BASIC

80%的世界人口生活在精神健康状况不佳的中低收入国家(LMIC) 资源，造成了巨大的心理健康治疗缺口。越来越多的证据表明，证据- 基于心理健康的治疗可以在LMIC中使用任务分担方法提供，在这种方法中，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， 在现有的、政府支持的系统中支持并有效地提供这些治疗 可以扩大到人口层面。由于LMIC政府通常花费国家预算的2% 在心理健康方面，需要有创新和低成本的选择来实施干预措施。 支持。为儿童建立和维持干预措施(基础)：任务分担精神卫生保健 低资源环境建立在我们与肯尼亚研究伙伴15年的合作历史基础上，之前 NIH资助的工作，确定了LMIC中孤儿的心理健康需求，并反复和 使用任务分担方法进行协作干预适应和测试，以满足这些需求。在……里面 基本，我们测试以创伤为中心的认知行为治疗(TF-CBT)的实施情况，通过 任务分担，在肯尼亚合作伙伴优先考虑的两个政府部门，作为扩大规模的潜在选择- 教育和健康推广。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，以及我们肯尼亚合作伙伴的赋权工作 对TF-CBT的热情正在汇聚，以创造一种当地的环境，在这种环境中，BASIC可以成为 县计划，如果存在以证据为基础的执行指导，主要使用现有资源。我们 测试心理健康治疗提供教育(通过教师提供)和健康推广(通过社区 卫生志愿者)，目的是确定实施做法和政策(IPP)，以解释 实施成果。这项阶梯式楔形整群随机试验包括40所学校和40所 周围的村庄(每个村庄120名业馀辅导员)为1280名青年提供工作队-CBT。我们用一本小说 方法，定性比较分析(QCA)，它具有大幅推进领域的潜力 实施科学。QCA充分利用了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关系(即，一个结果可以通过多个 手段)。研究目标是：1)确定可操作的IPP，以预测采用率(交付)和保真度(高 质量交付)在部门中的10个站点实施TF-CBT之后。使用已识别的IPP(目标1a)指南 为后续站点提供实施规划支持，并(目标1b)生成关于以下方面的可测试假设 作为因果机制的执行方案；2)在两个部门测试执行成功的机制；3)测试 这两个部门的TF-CBT有效性(即心理健康结果；功能)和成本。这项研究已经 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.