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

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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.