Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial.
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BACKGROUND:The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. METHODS:BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. DISCUSSION:The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. TRIAL REGISTRATION:Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.
Global mental health
School-based mental health care
Published Version (Please cite this version)10.1186/s12888-019-2364-4
Publication InfoTurner, Elizabeth; Whetten, Kathryn; Gray, Christine; Dorsey, Shannon; Wasonga, Augustine I; Amanya, Cyrilla; ... Mildon, Robyn (2020). Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial. BMC psychiatry, 20(1). pp. 10. 10.1186/s12888-019-2364-4. Retrieved from https://hdl.handle.net/10161/20156.
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Assistant Research Professor of Global Health
Dr. Christine (Chris) Gray is an assistant research professor in the Center for Health Policy and Inequalities Research (CHPIR) in the Duke Global Health Institute. She earned her PhD from the Department of Epidemiology at the University of North Carolina at Chapel Hill (UNC-CH) and her MPH from Emory University. She has been working with CHPIR since 2014, when she began analytic work on the longitudinal Positive Outcomes for Orphans cohort study as a doctoral student. Prior to her do
Associate Professor of Biostatistics and Bioinformatics
Dr. Turner is Assistant Professor of Biostatistics and Global Health and serves as Director of the Research Design and Analysis Core of the Duke Global Health Institute. Her primary methodological focus is on the design and analysis of randomized controlled trials, particularly those that involve clustering such as cluster randomized trials (CRTs), stepped wedge CRTs and individually-randomized group treatment trials. She is expert in the implementation of trials in low resource settings, with a
Professor in the Sanford School of Public Policy
Director, Center for Health Policy and Inequalities ResearchResearch Director, Hart Fellows Program,Professor, Public Policy and Global Health Professor, Nursing and Community & Family Medicine Kathryn Whetten (PhD) is Chair of the Maternal, Adolescent and Child Health working group, and she is the Co-Chair of the University Diversity Task Force and the Sanford Diversity Committee. Kathryn Whetten is the Principal Investigator on
Alphabetical list of authors with Scholars@Duke profiles.