Development of a scoring system for non-specialist ratings of clinical competence in global mental health: a qualitative process evaluation of the Enhancing Assessment of Common Therapeutic Factors (ENACT) scale

Abstract

Background.Task-sharing is the involvement of non-specialist providers to deliver mental health services. A challenge for task-sharing programs is to achieve and maintain clinical competence of non-specialists, including primary care workers, paraprofessionals, and lay providers. We developed a tool for non-specialist peer ratings of common factors clinical competency to evaluate and optimize competence during training and supervision in global mental health task-sharing initiatives.Methods.The 18-item ENhancing Assessment of Common Therapeutic factors (ENACT) tool was pilot-tested with non-specialists participating in mental health Gap Action Programme trainings in Nepal. Qualitative process evaluation was used to document development of the peer rating scoring system. Qualitative data included interviews with trainers and raters as well as transcripts of pre- and post-training observed structured clinical evaluations.Results.Five challenges for non-specialist peer ratings were identified through the process evaluation: (1) balance of training and supervision objectives with research objectives; (2) burden for peer raters due to number of scale items, number of response options, and use of behavioral counts; (3) capturing hierarchy of clinical skills; (4) objective v. subjective aspects of rating; and (5) social desirability when rating peers.Conclusion.The process culminated in five recommendations based on the key findings for the development of scales to be used by non-specialists for peer ratings in low-resource settings. Further research is needed to determine the ability of ENACT to capture the relationship of clinical competence with client outcomes and to explore the relevance of these recommendations for non-specialist peer ratings in high-resource settings.

Agricultural wealth better predicts mental wellbeing than market wealth among highly vulnerable households in Haiti: Evidence for the benefits of a multidimensional approach to poverty

“…This study further underscores the benefits of a more context-sensitive framework in this domain specifically (Cooper et al, 2012;Kaiser et al, 2017;Lazzarino et al, 2014), including the translation of human biological approaches to improve wellbeing of vulnerable populations (eg, Kohrt et al 2015).…”

“…Mental health, our focus here, is increasingly recognized as a core-if understudied-aspect of human biology, and one undermined by lack of wealth and power (eg, Hadley and Patil 2006;Kohrt et al 2015).…”

Brief Problem-solving Therapy for Antenatal Depressive Symptoms in Primary Care in Rural Ethiopia: Protocol for a Randomised, Controlled Feasibility Trial

“…Trained healthcare workers will deliver the intervention under the supervision of an Ethiopian clinical or counselling psychologist (master's level) or psychiatrist/psychiatric resident trained in psychological therapies. Healthcare worker training will consist of: (a) a ve day classroom-based training course which includes training on counselling and communication skills as well as PST-speci c skills, and (2) accelerated delivery of four sessions of PST, using high-intensity supervision and feedback to build competency (56,57). Competency will be established using the Enhancing Assessment of Common Therapeutic factors (ENACT) scale (56,57) administered by trained clinicians.…”

“…Healthcare worker training will consist of: (a) a ve day classroom-based training course which includes training on counselling and communication skills as well as PST-speci c skills, and (2) accelerated delivery of four sessions of PST, using high-intensity supervision and feedback to build competency (56,57). Competency will be established using the Enhancing Assessment of Common Therapeutic factors (ENACT) scale (56,57) administered by trained clinicians. The healthcare worker will be required to score level 3 ("Done Well") out of the three levels: ("Done Well", "Done partially" and "Need improvement") on each of the competencies in order to participate in the trial.…”

Improving quality of mental health care in low‐resource settings: lessons from PRIME

“…One example is the Enhancing Assessment of Common Therapeutic Factors (ENACT) scale in Nepal, which is used by mental health specialist supervisors to routinely assess clinical competence of non-specialist health workers in the delivery of mental health care 8 . Another is the adaptation and use of the Institute for Healthcare Improvement's Plan Do Study Act (PDSA) cycle in South Africa.…”