Increasing provider competence for treating stress-related mental health conditions in low resource settings

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Project Summary Lesbian, gay, bisexual and transgender individuals (LGBTI) present increased morbidity compared to the general population, which is attributed to healthcare discrimination and lack of LGBT-specific expertise, especially in high-stigma countries. Motivated by fear, Romanian LGBTI conceal their identities and report significantly more barriers to healthcare access than heterosexuals. Poor mental health, specifically anxiety and depression, is elevated for Romanian LGBTI, and associated with poor physical health (e.g., HIV risk, alcohol abuse.) However, LGBT-competent mental health professionals (MHPs) are nearly non-existent in Romania, and thus the negative impact of homophobia on mental health cannot be ameliorated. Neither universities nor continuing education include LGBT identity and health curricula, to the contrary, the dominant discourse promotes homosexuality as a dangerous anomaly in need of eradication. Given that a pilot of our in- person LGBT-affirmative MHP training we tested recently in Romania showed significant receptivity and increased competence among MHPs, this training is now ripe for testing its feasibility and efficacy in creating significant change via mobile delivery, in a randomized controlled trial (RCT). Proving the efficacy of this first mobile training and supervision model has high potential for cost-effective and expeditious boundless dissemination. In Aim 1, we will test the relative feasibility and efficacy of our mHealth MHP training by conducting an RCT comparing a mobile training (MT) of our MHP LGBT-competency program (n=60) to the equivalent in-person training (IPT) (n=60) we recently piloted. Both programs' content and structure will be identical (3-day trainings and two boosters 6 months apart). At baseline, 4, 8, and 12 months, we will assess, in a mobile fashion, all MHPs' LGBT-related attitudes, knowledge of LGBT health needs and clinical practice, and LGBT caseload. In Aim 2, we will test the efficacy of a companion mHealth supervision and consultation program in maintaining LGBT competency and enhancing LGBT-friendly practice. Half of the MHPs in each group will receive our mHealth supervision and expert consultation program, consisting of monthly 2-hour virtual group meetings to discuss case studies, in order to determine the added benefit of mobile supervision. After the training, 10 MHPs will provide interview-based program feedback. In Aim 3, we will build mHealth research capacity among MHPs by demonstrating how to integrate mobile data collection tools in clinical practice to monitor client progress for personalized treatment plans. We have chosen four types of partners to maximize the project's sustainability and benefit from the power of their multidisciplinarity: academics, direct service agencies supporting LGBTI, practicing MHPs, and a technical developer. This first RCT testing of an mHealth training in LGBT-competent mental healthcare in Romania affords us an unparalleled opportunity to introduce much needed expertize and mHealth methodologies in universities and clinical practice, and create a seed infrastructure for an implementation science R01 of national and global public health significance.