Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study

Christina M Cruz, Choden Dukpa, Juliana L Vanderburg, Abhishek K Rauniyar, Priscilla Giri, Surekha Bhattarai, Arpana Thapa, Karen Hampanda, Bradley N Gaynes, Molly M Lamb, Michael Matergia, Christina M Cruz, Choden Dukpa, Juliana L Vanderburg, Abhishek K Rauniyar, Priscilla Giri, Surekha Bhattarai, Arpana Thapa, Karen Hampanda, Bradley N Gaynes, Molly M Lamb, Michael Matergia

Abstract

Background: The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers', students', and caregivers' acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students.

Methods: In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, "education as mental health therapy" (Ed-MH). Measured with validated scales, teachers' and students' acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST.

Results: Teachers' quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children's measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers' ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out.

Conclusion: Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care.Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry-India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27.

Supplementary information: The online version contains supplementary material available at 10.1007/s44192-022-00024-z.

Keywords: Acceptability; Caregiver; Child mental health care; Community mental health; Global mental health; Primary school; School mental health; Student; Task-shifting; Teacher.

Conflict of interest statement

Competing interestsCMC, PG, and MM hold the copyright to the training materials, decision support tools, and intervention materials for the teacher-led task-shifted alternative system of children’s mental health care at the center of this manuscript.

© The Author(s) 2022.

Figures

Fig. 1
Fig. 1
Tealeaf’s 6 components are illustrated here. First, teachers receive training and supervision from study staff. Second, teachers under supervision identify children in need of mental health support in their classrooms. Third, teachers perform a behavior analysis on students to begin to understand targeted behaviors. Fourth, teachers create a behavior plan, choosing therapeutic techniques to use that target behaviors identified in behavior analysis and ones they feel they can implement during the school day. Fifth, teachers coordinate with parents, informing them of their child’s progress at school, learning of their child’s progress at home, and guiding how Tealeaf techniques may be used at home. Finally, teachers deliver therapy during the school day

References

    1. World Health Organization . mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings. Geneva: World Health Organization; 2010.
    1. Banerjee T. Psychiatric morbidity among rural primary school children in West Bengal. Indian J Psychiatry. 1997;39(2):130.
    1. Burns BJ, Costello EJ, Angold A, Tweed D, Stangl D, Farmer EM, et al. Children's mental health service use across service sectors. Health Aff. 1995;14(3):147–159. doi: 10.1377/hlthaff.14.3.147.
    1. Hossain MM, Purohit N. Improving child and adolescent mental health in India: status, services, policies, and way forward. Indian J Psychiatry. 2019;61(4):415. doi: 10.4103/psychiatry.IndianJPsychiatry_217_18.
    1. Miles J, Espiritu RC, Horen N, Sebian J, Waetzig E. A public health approach to children’s mental health: A conceptual framework. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. 2010.
    1. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–1663. doi: 10.1016/S0140-6736(11)61093-3.
    1. Van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera S, Pian J, et al. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle-income countries. Cochrane Database Syst Rev. 2013;11(11):CD009149.
    1. van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, et al. Primary-level worker interventions for the care of people living with mental disorders and distress in low-and middle-income countries. Cochrane Database Syst Rev. 2021 doi: 10.1002/14651858.CD009149.pub3.
    1. Are A, Olisah V, Bella-Awusah T, Ani C. Controlled clinical trial of teacher-delivered cognitive behavioural therapy (CBT) for adolescents with clinically diagnosed depressive disorder in Nigeria. Int J Mental Health. 2021 doi: 10.1080/00207411.2021.1891361.
    1. Shinde S, Weiss HA, Varghese B, Khandeparkar P, Pereira B, Sharma A, et al. Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial. Lancet. 2018;392(10163):2465–2477. doi: 10.1016/S0140-6736(18)31615-5.
    1. Robinson TR, Smith SW, Miller MD. Effect of a cognitive-behavioral intervention on responses to anger by middle school students with chronic behavior problems. Behav Disord. 2002;27:256–71.
    1. Connolly SM, Vanchu-Orosco M, Warner J, Seidi PA, Edwards J, Boath E, et al. Mental health interventions by lay counsellors: a systematic review and meta-analysis. Bull World Health Organ. 2021;99(8):572. doi: 10.2471/BLT.20.269050.
    1. Fazel M, Patel V, Thomas S, Tol W. Mental health interventions in schools in low-income and middle-income countries. Lancet Psychiatry. 2014;1(5):388–398. doi: 10.1016/S2215-0366(14)70357-8.
    1. Reinke WM, Stormont M, Herman KC, Puri R, Goel N. Supporting children's mental health in schools: teacher perceptions of needs, roles, and barriers. Sch Psychol Q. 2011;26(1):1. doi: 10.1037/a0022714.
    1. Auger RW. The accuracy of teacher reports in the identification of middle school students with depressive symptomatology. Psychol Sch. 2004;41(3):379–389. doi: 10.1002/pits.10164.
    1. Franklin CG, Kim JS, Ryan TN, Kelly MS, Montgomery KL. Teacher involvement in school mental health interventions: a systematic review. Child Youth Serv Rev. 2012;34(5):973–982. doi: 10.1016/j.childyouth.2012.01.027.
    1. Lane KL. Identifying young students at risk for antisocial behavior: the utility of “teachers as tests”. Behav Disord. 2003;28(4):360–369. doi: 10.1177/019874290302800404.
    1. Murray DW, Rabiner D, Schulte A, Newitt K. Feasibility and integrity of a parent–teacher consultation intervention for ADHD students. Child Youth Care Forum. 2008 doi: 10.1007/s10566-008-9054-6.
    1. Kazdin AE. Acceptability of child treatment techniques: the influence of treatment efficacy and adverse side effects. Behav Ther. 1981;12(4):493–506. doi: 10.1016/S0005-7894(81)80087-1.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–1327. doi: 10.2105/AJPH.89.9.1322.
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. doi: 10.1007/s10488-010-0319-7.
    1. Han SS, Weiss B. Sustainability of teacher implementation of school-based mental health programs. J Abnorm Child Psychol. 2005;33(6):665–679. doi: 10.1007/s10802-005-7646-2.
    1. Elliott SN. Acceptability of behavioral treatments: review of variables that influence treatment selection. Prof Psychol Res Pract. 1988;19(1):68. doi: 10.1037/0735-7028.19.1.68.
    1. Reimers TM, Wacker DP, Koeppl G. Acceptability of behavioral interventions: a review of the literature. Sch Psychol Rev. 1987;16(2):212–227. doi: 10.1080/02796015.1987.12085286.
    1. Dorsey S, Meza RD, Martin P, Gray CL, Triplett NS, Soi C, et al. Lay counselor perspectives of providing a child-focused mental health intervention for children: task-shifting in the education and health sectors in Kenya. Front Psych. 2019;10:860. doi: 10.3389/fpsyt.2019.00860.
    1. Dorsey S, Gray CL, Wasonga AI, Amanya C, Weiner BJ, Belden CM, et al. Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial. BMC Psychiatry. 2020;20(1):1–14. doi: 10.1186/s12888-019-2364-4.
    1. Shinde S, Pereira B, Khandeparkar P, Sharma A, Patton G, Ross DA, et al. The development and pilot testing of a multicomponent health promotion intervention (SEHER) for secondary schools in Bihar, India. Glob Health Action. 2017;10(1):1385284. doi: 10.1080/16549716.2017.1385284.
    1. Owens JS, Richerson L, Beilstein EA, Crane A, Murphy CE, Vancouver JB. School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome. J Atten Disord. 2005;9(1):261–274. doi: 10.1177/1087054705279299.
    1. McEvoy PM, Nathan P, Norton PJ. Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. J Cogn Psychother. 2009;23(1):20–33. doi: 10.1891/0889-8391.23.1.20.
    1. Cruz CM, Giri P, Vanderburg JL, Ferrarone P, Bhattarai S, Giardina AA, et al. The potential emergence of “education as mental health therapy” as a feasible form of teacher-delivered child mental health care in a low and middle income country: a mixed methods pragmatic pilot study. Front Psychiatry. 2021 doi: 10.3389/fpsyt.2021.790536.
    1. Vanderburg J, Dukpa C, Rauniyar A, Giri P, Bhattarai S, Thapa A, et al. Exploring mental health and academic outcomes of children receiving non-manualized, transdiagnostic, task-shifted mental health care from their teachers in a low-and-middle income country. Front Pediatr. 2022 doi: 10.3389/fped.2022.807178.
    1. Creswell JW. A concise introduction to mixed methods research. Thousand Oaks: SAGE publications; 2021.
    1. Rai RP. Small farmers: locating them in “Darjeeling Tea”. In: Bag A, Bag N, Palini LMS, editors. Tea technological initiatives. New Delhi: New Delhi Publishing Agency; 2017. pp. 19–38.
    1. Matergia M, Ferrarone P, Khan Y, Matergia DW, Giri P, Thapa S, et al. Lay field-worker–led school health program for primary schools in low-and middle-income countries. Pediatrics. 2019;143(4):e20180975. doi: 10.1542/peds.2018-0975.
    1. Kingdon GG. The emptying of public schools and growth of private schools in India. Budget Private. 2017; p. 12.
    1. Cruz CM, Lamb MM, Hampanda K, Giri P, Campbell M, Chowdhury B, et al. Teacher nomination of school-aged children for mental health services in a low and middle income country. Glob Health Action. 2021;14(1):1861921. doi: 10.1080/16549716.2020.1861921.
    1. Witt J, Elliott S. Acceptability of classroom management strategies. In: Kratochwill TR, editor. Advances in school psychology. Hillsdale: Erlbaum; 1985. pp. 251–288.
    1. Turco TL, Elliott SN. Assessment of students' acceptability ratings of teacher-initiated interventions for classroom misbehavior. J Sch Psychol. 1986;24(3):277–283. doi: 10.1016/0022-4405(86)90060-9.
    1. . Social_Validity_Adapted_CIRP_Student. 2019. . Accessed 1 Feb 2019.
    1. Government of India. Primary census abstract. In: India Co, editor. Delhi. 2011.
    1. Achenbach TM. Manual for the teacher's report form and 1991 profile: Univ Vermont/Department Psychiatry; 1991.
    1. Leung PW, Wong MM. Measures of child and adolescent psychopathology in Asia. Psychol Assess. 2003;15(3):268. doi: 10.1037/1040-3590.15.3.268.
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>;2-G.
    1. Terrell SR. Mixed-methods research methodologies. Qual Rep. 2012;17(1):254–280.
    1. Dawson KS, Bryant RA, Harper M, Kuowei Tay A, Rahman A, Schafer A, et al. Problem management plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry. 2015;14(3):354–357. doi: 10.1002/wps.20255.
    1. Cooper JO, Heron TE, Heward WL. Applied behavior analysis. London: Pearson UK; 2020.
    1. Knell SM. Cognitive-behavioral play therapy. Lanham: Rowman & Littlefield; 1993.
    1. Beck AT. Cognitive therapy of depression. New York: Guilford Press; 1979.
    1. SAS Institute Inc. SAS. 9.4 ed. Cary, NC; 2019.
    1. Thomas DR. A general inductive approach for qualitative data analysis. 2003.
    1. Crabtree BF, Miller WL. Doing qualitative research. Thousand Oaks: Sage Publications; 1999.
    1. Cunningham JM, Suldo SM. Accuracy of teachers in identifying elementary school students who report at-risk levels of anxiety and depression. Sch Ment Heal. 2014;6(4):237–250. doi: 10.1007/s12310-014-9125-9.
    1. Loades ME, Mastroyannopoulou K. Teachers’ recognition of children’s mental health problems. Child Adolesc Mental Health. 2010;15(3):150–156. doi: 10.1111/j.1475-3588.2009.00551.x.
    1. Splett JW, Garzona M, Gibson N, Wojtalewicz D, Raborn A, Reinke WM. Teacher recognition, concern, and referral of children’s internalizing and externalizing behavior problems. Sch Ment Heal. 2019;11(2):228–239. doi: 10.1007/s12310-018-09303-z.
    1. Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–86. doi: 10.1016/j.socscimed.2013.08.004.
    1. Maggin DM, Wehby JH, Moore-Partin TC, Robertson R, Oliver RM. Supervising paraeducators in classrooms for children with emotional and behavioral disorders. Children. 2009;18:2–9.
    1. Chesley GM, Jordan J. What’s missing from teacher prep. Educ Leadersh. 2012;69(8):41–45.
    1. Duchaine EL, Jolivette K, Fredrick LD. The effect of teacher coaching with performance feedback on behavior-specific praise in inclusion classrooms. Educ Treat Child. 2011;34(2):209–227. doi: 10.1353/etc.2011.0009.
    1. Haine-Schlagel R, Walsh NE. A review of parent participation engagement in child and family mental health treatment. Clin Child Fam Psychol Rev. 2015;18(2):133–150. doi: 10.1007/s10567-015-0182-x.
    1. Sriprakash A. ‘Joyful Learning’in rural Indian primary schools: an analysis of social control in the context of child-centred discourses. Compare. 2009;39(5):629–641. doi: 10.1080/03057920903125677.
    1. Vanderburg JL, Bhattarai S, Ferrarone P, Giri P, Lamb MM, Giardina AA, et al. Teacher and caregiver perceptions of family engagement in teacher-led task-shifted child mental health care in a low-and-middle-income country. Global Public Health. 2021 doi: 10.1080/17441692.2021.2002924.
    1. Dempster R, Wildman B, Keating A. The role of stigma in parental help-seeking for child behavior problems. J Clin Child Adolesc Psychol. 2013;42(1):56–67. doi: 10.1080/15374416.2012.700504.
    1. Pescosolido BA, Perry BL, Martin JK, McLeod JD, Jensen PS. Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatr Serv. 2007;58(5):613–618. doi: 10.1176/ps.2007.58.5.613.
    1. Cruz CM, Lamb MM, Giri P, Vanderburg J, Ferrarone P, Bhattarai S, et al. Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study. Int J Ment Heal Syst. 2021;15(1):1–16.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren