Development of a transdiagnostic stepped care programme for common adolescent mental health problems in Indian secondary schools: lessons from a pilot study examining acceptability and feasibility

Malik, Kanika; Ibrahim, Maliha; Mathur, Sonal; Jose, James; Nair, Pooja; Sahu, Rooplata; Krishna, Madhuri; Jangra, Deepak; Mathews, Rhea; Cuijpers, Pim; Chorpita, Bruce F.; Fairburn, Christopher G.; Patel, Vikram; Michelson, Daniel

doi:10.1017/gmh.2022.7

Cited by 7 publications

(18 citation statements)

References 13 publications

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“…Kids also may prefer to stay with one provider and may not understand why they are being moved between steps and providers -this could interfere with engagement and contribute to difficulties building rapport." This finding was replicated in a later pilot (37), leading the team to modify the treatment to be a singleprovider model rather than having students change providers between levels of care.…”

Section: Level Of Carementioning

confidence: 88%

“…Not knowing the treatment duration may be anxiety provoking for students and lead to dropouts." The relationship between engagement and treatment duration informed later revisions to the treatment that aimed to reduce dropout by capping the number of sessions (37).…”

Section: Engagementmentioning

confidence: 99%

“…The team also highlighted the types of problems seen in students and whether they aligned with expectations, such as when one provider stated that "in the manual, we use a specific phobia as an example, though that hasn't come up in our sample; we should revise the manual to fit the problems that have come up (social anxiety)." These discussions resulted in proposed modifications to emphasize shared decision-making in future iterations of the protocol (37) and revise examples in the protocol to be a stronger fit with the actual problems experienced by participating students.…”

Section: Practice Contentmentioning

confidence: 99%

“…Difficult to decide what flow the student should go into if there isn't a lot of information." Solutions offered across meetings varied and were often discussed for months before the group decided on changes for the next research phase, including using the YTP as the primary measure informing decisions, along with emphasizing shared decision-making with the adolescent (37).…”

Section: Clinical Decision-makingmentioning

confidence: 99%

“…[A different measure] is difficult for the student to read, they don't reflectively think about responses." This feedback informed the team's decision to retain the YTP as the primary routine outcome monitoring tool in later phases of piloting (37).…”

Section: Monitoringmentioning

confidence: 99%

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A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India

et al. 2022

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IntroductionIn low- and middle-income countries (LMICs), the gap between need for mental health (MH) treatment and access to services is stark, particularly among children and adolescents. In service of addressing this treatment gap, the current study provides an in-depth illustration of later-stage collaborative design of a school-based, transdiagnostic MH intervention in New Delhi and Goa, India, using a combination of contextual insights from local stakeholders and knowledge derived from the global evidence base.MethodsUsing an inductive-deductive approach to qualitative thematic analysis, we examined coded data from qualitative sources related to experiences of developing and implementing an intervention prototype. These sources included notes from meetings attended by treatment development team members and providers, written feedback on protocol materials (e.g., provider manual, student handouts), field notes reflecting researcher observations, and minutes from weekly clinical supervision meetings.ResultsResults revealed that codes involving cultural/contextual considerations, protocol material and content, and intervention complexity arose consistently throughout treatment development and across document types, illustrating their central role in finalizing protocol design.DiscussionThese findings have implications for the future of mental health treatment development and implementation globally.

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Section: Level Of Carementioning

confidence: 88%

Section: Engagementmentioning

confidence: 99%

Section: Practice Contentmentioning

confidence: 99%

Section: Clinical Decision-makingmentioning

confidence: 99%

Section: Monitoringmentioning

confidence: 99%

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A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India

et al. 2022

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Peer-delivered Problem-solving Therapy for Adolescent Mental Health in Kenya: Adaptation for Context and Training of Peer-counselors

Giusto,

Vander Missen,

Kosgei

et al. 2023

Res Child Adolesc Psychopathol

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Peer-delivered interventions for adolescent mental health can help address poor access to mental health interventions. Questions remain about how interventions can be adapted for peer delivery and whether peers can be trained. In this study, we adapted problem solving therapy (PST) for peer-delivery with adolescents in Kenya and explored whether peer counselors can be trained in PST. We adapted treatment prior to and during training using the Cultural Adaptation and Contextualization for Implementation framework. Nine peer counselors (Ages 20–24) were selected and trained over 10 days. Peer competencies and knowledge were measured pre-post using a written exam, a written case study, and role plays rated using a standardized competency measure. We chose a version of PST used in India with secondary school adolescents originally delivered by teachers. All materials were translated into Kiswahili. Language and format were adapted to Kenyan adolescents as well as for delivery by peers with a focus on understandability and relevance (e.g., noting shared experience). Metaphors, examples, and visual materials were adapted for the context to reflect the culture and vernacular of Kenyan youth. Peer counselors were able to be trained in PST. Pre-post competencies and understanding of content showed improvements with peers minimally meeting patient needs (pre) on average to moderate/fully meeting patient needs (post). Post-training written exam score showed an average 90% correct. There is an adapted version of PST for Kenyan adolescents and peer delivery. Peer counselors can be trained to deliver a 5-session PST in a community context.

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Can Common Elements Support a Public Health Approach to Child Maltreatment?

Polimeni

Tan

Fang

et al. 2022

Int. Journal on Child Malt.

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Despite ongoing reforms to child protection systems and calls for a greater focus on prevention and early intervention, demand on statutory services continues to grow across developed countries. The reasons for this are multiple and complex and include: (1) barriers that exist within service systems themselves; (2) the entrenched and interwoven nature of the drivers of child maltreatment and (3) limited access to programs that can be implemented at scale. This means that empirically supported interventions that can address child maltreatment are not widely available to support a public health response. Several innovations to address the aforementioned challenges draw on ‘common elements’ approaches. Common elements are the discrete techniques commonly found in programs supported by evidence. Over the last 30 years, the evidence base regarding therapeutic techniques for child maltreatment has remained relatively stable, yet there has been a significant increase in the number of evidence-based programs or protocols available. Many of these protocols consist of different combinations of the same therapeutic elements. The Institute of Medicine in the USA has recently called for further research into common elements for psychosocial interventions as an approach to widening access to empirically supported techniques. This article will explore whether common elements may assist in overcoming some of the challenges we are facing in ‘realising’ a public health response to child maltreatment. The potential benefits and limitations of the approach will be outlined, as well as the existing evidence base, and future directions for research and evaluation.

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Development of a transdiagnostic stepped care programme for common adolescent mental health problems in Indian secondary schools: lessons from a pilot study examining acceptability and feasibility

Cited by 7 publications

References 13 publications

A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India

A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India

Peer-delivered Problem-solving Therapy for Adolescent Mental Health in Kenya: Adaptation for Context and Training of Peer-counselors

Can Common Elements Support a Public Health Approach to Child Maltreatment?

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