Evaluating Implementation Strategies to Scale-up Transdiagnostic Evidence-based Mental Health Care in Zambia

评估在赞比亚扩大跨诊断循证精神卫生保健的实施策略

基本信息

批准号：
9983924
负责人：
Laura Kay Murray
金额：
$ 21.93万
依托单位：
CENTRE FOR INFECTIOUS DISEASE RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9983924
关键词：
AIDS/HIV problem Address Adolescent Alcohol or Other Drugs use Attention Behavioral Benchmarking Chronic Disease Client Clinical Cognitive Therapy Collaborations Communities Competence Data Discipline Disease Educational process of instructing Effectiveness Elements Evaluation Evidence based practice Evidence based treatment Goals Gold Government Grant Health Health Policy Healthcare Healthcare Systems High Prevalence Human Resources Hybrids Individual Intervention Knowledge Learning Mental Depression Mental Health Mental Health Services Mental disorders Modeling Monitor Outcome Persons Policies Poverty Professional counselor Provider Psychotherapy Randomized Randomized Clinical Trials Randomized Controlled Trials Research Resources Risk Factors Science Severities Site Supervision System Technology Testing Trainers Training Training Translations Trauma USAID United States National Institutes of Health Video Recording Violence Zambia base behavioral health clinically significant common treatment compare effectiveness cost cost effective cost effectiveness design evidence base experience follow-up food insecurity implementation research implementation science implementation strategy improved innovation low and middle-income countries member programs rehearsal research study routine practice scale up skills stressor symptomatology trial design young adult

项目摘要

Program Summary The overall objective of this study is to evaluate implementation strategies that can reduce the science-to- practice gap of evidence-based treatments (EBT) for mental health. Although evidence suggests that mental health treatments are acceptable and efficacious in low-and-middle income countries (LMIC) for the treatment of common mental disorders, there remains a gap in our understanding of how to bring these interventions to scale. A significant challenge is training and sustaining counselors in EBT. We will conduct implementation research evaluating the effectiveness of two Train-the-Trainer (TTT) implementation strategies to increase and sustain the number of counselors in a non-inferiority design. One TTT strategy is the gold-standard of utilizing expert trainers to conduct in-person training and coaching to produce local trainers. The second strategy is technology based with no experts needed on-site, utilizing phones that function both on and offline and allow for pre-recorded teachings. Trainers (6-8) will be randomized to one of the TTT strategies, and subsequently complete two Common Elements Treatment Approach (CETA) trainings with local lay counselors. A total of 100 lay counselors trained in CETA will serve at least 5 adolescents or young adults under supervision of the local trainers. The transdiagnostic treatment being scaled up, CETA, was effective in two randomized clinical trials in LMIC settings with lay providers. CETA provides the basis for feasible scale-up through the use a single therapy to treat multiple common mental disorders with varying severities, an approach that is more cost-effective than implementing multiple single-disorder focused psychotherapy treatments in LMIC. Outcomes will include: 1) trainer and counselor competency, knowledge and fidelity through tests, behavioral rehearsal, and audio/video recordings, 2) client mental health symptomatology, and 3) implementation constructs of reach, acceptability, appropriateness, feasibility, and scale-up potential. The cost-effectiveness of the two TTT strategies will also be evaluated. The project will specifically strengthen the capacity of: 1) study staff to conduct mental health implementation science research, 2) counselor and trainers in CETA training, supervision and delivery, and 3) policy and decision makers to interpret and appropriately utilize the scientific evidence to improve mental health policies and programs. At 15+ organizations with CETA providers, we will set up monitoring systems to assess quality, reach and cost going beyond the study. These aims will contribute to developing dynamic sustainable Learning Health Care Systems in LMIC. This proposal leverages previous studies and strong collaborations in Zambia with the Ministry of Health and numerous local organizations. Results from this trial will produce effectiveness and costing data on 2 TTT strategies that could inform the scale-up potential of diverse EBT in LMIC across and beyond mental health. This research study ultimately addresses both the treatment and implementation gaps in lower-resource settings globally.

计划概要这项研究的总体目标是评估可以减少科学到- 心理健康循证治疗（EBT）的实践差距。尽管有证据表明心理健康治疗在中低收入国家 (LMIC) 是可接受且有效的对于常见的精神障碍，我们对如何将这些干预措施应用于规模。一项重大挑战是培训和维持 EBT 顾问。我们将进行实施研究评估了两种培训师培训 (TTT) 实施策略的有效性，以提高和在非劣效设计中维持辅导员的数量。 TTT 策略之一是利用专家培训师进行现场培训和辅导，以培养本地培训师。第二个策略是基于技术，无需现场专家，利用可在线和离线运行的电话，并允许用于预先录制的教学。培训师 (6-8) 将被随机分配到其中一种 TTT 策略，随后与当地非专业顾问一起完成两次通用要素治疗方法 (CETA) 培训。总共有 100 名接受过 CETA 培训的非专业辅导员将在辅导员的监督下为至少 5 名青少年或年轻人提供服务。当地培训师。扩大规模的跨诊断治疗 CETA 在两项随机临床试验中有效在中低收入国家环境中与非专业医疗服务提供者进行试验。 CETA 通过使用单一疗法可治疗多种不同严重程度的常见精神障碍，这种方法更有效比在中低收入国家实施多种针对单一疾病的心理治疗更具成本效益。结果将包括： 1) 通过测试、行为、培训师和辅导员的能力、知识和忠诚度排练和音频/视频记录，2) 客户心理健康症状，以及 3) 实施范围、可接受性、适当性、可行性和扩大潜力的构建。成本效益还将评估两种 TTT 策略。该项目将具体加强以下能力：1）学习进行心理健康实施科学研究的工作人员，2) CETA 培训的顾问和培训师，监督和交付，以及3）政策和决策者解释和适当利用科学改善心理健康政策和计划的证据。在超过 15 个拥有 CETA 提供商的组织中，我们将建立监测系统来评估研究之外的质量、范围和成本。这些目标将有助于在中低收入国家开发动态可持续的学习保健系统。该提案利用了之前的在赞比亚与卫生部和众多当地组织进行研究并开展强有力的合作。该试验的结果将产生 2 个 TTT 策略的有效性和成本数据，这些数据可以为扩大中低收入国家心理健康领域和其他领域多样化 EBT 的潜力。本研究最终解决全球资源匮乏地区的治疗和实施差距。