Effectiveness and implementation of pre-training interpersonal skills assessment of community health workers in South Africa to predict post-training competence in mental health care

项目摘要 世界范围内心理健康（MH）专家的短缺导致了全球心理健康治疗的巨大差距。 尽管有证据表明，非专业卫生工作者（LHWs）或几乎没有受过正规培训的卫生工作者可以有效地 在提供MH护理方面，LHWs提供MH护理的能力差异很大。 来自高收入国家的研究 低收入和中等收入国家的形成性工作表明，这种可变性可以通过以下方式预测： LHW人际交往能力 .然而，没有评估LHW人际交往能力的方法， 预测MH护理的能力。这一证据差距代表了LHW提供优质MH护理的障碍， 规模在南非，对培训前LHW人际交往技能评估的需求尤为迫切 (SA)，它正在积极地将MH护理服务纳入LHW角色。关于NIMH 战略优先事项4.1：“通过以下措施提高现有精神卫生服务的效率和成效 本研究旨在为南非的LHWs开发和试点培训前人际关系技能评估。 这种评估在未来可以帮助实施者使受训者与适当类型和数量的培训相一致。 培训，并帮助确保LHW提供的MH护理的质量。拟议的研究将利用正在进行的 申办者（Magidson）和共同申办者（Kohrt）的研究和合作。 我们的第一个研究目标是 确定人际交往技能作为MH护理中LHW能力预测因子 .我们将进行第二次 使用分类和回归树（CART）方法分析现有LHW数据（n=205），以确定 在MH培训前评估人际关系技能，预测培训后的MH护理能力。下一个是 在治疗师特征和实施障碍框架的指导下，我们将重点开展 南澳大利亚州的团体（n=20，研究人员，政策制定者，非政府组织工作人员），以文化验证定量研究结果， 确定额外的人际交往技能。我们的第二个研究目标是对 在南非开普敦的LHWs（n=30）中确定了人际交往技能。我们将评估初步的 人际关系技能在预测MH护理中LHW能力方面的有效性。最后，在 实施研究的综合框架，我们的第三个研究目标是评估可行性， 使用焦点小组和经验证的定量措施进行培训前评估的可接受性（n= 20 非政府组织工作人员）。研究目标与候选人Alexandra Rose女士（博士生）的培训目标一致 在马里兰州大学的临床心理学。培训目标包括： 全球心理健康研究中的实施科学; 在统计方法方面发展强大的技能 用于工具开发和评估心理测量学;并获得道德和专业方面的高级培训 发展 量身定制的培训计划将使Rose女士成为一名独立的研究人员， 共享MH劳动力发展。她将由美国和南非的导师指导， 研究所需的实施科学，统计和心理测量方法的专业知识。

PROJECT SUMMARY A worldwide shortage of mental health (MH) specialists contributes to a substantial global MH treatment gap. Despite evidence that lay health workers (LHWs), or health workers with little formal training, can effectively deliver MH care, LHWs vary widely in their abilities to deliver MH care. Prior research from high-income countries and formative work in low- and middle-income countries suggests this variability may be predicted by LHW interpersonal skills . However, there are no methods for assessing LHW interpersonal skills in order to predict competence in MH care. This evidence gap represents a barrier to LHW delivery of quality MH care at scale. The need for a pre-training LHW interpersonal skills assessment is particularly urgent in South Africa (SA), which is actively moving towards integrating MH care delivery into LHW roles. In response to NIMH Strategic Priority 4.1 to “improve the efficiency and effectiveness of existing mental health services through research,” this study aims to develop and pilot a pre-training interpersonal skills assessment for LHWs in SA. This assessment could, in the future, help implementers align trainees with the appropriate type and amount of training and help ensure the quality of LHW-delivered MH care. The proposed study will leverage the ongoing research and collaborations of the sponsor (Magidson) and co-sponsor (Kohrt). Our first research aim is to identify interpersonal skills to pilot as predictors of LHW competence in MH care . We will conduct secondary analysis of existing LHW data (n=205) using a classification and regression tree (CART) approach to identify interpersonal skills assessed before MH training that predict competence in MH care after training. Next, guided by the Therapist Characteristics and Barriers to Implementation Framework, we will conduct focus groups in SA (n=20, researchers, policymakers, NGO staff) to culturally validate quantitative findings and identify additional interpersonal skills for piloting. Our second research aim is to pilot assessment of the identified interpersonal skills among LHWs (n=30) in Cape Town, SA. We will assess the preliminary effectiveness of interpersonal skills in predicting LHW competence in MH care. Finally, guided by the Consolidated Framework for Implementation Research, our third research aim is to evaluate the feasibility and acceptability of the pre-training assessment using focus groups and a validated quantitative measure (n= 20 NGO staff). Research aims align with the training goals of the candidate, Ms. Alexandra Rose, a PhD student in Clinical Psychology at the University of Maryland. Training goals include: gaining expertise in dissemination and implementation science in global mental health research; developing strong skill sets in statistical methods for tool development and evaluating psychometrics; and obtaining advanced training in ethics and professional development. The tailored training plan will prepare Ms. Rose to become an independent researcher in task- shared MH workforce development. She will be guided by mentors in the US and SA with complementary expertise in the implementation science, statistical, and psychometric methods required for the study.