Addressing barriers to Scaling-up Perinatal Mental Health Intervention

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Project Summary/Abstract The burden of perinatal depression is extremely high in LMICs. It is linked with poor child health outcomes. Psychosocial interventions delivered through non-mental health professionals as part of task sharing have shown to be effective in reducing perinatal depression. Recently, WHO mhGAP Program adopted the evidence based psychosocial intervention Thinking Healthy Program (THP) for global dissemination. There is increasing evidence that task sharing interventions are effective in improving mental health in LMIC. There is also growing documentation of barriers to the scalability of such interventions. Lack of integration into existing health care platforms and large scale quality training and supervision are some of the barriers to scaling up. The goal of this International Research Career Development Award K43 is to develop candidate’s expertise in implementing scale up of evidence based perinatal mental health interventions. Through research, coursework, and structured mentorship activities, the candidate will develop new competencies in implementation research including i) conceptual knowledge of implementation research grounded in theory and practice; ii) methodological expertise in implementation research designs, and iii) professional development towards becoming an independent LIMIC researcher. Drs Lawrence Wissow, Atif Rahman, Assad Hafeez, Vikram Patel and Joanna Maselko will mentor the candidate in these three objectives. The research will be conducted in Pakistan and the infrastructure provided by the ongoing NIMH U19 SHARE and NICHD/NIH RO1 SHARE CHILD projects in Pakistan. The candidate will evaluate, in a randomized controlled trial competencies of government employed community health workers trained and supervised on a technology assisted version of THP (called THP-TA for short) and elaborate the process of scaling-up THP-TA by identifying barriers and strategies. Using community health workers in Pakistan delivering MCH services and technology innovation has the potential of scaling-up THP in Pakistan. It also has the potential of take up by WHO for global dissemination. By the conclusion of this mentored career development, candidate will have the foundational skills for implementation research with grounding in the principles of implementation science. Furthermore the candidate will have the technology assisted version of THP developed and assessed for acquisition of competencies lay workers and the pathway to scale up informed. This will inform an R01 for an implementation program of Thinking Healthy Program – Technology Assisted (THP-TA).