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.

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Published Version (Please cite this version)

10.1186/s12888-019-2364-4

Publication Info

Dorsey, Shannon, Christine L Gray, Augustine I Wasonga, Cyrilla Amanya, Bryan J Weiner, C Micha Belden, Prerna Martin, Rosemary D Meza, et al. (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). p. 10. 10.1186/s12888-019-2364-4 Retrieved from https://hdl.handle.net/10161/20156.

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Gray

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 doctoral studies, Chris worked for nearly a decade in public health, including completion of a three-year, post-masters fellowship at the Centers for Disease Control and Prevention (CDC), and as a program manager and scientist with the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences. During her doctoral studies, Chris also worked with the Environmental Protection Agency for four years examining how simultaneous exposure to multiple environmental domains affects human health. Broadly, her research examines the role of social-environmental structures that drive disparities in mental health and well-being in vulnerable populations, particularly pediatric populations.

As an epidemiologist, Chris has great appreciation for study design, analysis, and the capacity for data to inform public health policies and practice. As a human, she understands the importance of contextualizing quantitative data with lived experiences.


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