Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers

Laura K Murray, Shannon Dorsey, Paul Bolton, Mark Jd Jordans, Atif Rahman, Judith Bass, Helena Verdeli, Laura K Murray, Shannon Dorsey, Paul Bolton, Mark Jd Jordans, Atif Rahman, Judith Bass, Helena Verdeli

Abstract

Background: Recent global mental health research suggests that mental health interventions can be adapted for use across cultures and in low resource environments. As evidence for the feasibility and effectiveness of certain specific interventions begins to accumulate, guidelines are needed for how to train, supervise, and ideally sustain mental health treatment delivery by local providers in low- and middle-income countries (LMIC). MODEL AND CASE PRESENTATIONS: This paper presents an apprenticeship model for lay counselor training and supervision in mental health treatments in LMIC, developed and used by the authors in a range of mental health intervention studies conducted over the last decade in various low-resource settings. We describe the elements of this approach, the underlying logic, and provide examples drawn from our experiences working in 12 countries, with over 100 lay counselors.

Evaluation: We review the challenges experienced with this model, and propose some possible solutions.

Discussion: We describe and discuss how this model is consistent with, and draws on, the broader dissemination and implementation (DI) literature.

Conclusion: In our experience, the apprenticeship model provides a useful framework for implementation of mental health interventions in LMIC. Our goal in this paper is to provide sufficient details about the apprenticeship model to guide other training efforts in mental health interventions.

Figures

Figure 1
Figure 1
Apprenticeship Model.

References

    1. World Health Organization (WHO) Mental health systems in selected low and middle-income countries: a WHO-AIMS cross-national analysis. 2009.
    1. World Health Organization (WHO) The global burden of disease: 2004 update. Switzerland; 2008.
    1. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, Neugebauer R, Murray L, Verdeli H. Interventions for depressions symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. JAMA. 2007;298:519–27. doi: 10.1001/jama.298.5.519.
    1. Bolton P, Bass J, Sabir G, Kama T, Mohamed T, Gorman W, Murray L. Sixth World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders. Washington, DC; 2010. Preliminary results from a multi-armed trial of psychotherapy for torture survivors in Northern Iraq.
    1. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. The Lancet. 2008;372:902–9. doi: 10.1016/S0140-6736(08)61400-2.
    1. Verdeli H, Clougherty K, Bolton P, Speelman L, Lincoln N, Bass J, Neugebauer R, Weissman M. Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry. 2003;2:114–20.
    1. Tol WA, Komproe IH, Susanty D, Jordans MJD, De Jong JTVM. School-based mental health intervention for political violence-affected children in Indonesia: A cluster randomized trial. JAMA. 2008;300:655–62. doi: 10.1001/jama.300.6.655.
    1. Jordans MJD, Komproe IH, Tol WA, Kohrt B, Luitel N, Macy RDM, de Jong JTVM. Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized controlled trial. J Child Psychol Psychiatry. 2010;51:818–826. doi: 10.1111/j.1469-7610.2010.02209.x.
    1. Wang PS, Angermeyer M, Borges G. et al.Delay and failure in treatment seeking after first onset of mental health disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007;6:3:177–185.
    1. Saraceno B, van Ommeren M, Batniji R. et al.Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet. 2007;370:9593:1164–1174.
    1. Patel P, Chowdhary N, Rahman A, Verdeli H. Improving access to psychological treatments: Lessons from developing countries. Behavior Research and Therapy. 2011;49:523–528. doi: 10.1016/j.brat.2011.06.012.
    1. Patel V, Weiss H, Chowdhary N, Naik S, Pednekar S, Chatterjee S, De Silva MJ, Bhat B, Araya R, King M, Simon G, Verdeli H, Kirkwood BR. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. The Lancet. 2010;376:2086–95. doi: 10.1016/S0140-6736(10)61508-5.
    1. Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med. 2009;39:1759–62. doi: 10.1017/S0033291709005224.
    1. Bolton P, Bass J, Neugebauer R, Clougherty K, Verdeli H, Ndogoni L, Weissman M. Results of a clinical trial of a group intervention for depression in rural Uganda. JAMA. 2003;279:3117–24.
    1. Bass J, Neugebauer R, Clougherty KF, Verdeli H, Wickramaratne P, Ndogoni L, Speelman L, Weissman M, Bolton P. Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: Randomised controlled trial. Br J Psychiatry. 2006;188:567–73. doi: 10.1192/bjp.188.6.567.
    1. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82:858–66.
    1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370:841–50. doi: 10.1016/S0140-6736(07)61414-7.
    1. World Health Organization (WHO) mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings. 2010.
    1. World Health Organization. Mental Health Gap Action Programme; Scaling up care for mental, neurological, and substance abuse disorders. 2008. 2011.
    1. Verdeli H, Clougherty K, Onyango G, Lewandowski E, Speelman L, Betancourt T, Neugebauer R, Stein TR, Bolton P. Group Interpersonal Psychotherapy for depressed youth in IDP camps in Northern Uganda: Adaptation and training. Child Adolesc Psychiatr Clin N Am. 2008;17:605. doi: 10.1016/j.chc.2008.03.002.
    1. Murray LK, Skavenski S, Jere J, Kasoma M, Dorsey S, Imasiku M, Hupunda G, Bolton P, Bass J, Cohen J. Trauma-Focused Cognitive Behavioral Therapy for Children in Zambia: Cross-Cultural Training and Application (under review)
    1. Jordans MJ, Tol WA, Komproe IH, Susanty D, Vallipuram A, Ntamatumba P, Lasuba AC, de Jong JT. Comprehensive psychosocial support for children in areas of armed conflict. Int J Ment Health Syst. 2010;4:15:1–12.
    1. Rahman A. Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan - a multi-method study. Arch Womens Ment Health. 2007;10:211–19. doi: 10.1007/s00737-007-0193-9.
    1. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: A synthesis of the literature (FMHI Publication No. 231) Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network; 2005.
    1. Beidas RS, Kendall PC. Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clin Psychol (New York) 2010;17:1–30.
    1. Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clin Psychol Rev. 2010;30:448–66. doi: 10.1016/j.cpr.2010.02.005.
    1. Henggeler S, Schoenwald S, Liao J, Letourneau E, Edwards D. Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Clinical Child and Adolescent Psychology. 2002;31:155–167.
    1. Schoenwald SK, Sheidow AJ, Chapman JE. Clinical supervision in treatment transport: Effects on adherence and outcomes. J Consult Clin Psychol. 2009;77:3:410–421.
    1. Beidas RS, Koerner K, Weingardt K, Kendall PC. Training research: Seven practical suggestions for maximum impact. Admin Pol Ment Health. 2011. advance online publication 2011: n. pag. 5 .
    1. Collins A. In: Cambridge Handbook of the Learning Sciences. Sawyer RK, ed, editor. Cambridge, UK: Cambridge University Press; 2006. Cognitive apprenticeship; pp. 47–60.
    1. Glisson C, Hemmelgarn A. The effects of organizational climate and interorganizational coordination. Child Abuse Negl. 1998;22:401–21. doi: 10.1016/S0145-2134(98)00005-2.
    1. McHugh RK, Barlow DH. The dissemination and implementation of evidence-based psychological treatments. A review of current efforts. Am Psychol. 2010;65:73–84.
    1. Jordans MJD, Tol W, Sharma B, van Ommeren M. Training psychosocial counselling in Nepal: Content review of a specialised training program. Intervention. 2003;1:18–35.
    1. Lawson K. The trainer's handbook. San Francisco, CA: Pfieffer; 2009.
    1. Milne D. Evidence-based clinical supervision: Principles and practice. Malden Leicester England: Blackwell Publishing. 2009.
    1. Nothnagle M, Goldman R, Quirk M, Reis S. Promoting self-directed learning skills in residency: a case study in program development. Acad Med. 2010;85:1874–9. doi: 10.1097/ACM.0b013e3181fa02a4.
    1. Kendall PC, Beidas RS. Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity. Prof Psychol Res Pract. 2007;38:13–20.
    1. Barber JP, Crits-Christoph P, Luborksy L. Effects of therapist adherence and competence on patient outcome in brief dynamic therapy. J Consul Clin Psychol. 1996;64:619–22.
    1. Schoenwald S, Carter RE, Chapman JE, Sheidow AJ. Therapist adherence and organizational effects on change in youth behavior problems one year after Multisystemic Therapy. Adm Policy Ment Health. 2008;35:379–94. doi: 10.1007/s10488-008-0181-z.
    1. Hurlburt MS, Garland AF, Nguyen K, Brookman-Frazee L. Child and family therapy process: Concordance of therapist and observational perspectives. Adm Policy Ment Health. 2010;37:230–44. doi: 10.1007/s10488-009-0251-x.
    1. Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. Adm Policy Ment Health. 2010;37:15–26. doi: 10.1007/s10488-010-0279-y.
    1. Bickman L. A measurement feedback system (MFS) is necessary to improve mental health outcomes. J Am Acad Child Adolesc Psychiatry. 2008;47:1114–9. doi: 10.1097/CHI.0b013e3181825af8.
    1. Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noël PH, Lin EH, Areán PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C. IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment. Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA. 2002;288:2836–45. doi: 10.1001/jama.288.22.2836.
    1. Worthen VE, Lambert MJ. Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counsell Psychother Res J. 2007;7:48–53. doi: 10.1080/14733140601140873.
    1. Massatti RR, Sweeney H, Panzano PC, Roth D. The de-adoption of innovative mental health practices (IMHP): Why organizations choose not to sustain an IMHP. Adm Policy Ment Health. 2008;35:50–65. doi: 10.1007/s10488-007-0141-z.
    1. Miller W, Yahne C, Moyers T, Martinez J, Pirritano M. A randomized trial of methods to help clinicians learn motivational interviewing. J Consul Clin Psychol. 2004;72:1050–62.
    1. Sholomskas DE, Syracuse-Siewert G, Rounsaville BJ, Ball SA, Nuro KF. We don't train in vain: A dissemination trial of three strategies of training clinicians in cognitive behavioral therapy. J Consul Clin Psychol. 2005;73:106–15.
    1. Beidas RS, Edmunds J, Kendall PC. A randomized controlled trial of training in cognitive-behavioral therapy for youth anxiety (Under review)
    1. Aladjem D, Borman K. A paper prepared for the annual meeting of the American Educational Research Association. San Francisco, CA; 2006. Summary of findings from the national longitudinal evaluation of comprehensive school reform.
    1. Tibbits MK, Bumbarger BK, Kyler SJ, Perkins DF. Sustaining evidence-based interventions under real-world conditions: Results from a large-scale diffusion project. Prev Sci. 2010;11:252–62. doi: 10.1007/s11121-010-0170-9.
    1. Vernez G, Karam R, Mariano L, DeMartini C. Evaluating comprehensive school reform models at scale: A focus on implementation. Santa Monica, CA: Rand Corporation; 2006.
    1. Kolko DJ, Hoagwood KE, Springgate B. Treatment research for children and youth exposed to traumatic events: moving beyond efficacy to amp up public health impact. Gen Hosp Psychiatry. 2010;32:465–76. doi: 10.1016/j.genhosppsych.2010.05.003.
    1. Forehand R, Dorsey S, Jones DJ, Long N, McMahon RJ. Adherence and flexibility: They can (and do) coexist. Clin Psychol Sci Prac. 2010;17:258–64. doi: 10.1111/j.1468-2850.2010.01217.x.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit