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Under the hood: lay counsellor element use in a modular multi-problem transdiagnostic intervention in lower resource countries

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  10 January 2019

Laura K. Murray ,
Emily E. Haroz ,
Michael D. Pullmann ,
Shannon Dorsey ,
Jeremy Kane ,
Jura Augustinavicius ,
Catherine Lee  and
Paul Bolton
Laura K. Murray*
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
Emily E. Haroz
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
Michael D. Pullmann
Affiliation:
Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, UW Box 358015, Seattle, WA 98102-3086, USA
Shannon Dorsey
Affiliation:
Department of Psychology, University of Washington, Guthrie Hall, Seattle, WA 98195, USA
Jeremy Kane
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
Jura Augustinavicius
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
Catherine Lee
Affiliation:
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
Paul Bolton
Affiliation:
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
*
*Author for correspondence: Laura K. Murray, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th floor, Baltimore, MD 21205, USA (email: lmurra15@jhu.edu).
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Abstract

The use of transdiagnostic mental health treatments in low resource settings has been proposed as a possible aid in scaling up mental health services. Modular, multi-problem transdiagnostic treatments can be used to treat a range of mental health problems and are designed to handle comorbidity. Two randomized controlled trials have been completed on one treatment – the Common Elements Treatment Approach, or CETA – delivered by lay counsellors in Iraq and Thailand. This paper utilizes data from two clinical trials to explore the delivery of CETA by lay providers, examining fidelity and flexibility of element use. Data were collected at every therapy session. Clients completed a short symptom assessment and providers described the clinical elements delivered during sessions. Analyses included descriptive statistics of delivery including selection and sequencing of treatment elements, and the variance in element dose, clustering at the counsellor level, using multi-level models. Results indicate that lay providers in low resource settings (with supervision) demonstrated fidelity to the recommended CETA elements, order and dose, and occasionally added in elements and flexed dosage based on client presentation (i.e. flexibility). This modular approach did not result in significantly longer treatment duration. Our analysis suggests that lay providers were able to learn decision-making processes of CETA based on client presentation and adjust treatment as needed with supervision. As modular multi-problem transdiagnostic treatments continue to be explored in low resource settings, research should continue to focus on ‘unpacking’ lay counsellor delivery of these interventions, decision-making processes, and the level of supervision required.

Keywords

transdiagnosticglobal mental healthimplementationfidelitylay counsellortask sharing

Information

Type
Special Issue: Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e6
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Suggested follow-up reading

McHugh, RK, Murray, HW, Barlow, DH (2009). Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behaviour Research and Therapy 47, 946–953. doi: 10.1016/j.brat.2009.07.005Google Scholar
Murray, LK, Dorsey, S, Haroz, E, Lee, C, Alsiary, MM, Haydary, A et al. (2014). A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cognitive and Behavioral Practice 21, 111–123. doi: 10.1016/j.cbpra.2013.06.005Google Scholar
Weisz, JR, Chorpita, BF, Palinkas, LA, Schoenwald, SK, Miranda, J, Bearman, SK et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Archives of General Psychiatry 69, 274–282. doi: 10.1001/archgenpsychiatry.2011.147Google Scholar

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