Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial
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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DOI：
10.1186/s12888-019-2364-4
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发表时间：
2020-01-08
期刊：
影响因子：
4.4
通讯作者：
Whetten, Kathryn
中科院分区：
文献类型：
--
作者：
Dorsey, Shannon;Gray, Christine L.;Whetten, Kathryn
背景 在低收入和中等收入国家，心理健康治疗差距（有心理健康需求的人和接受治疗的人之间的差异）很大。任务转移已被用来解决心理健康专业人员的短缺问题，越来越多的研究表明通过任务转移提供心理健康干预措施的有效性。然而，很少有研究关注如何在具有扩大潜力的政府资助系统中嵌入、支持和维持任务转移。建立和维持儿童干预措施 (BASIC) 研究的目标是检查实施政策和实践，以预测教育部门通过教师实施和卫生部门通过社区卫生志愿者实施的心理健康干预措施的采用、忠诚度和维持。 BASIC 方法是一种混合型 II 型实施有效性试验。该研究设计是一项阶梯式楔形整群随机试验，涉及 7 个序列，包括 40 所学校和学校周围的 40 个社区。注册人数包括 120 名教师、120 名社区卫生志愿者、最多 80 名现场领导、最多 1280 名青少年及其一名主要监护人。这种基于证据的心理健康干预措施是针对创伤的认知行为疗法的本地化版本，称为 Pamoja Tunaweza。非专业咨询师在帕莫贾图纳韦扎接受当地培训师的培训和监督，这些培训师在提供干预方面经验丰富，并参与了培训师培训技能转移模式。第一个序列完成实施后，对初始实施地点的顾问和领导进行深入访谈。研究结果用于为后续序列位点的实施促进提供信息。我们使用包括定性比较分析在内的混合方法来确定必要且充分的实施政策和实践，以预测感兴趣的 3 个实施结果：采用、忠诚度和维持。我们还研究了儿童心理健康结果以及教育和卫生部门干预的成本。讨论 BASIC 研究将提供有关如何在已经为儿童和青少年提供服务的政府系统中支持任务转移精神卫生保健实施的知识。有关 BASIC 实施政策和实践的知识可以促进资源匮乏环境下的实施科学。
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.