Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial.
Abstract
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.
Type
Journal articleSubject
AdolescentsChildren
Evidence-based treatment
Global mental health
Implementation climate
Implementation science
Organizational theory
School-based mental health care
Task-sharing
Task-shifting
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https://hdl.handle.net/10161/20156Published Version (Please cite this version)
10.1186/s12888-019-2364-4Publication Info
Dorsey, Shannon; Gray, Christine L; Wasonga, Augustine I; Amanya, Cyrilla; Weiner,
Bryan J; Belden, C Micha; ... Whetten, Kathryn (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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Christine L Gray
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
Elizabeth Louise Turner
Associate Professor of Biostatistics & Bioinformatics
Dr. Turner is Associate 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
Kathryn Whetten
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 Pronouns: they/themKathryn Whetten is the Principal Investigator
on multiple grants and publishes numerous scientific articles every year. In addition,
they mentor many students and give guest lectures and presentations throughout the
year.
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