Enhancing Quality Supervision for the Delivery of Mental Health Care Through Nonspecialist Clinicians in Resource-Limited Settings.

ABSTRACT: Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists' role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings.

"I feel like I'm carrying a weapon." Information and motivations related to sexual risk among girls with perinatally acquired HIV.

Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender- and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach US girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The information-motivation-behavioral skills (IMB) model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12-16 years) had experienced kissing (n=12), genital touching (n=6), and oral (n=3), vaginal (n=2), and anal sex (n=1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners' awareness of the girl's HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing one's HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive-behavioral interventions are discussed.

Mental health of early adolescents from high-risk neighborhoods: the role of maternal HIV and other contextual, self-regulation, and family factors.

OBJECTIVES: To examine the effect of maternal HIV infection, as well as other individual, family, and contextual factors on the mental health of inner-city, ethnic minority early adolescents. METHODS: Participants included 220 HIV-negative early adolescents (10-14 years) and their mothers, half of whom were HIV-infected. Individual interviews were conducted regarding youth depression, anxiety, externalizing and internalizing behaviour problems, as well as a range of correlates of youth mental health guided by a modified version of Social Action Theory, a theoretical model of behavioral health. RESULTS: Although the HIV status of mothers alone did not predict youth mental health, youth knowledge of mother's HIV infection and mother's overall health were associated with worse youth mental health outcomes, as were contextual, self-regulation, and family interaction factors from our theoretical model. CONCLUSIONS: There is a need for family-based mental health interventions for this population, particularly focusing on parent-child relationships, disclosure, and youth self-esteem.