-level. Development, implementation, and evaluation of CIC will not only advance contextual behavioral science but also move society forward to more equitable mental health and well-being.
ABSTRACT
AIMS: The mounting evidence for effective delivery of psychological interventions by non-specialists in low- and middle-income settings has led to a rapid expansion of mental health and psychosocial support trainings globally. As such, there is a demand for strategies on how to train and implement these services to attain adequate quality. This study aims to evaluate the added value of a competency-driven approach to training of facilitators for a group intervention for children with severe emotional distress in Lebanon. METHODS: In a controlled before and after study, 24 trainees were randomly allocated to participate in either a competency-driven training (CDT) or training-as-usual (TAU) (1 : 1) for a psychological intervention for children with severe emotional distress. We assessed the change in demonstrated competencies, using standardised role-plays, before and after the training. Measures included the 13-item Working with children-Assessment of Competencies Tool (WeACT), the 15-item ENhancing Assessment of Common Therapeutic factors (ENACT) and the 6-item Group facilitation: Assessment of Competencies Tool (GroupACT). The trainer in the experimental arm used pre-training and during training competency assessment scores to make real-time adjustment to training delivery. Due to COVID-19 pandemic restrictions, all activities were done remotely. RESULTS: CDT resulted in significantly better outcomes on increasing competencies on the WeACT (repeated measures analysis of variance; F(1, 22) = 6.49, p < 0.018) and on the GroupACT (Mann-Whitney U = 22, p < 0.003), though not statistically significant on the ENACT. There is no significant between-group difference on the reduction of harmful behaviours, mainly because both forms of training appear equally successful in eliminating such behaviours. CONCLUSIONS: This proof-of-concept study demonstrates the potential of CDT, using standardised assessment of trainee competencies, to contribute to better training outcomes without extending the duration of training. CDT can result in up to 18% greater increase in adequate competency, when compared to TAU. The study also yields recommendations for further enhancing the benefits of competency-driven strategies. A fully powered trial is needed to confirm these findings.
Subject(s)
COVID-19 , Psychosocial Intervention , Child , Humans , Lebanon , Mental Health , PandemicsABSTRACT
Objectives: As delivery of psychological interventions by nonspecialists becomes more commonplace, assurance that training and supervision methods achieve minimum competency standards is needed. The United Nations Children’s Fund and World Health Organization (UNICEF-WHO) Ensuring Quality in Psychological Support (EQUIP) platform is a digital tool to provide guidance on conducting competency-based trainings of nonspecialists. The platform includes competency assessment tools for adults (the ENhancing Assessment of Common Therapeutic Factors [ENACT] tool) and for children (Working with children—Assessment of Competencies Tool [WeACT]), as well as a suite of treatment-specific competency tools for adult- and child-focused psychological interventions. Methods: Role-play based (RPB) competency assessment tools were evaluated in a range of global settings for feasibility and acceptability. Study sites included Ethiopia, Kenya, Lebanon, Nepal, the occupied Palestinian territory, Peru, Uganda, and Zambia. In addition, a US pilot of the tool was conducted in New York City (NYC). Acceptability and feasibility were evaluated through both qualitative assessments and evaluation of interrater reliability (IRR) and responsivity to change. Results: IRR ranged from 0.54 to 0.80 across sites and tools. The use of microcompetency video demonstrations of helpful vs potential harmful/unhelpful techniques helped increase IRR. Most individual competencies showed responsivity to change when evaluated pre- vs posttraining. For child competencies, youth drama clubs were feasibly trained to be actors in the standardized role-plays. Competencies were also modified for remote delivery of psychological interventions, which is of particular importance to deliver services during the COVID-19 pandemic. Conclusions: RPB assessments of competencies can be implemented in diverse settings ranging from refugee camps in low-income countries to urban centers of high-income countries (HICs). Rater training and standardized actors require a significant time investment, which can then yield high rates of IRR for observational assessments. With the transition to more remote care, RPB structured competency assessments are increasingly feasible even in low-resource settings. Reciprocal learning with the NYC site demonstrated that the tool can also be beneficial in an HIC. R, OTH
ABSTRACT
Problem Management Plus (PM+) is used to address mental health needs in humanitarian emergencies, including in response to COVID-19. Because PM+ is designed for non-specialist facilitators, one challenge is ensuring that trainees have the necessary competencies to effectively deliver the intervention and not cause unintended harm. Traditional approaches to evaluating knowledge of an intervention, such as written tests, may not capture the ability to demonstrate PM+ skills. As part of the World Health Organization Ensuring Quality in Psychological Support (EQUIP) initiative, we developed a structured competency rating tool to be used with observed standardised role plays. The role plays were designed to elicit demonstration of the key mechanisms of action for PM+. These role plays can be objectively rated by trainers, supervisors or other evaluators to determine facilitators' competency levels in PM+. These competency assessments can highlight what skills require additional attention during training and supervision, thus supporting facilitators to fill gaps in competencies. The integration of role plays in training and supervision also allows organisations to establish quality control metrics for competency standards to deliver PM+. We describe lessons learned from piloting the PM+ competency role plays with the Center for Victims of Torture programme with Eritrean refugees in Ethiopia. © 2021 Lippincott Williams and Wilkins. All rights reserved.
ABSTRACT
On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. In response to the sudden rise in COVID-19-related mental health and psychosocial impacts, we embarked on a digital training (e-learning) and remote delivery adaptation for Problem Management Plus Training for Helpers (Remote PM+ Training) based in New York City, four European countries and six African countries. This paper provides an overview of the two Remote PM+ Trainings, including key adaptations and lessons learned across the contexts. Trainings were approximately 75 hours in duration, with a mix of group and individual work, in diverse contexts. Overall, remotely delivered PM+ training and intervention appear appropriate. There were a number of critical lessons learned that contributed to the efficacy of the trainings, such as technological support, digital literacy, preparation and flexibility among the trainers and the trainees. There is also a need for cultural and contextual adaptation towards the delivery of remote training and implementation of PM+. However, the outcomes from these two trainings indicate that PM+ may be adapted for remote (online) training and, if supported with additional studies, could build workforce capacity in contexts in which there is limited in-person access to mental health and psychosocial support services and staff. © 2021 Lippincott Williams and Wilkins. All rights reserved.