Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care

Abstract

Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.

What about lay counselors’ experiences of task-shifting mental health interventions? Example from a family-based intervention in Kenya

“…In ongoing supervision, this process of support in coping and problem-solving should continue, providing structured, frequent opportunities for lay counselors to share their own emotional responses and difficulties that arise throughout the process. This process of implementation support is recognized as an important component of supervision in the training of mental health professionals in high-resource settings [48]. Because supervision efforts are already difficult to scale [49,50], this can be a brief check-in to provide ongoing support with a mechanism for flagging concerns.…”

Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention

“…In recent years, there has been a global push for using lay health workers to meet the growing health and mental health needs in underserved communities (Barnett et al 2018). Lay health workers (referred to here as paraprofessionals) can provide services at a lower cost and assist in removing barriers to service delivery (Boer et al 2005;Montgomery et al 2010; Barnett et al 2018).…”

“…In recent years, there has been a global push for using lay health workers to meet the growing health and mental health needs in underserved communities (Barnett et al 2018). Lay health workers (referred to here as paraprofessionals) can provide services at a lower cost and assist in removing barriers to service delivery (Boer et al 2005;Montgomery et al 2010; Barnett et al 2018). Additionally, paraprofessionals can aid in reducing the stigma of receiving mental health services by being able to offer culturally-appropriate services in agencies where people are already receiving other types of health and social services (Montgomery et al 2010;Barnett et al 2018).…”

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions

“…These are individuals drawn from the local communities that they serve, usually of the same ethnic group, with the equivalent of high‐school education but without formalized mental health training. Family support and early intervention models usually require the community workers to have had children with similar emotional and developmental needs as the parents with whom they will intervene (Barnett et al., , Hoagwood et al. , Olin et al., ).…”

“…The United Nations Sustainable Development Goals are regarded as an opportunity to scale up evidence‐based early childhood development interventions, in lower and middle‐income countries (LMICs) and for ethnic minority groups in high‐income countries (Barnett, Lau, & Miranda, ; Collins et al., ). Recommendations for this scale up of services include the implementation of interventions within the first 1,000 days that target multiple risks and “build on existing delivery platforms for feasibility of scale‐up” (Britto et al., , p. 91).…”