BASIC

世界上80%的人口生活在低收入和中等收入国家（LMIC），几乎没有心理健康 资源，造成巨大的心理健康治疗差距。越来越多的证据表明，证据- 基于心理健康治疗可以提供在LMIC使用任务共享的方法，其中非 专业人员在监督下提供护理。然而，非常有限的研究集中在如何嵌入， 支持，并在现有的政府支持的系统内有效地提供这些治疗， 可以扩大到人口水平。LMIC政府通常花费不到国家预算的2%， 在心理健康方面，需要创新和低成本的干预措施， 支持.为儿童建立和维持干预措施（基本）： 低资源环境建立在我们与肯尼亚研究伙伴合作15年的历史基础上， NIH资助的工作，确定了LMIC孤儿的心理健康需求， 协作干预调整和测试使用任务分担的方法，以满足这些需求。在 基本上，我们测试创伤集中认知行为疗法（TF-CBT）的实施，通过 在我们的肯尼亚合作伙伴优先考虑的两个政府部门分担任务，作为扩大规模的可能选择， 教育和卫生推广。肯尼亚政府最近的权力下放（导致更多的地方 决策），启动国家精神卫生政策，以及我们的肯尼亚合作伙伴的赋权工作 对TF-CBT的热情正在聚集，以创造一种当地气候，在这种气候中，BASIC可以成为 存在国家计划，如果以证据为基础的执行指导，则主要利用现有资源。我们 在教育（通过教师提供）和健康推广（通过社区）中测试心理健康治疗的提供 卫生志愿者），目标是确定实施实践和政策（IPP）， 执行成果。这项阶梯楔形群随机试验包括40所学校和40所 该组织还在周边村庄（每个村庄有120名非专业顾问）为1，280名青年提供TF-CBT。我们用一本小说 方法，定性比较分析（QCA），具有实质性推进领域的潜力， 执行科学。QCA利用定量方法的严谨性和定性方法的细节， 方法，并允许复杂的因果关系和等价性（即，一个结果可以通过多个 手段）。研究目的是：1）确定可操作的IPP，预测采用（交付）和保真度（高- 质量交付）。使用已确定的IPP（目标1a）指南 为后续站点提供实施规划支持，并（目标1b）生成可验证的假设， 作为因果机制的独立专业伙伴关系; 2）测试两个部门执行成功的机制; 3）测试 TF-CBT有效性（即，心理健康结果;功能）和两个部门的成本。本研究 在包括美国在内的低资源环境中实施EBT的重要影响。

Eighty percent of the world’s population lives in low and middle income countries (LMIC) with few mental health resources, resulting in a substantial mental health treatment gap. Growing evidence indicates that evidence- based mental health treatments can be delivered in LMIC using a task-sharing approach, in which non- professionals deliver care under supervision. Very limited research, however, focuses on how to embed, support, and effectively deliver these treatments within existing, government-supported systems in which they could be scaled up to population-level. With LMIC governments typically spending <2% of their national budget on mental health, innovative and low-cost options are needed for intervention delivery and for implementation support. Building and Sustaining Interventions for Children (BASIC): Task-sharing mental health care in low-resource settings builds on our 15-year history of collaborations with research partners in Kenya, prior NIH-funded work that identified mental health needs of orphaned children in LMIC, and iterative and collaborative intervention adaptation and testing using a task-sharing approach, to address these needs. In BASIC, we test the implementation of Trauma-focused Cognitive Behavioral Therapy (TF-CBT), delivered via task-sharing, in two governmental sectors prioritized by our Kenyan partners as potential options for scale up— Education and Health Extension. The recent devolvement of the Kenyan government (leading to more local decision-making), the launch of a National Mental Health Policy, and our Kenyan partners’ empowerment work building enthusiasm for TF-CBT are converging to create a local climate in which BASIC could become part of the county plan, if evidence-based guidance for implementation, using mostly existing resources, existed. We test mental health treatment delivery in Education (via teacher delivery) and Health Extension (via community health volunteers) with the goal of identifying implementation practices and policies (IPPs) that explain implementation outcomes. This stepped wedge cluster randomized trial includes 40 schools and the 40 surrounding villages (120 lay counselors in each) who provide TF-CBT to 1,280 youth. We use a novel method, qualitative comparative analyses (QCA), that holds potential for substantially advancing the field of implementation science. QCA leverages the rigor of quantitative approaches and the detail of qualitative approaches, and allows for complex causality and equifinality (i.e., an outcome can be reached by multiple means). Study aims are: 1) Identify actionable IPPs that predict adoption (delivery) and fidelity (high- quality delivery) after 10 sites in sector implement TF-CBT. Use identified IPPs to (Aim 1a) guide implementation planning support for subsequent sites and to (Aim 1b) generate testable hypotheses about IPPs as causal mechanisms; 2) Test mechanisms of implementation success in both sectors; and 3) Test TF-CBT effectiveness (i.e., mental health outcomes; functioning) and cost in both sectors. This research has important implications for implementing an EBT in low-resource settings, including the US.