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

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.Copyright © 2023 The Author(s).

The Impact of the COVID-19 Pandemic on Neurosurgery Worldwide

The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), first appeared in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020 (World Health Organization. WHO director-general's opening remarks at the media briefing on COVID-19—11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%2D%2D-11-march-2020. Accessed 2020). By September 9, 2020, 27.7 million cases and 0.9 million deaths were confirmed globally (Center for Systems Science and Engineering – Johns Hopkins Coronavirus Resource Center: COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.jhu.edu/map.html. Accessed 2020). This disease placed an unprecedented strain on healthcare systems around the world (Remuzzi and Remuzzi. Lancet. 395(10231):1225–8, 2020) and had a substantial effect on clinical practice across all surgical specialties, with neurosurgery being no exception (Bernstein. J Neurosurg. 2020:1–2. https://doi.org/10.3171/2020.4.JNS201031). Many hospitals implemented no-visitor policies and COVID-19 testing for all inpatients in order to prevent spread and protect patients and healthcare workers (Calderwood. Infect Control Hosp Epidemiol. 2020:1–9. https://doi.org/10.1017/ice.2020.303). To conserve beds, workforce, and valuable resources such as masks, gowns, and ventilators, surgeons had to restrict operations to emergency and essential interventions. Some neurosurgeons were redeployed to new intradepartmental roles, others lateralized to provide care for coronavirus patients. In order to limit in-person interactions and contagion, there was a surge in telehealth and digital innovation for remote monitoring and management. Research laboratories were closed for prolonged periods. Medical education and residency training were also substantially altered, with cancellation of many in-person events and a transformation to online meetings and educational sessions. In this chapter, we discuss the impact of COVID-19 on the global neurosurgery community with respect to clinical care, education, and research. While the pandemic has caused tremendous disruption in global neurosurgery already, there is hope that many of the lessons learned during this time have contributed to our resilience and preparedness for the future, be it a second wave of COVID-19 or a new unexpected challenge. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Reimagining communities of care in the performing arts: A call for a community-based task-sharing approach to address the mental health needs of performing artists

Performing artists are known for playing a critical role in the cultural and intellectual richness and wellbeing of society. Additionally, whereas engaging in art and performance can offer a myriad of mental health benefits, mental health and substance abuse disorders are common in this industry yet significant barriers, such as stigma, financial constraints, and lack of relevant training, appear to negatively impact access to mental healthcare. Moreover, the profound changes and uncertainty in the performing arts sector throughout the COVID-19 pandemic highlighted the need to enhance systems of mental health support in this community. Although changing perceptions around mental health and increasing access to care are complex and multi-faceted, approaches from global mental health may offer novel solutions to promote greater access and equity to mental healthcare for performing artists. In particular, capacity building strategies, such as task-sharing, may help to facilitate both the identification of individuals in need of care, and the delivery of basic forms of support, through training of individuals working in the performing arts community. If adopted, task-sharing approaches in the performing arts, could lead to the introduction of new roles that performers can adopt, which in turn, may lead to new job categories within this industry, while still contributing to the sociocultural fabric of the arts. Efforts to engage performing artists in the co-design and adaptation of materials and intervention strategies will play a critical role in the translation of current evidence-based and evidence-informed interventions to contexts and cultures within the arts. Importantly, while certain aspects of the entertainment industry have long been associated with poor mental health, movements among artists and performers are calling for a change in culture. Integrating scalable mental health strategies into the spaces in which the performing arts take place, may offer a critical framework for reimagining mental health support within the arts community.

Surgeons' involvement in COVID-19 treatment: a practice by a regional core hospital in Japan to avoid physician burnout.

BACKGROUND: To prevent task accumulation on certain divisions, our institution developed a unique system of allocating inpatient treatment of COVID-19 patients to doctors who were not specialized in respiratory infections. The objective of this study was to investigate whether surgeons can be involved in the COVID-19 inpatient treatment without negatively affecting patient outcome, and how such involvement can affect the wellbeing of surgeons. METHODS: There were 300 patients diagnosed with COVID-19 and hospitalized from January to June 2021, and 160 of them were treated by the redeployed doctors. They were divided into 3 groups based on the affiliation of the treating doctor. Patient characteristics and outcomes were compared between the groups. In addition, the impact of COVID-19 duty on participating surgeons was investigated from multiple perspectives, and a postduty survey was conducted. RESULTS: There were 43 patients assigned to the Department of Surgery. There were no differences in the backgrounds and outcomes of patients compared with other groups. The surgeon's overtime hours were significantly longer during the duty period, despite no change in the number of operations and the complication rate. The questionnaire revealed that there was a certain amount of mental and physical burden from the COVID-19 duty. CONCLUSION: Surgeons can take part in inpatient COVID-19 treatment without affecting patient outcome. However, as such duty could negatively affect the surgeons' physical and mental wellbeing, further effort is needed to maintain the balance of fulfilling individual and institutional needs.

Scaling up community-delivered mental health support and care: A landscape analysis.

Introduction: The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. Methods: A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. Results: The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. Discussion: This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.

Nurse-led service delivery models in primary care: a scoping review protocol.

BACKGROUND: Ensuring equitable access to health care is reliant on the strengthening of primary care services. Increasing the utilisation of task-sharing and telehealth models is one strategy to improve patient access and outcomes in primary care. This protocol details the methodology of a proposed scoping review of nurse and midwife involvement in task-sharing and telehealth models in primary care. AIM: To identify what task-sharing and telehealth models have been utilised in the primary care setting globally, and to capture the characteristics and health and economic outcomes of the models, and whether they are acceptable and feasible. DESIGN & SETTING: This protocol was developed in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). METHOD: Five databases (Ovid MEDLINE, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature [CINAHL] and Cochrane Library) will be searched for relevant studies published in English. Articles will be screened for inclusion in Covidence by three authors, with data extracted and synthesised using a chart designed for this review. Evidence will be mapped in both tabular and narrative forms to show characteristics, outcomes, and acceptability of the models of care. CONCLUSION: Understanding how nurse- and midwife-led models of care may operate is crucial to strengthening service provision in primary care. Evidence on nurse and midwife-led primary care models will be collated and synthesised to inform future models.

Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa.

BACKGROUND: There is a shortage of the human resources needed to deliver mental health services which is likely to be exacerbated by COVID-19. Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in a number of countries. Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared. This study explored the mental health curriculum content of the undergraduate clinical associate training programmes in South Africa and the views of key informants of the adequacy of training in mental health. METHODS: A qualitative collective case study approach was utilised for this multisite study at the three universities in South Africa offering clinical associate degrees. The study consisted of in-depth interviews utilising videoconferencing of individuals involved in each programme and a document review. Thematic analysis of the data was conducted. RESULTS: Nineteen interviews were conducted. Mental health formed part of the curriculum in all three programmes with the bulk of the training taking place in the final year of the three-year degree. Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive. The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets. CONCLUSION: There is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardisation, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.

Scaling up of mental health services in the digital age: The rise of technology and its application to low- and middle-income countries

This chapter describes the rapid spread of digital mental health technologies across the world and further explores specific case studies in low-income and middle-income countries (LMICs). We are increasingly seeing rapid rates of technological innovation and adaptation in low-resource settings including the widespread use of smartphone mobile devices, apps and web-based platforms. Health-care settings have taken advantage of this growth and are maximizing its potential by introducing these technologies in their service delivery. These technologies have been applied to various settings such as training of health workers, screening patients, and care delivery. This chapter explores five major areas benefitting from these emerging technologies: (1) community outreach, challenging stigma, and spreading awareness, (2) youth mental health, (3) mental health in humanitarian settings, (4) clinical care and frontline health workers, and (5) technology for severe mental disorders. We close the chapter with a discussion of broad ethical considerations in LMICs, highlighting risks pertaining to misinformation, victimization, and widening health inequities. Finally, we emphasize the role of digital technologies during the COVID-19 pandemic in addressing the potential rise and exacerbation of mental health problems, and how these technologies can potentially be leveraged to alleviate this burden through the remote provision of essential mental health services. © 2022 Elsevier Inc. All rights reserved.

Cost-Aware Dynamic Task Sharing Among Decentralized Autonomous Agents: Towards Dynamic Patient Sharing Among Hospitals

In the COVID-19 pandemic era, hospitals tend to be crowded with patients. Dynamic task sharing is becoming an important research theme and can be applied to patient sharing among hospitals. Unlike in standard task scheduling, the tasks are created dynamically and asynchronously, and each agent (hospital or region) is independent. Hence, we previously designed and compared the decentralized algorithms for dynamic task sharing. However, in these algorithms, the cost of task transfers was not considered. The cost of transferring a patient to a distant hospital is high and cannot be ignored. In this paper, we present new decentralized algorithms for dynamic task sharing that consider the cost of task transfers. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Evaluation of competency-driven training for facilitators delivering a psychological intervention for children in Lebanon: a proof-of-concept study.

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.

Comparing Decentralized Algorithms for Dynamic Task Sharing among Agents with Limited Resources

Dynamic task sharing among organizations is attracting attention in research as the COVID-19 pandemic continues and many hospitals are filled with patients. Here, the task is, for example, the treatment of patients requiring resources such as beds and medical staffs for certain periods of time. This task must be started before its completion becomes overdue. However, because these tasks are created dynamically, the task-handling cannot be scheduled in advance;in addition, these tasks are handled by multiple independent organizations. Because the distribution of tasks are not uniform across the organizations, some tasks should be transferred to unoccupied organizations. In this study, we present and compare some decentralized algorithms for dynamic task sharing among organizations with limited resources. We aim to minimize the number of unstarted tasks within the time limit. © 2021 ACM.

Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico.

BACKGROUND: The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes. OBJECTIVE: The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico. METHODS: To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed. RESULTS: Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed. CONCLUSIONS: The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations.

Lay social workers implementing a task-sharing approach to managing depression in Vietnam.

BACKGROUND: While depression is a leading contributor to burden of disease in Vietnam, there is a critical gap in depression care due to the shortage of mental health specialists and extremely limited mental health services in general health care settings. We have previously reported the effectiveness of a supported self-management (SSM) task-sharing intervention for depression, delivered by social collaborators (lay social workers). The purpose of this study was to identify factors influencing the effectiveness of delivery of SSM by social collaborators and delineate areas for further attention that are relevant for scale-up. METHODS: A hundred and ten (110) key informant interviews were conducted with three stakeholder groups (patients, social collaborators, experts) from eight provinces in Vietnam. Participants were identified through records from a recently completed randomized trial that showed the effectiveness of SSM in community-based settings in Vietnam. Qualitative descriptive methods and thematic analysis were used to examine the interviews. A coding framework and corresponding themes were developed deductively, based on the findings from the randomized trial and the literature, and through inductive analysis, to describe the contextual factors that impacted the social collaborators' role in successfully implementing the SSM intervention. RESULTS: Our analysis identified the following benefits of working with social collaborators: (1) increased awareness of mental health in the family and community; (2) reduced stigma; (3) a better understanding that depression is treatable; (4) increased help-seeking; and (5) improved access to care. There were also significant challenges, including social collaborator characteristics (age, education, pre-existing training and skills) and contextual factors influencing their work (roles and responsibilities, training, compensation, support from government). CONCLUSIONS: Engaging social collaborators in the delivery of SSM in the community can help fill a critical gap in depression care in Vietnam. However, several contextual challenges that are an impediment to increased engagement and sustainable integration into health and social systems need to be resolved through policy change to regulate their practice, define their scope of work, and provide adequate remuneration.

Asian American mental health during COVID-19: A call for task-sharing interventions.

In the age of COVID-19, the Asian American community is facing a number of unique risks and barriers to mental health care. Mounting challenges-including language barriers, unemployment, racialized trauma, and anti-Asian violence-threaten the health and wellness of these communities. Yet, structural obstacles prevent Asian Americans from accessing care within the professionalized behavioral health workforce. Leveraging the resources of Asian American peer networks, collectives, and community-based organizations through a task-sharing program presents an attractive alternative for mental health care provision. Investing in task-sharing approaches to care would both address access barriers and build capacity within the Asian American community.

Challenges to neonatal care in Cambodia amid the COVID-19 pandemic.

Since mid-February, 2020, coronavirus disease-2019 (COVID-19) has been spreading in Cambodia and, as of April 9, 2020, the Ministry of Health has identified 119 polymerase chain reaction (PCR)-positive cases. However, the PCR test is available in only two specialized institutes in the capital city Phnom Penh; therefore, exact and adequate identification of the cases remains still limited. Many vulnerable newborn infants have been admitted to the neonatal care unit (NCU) at the National Maternal and Child Health Center in Phnom Penh. Although the staff have implemented strict infection prevention and control measures, formidable gaps in neonatal care between Cambodia and Japan exist. Due to the shortages in professional workforce, one family member of sick newborn(s) should stay for 24 hours in the NCU to care for the baby. This situation, however, may lead to several errors, including hospital-acquired infection. It is crucial not only to make all efforts to prevent infections but also to strengthen the professional healthcare workforce instead of relying on task sharing with family members.