Browsing by Subject "task-shifting"

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    Open Access
    Creating a Sustainable Future: Task-shifting for Adolescent Mental Health Care
    (2022) Faku, Nqabisa; Ward, Catherine; Lund, Crick
    South African adolescents face many historical, political, social, cultural, and economic influences in their lives that are perpetuated based on race and class. Unfortunately, the availability of mental health treatment for at-risk adolescents is inadequate in the current mental healthcare system in South Africa. Project ASPIRE is a counselling mental health programme designed for registered counsellors to deliver age-appropriate mental health services to meet the mental health needs of adolescents in community-based settings. This study aimed to explore the facilitators and barriers to task-shifting in Project ASPIRE through the views and experiences of the registered counsellors, the supervisor, and the adolescents. The researcher conducted semi-structured interviews and used the framework analysis method and thematic narrative analysis to analyze the data. The facilitating factors associated with making the intervention successful were intervention-related factors such as the value of the counselling techniques, flexibility and adaptability of the structure of the sessions and content relevance; supervision and supervisor-related factors such as ongoing supervision and monitoring and evaluation assessments; counsellor-related factors such as patient-tracking duties and upholding diversity, equity and inclusion; and adolescent-related factors such as intrinsic motivation and accessible and appropriate counselling services and sites. The barriers associated with posing challenges to the conditions, design, and structure of the ASPIRE counselling programme were intervention-related factors such as weak referral pathways and the amount of reading required by the patient handbook; contextual factors such as the multiple deprivations that severely disadvantaged Black adolescents and the impact of the COVID-19 pandemic; supervisor-related factors such as experiencing imposter syndrome, lacking cultural sensitivity training for the Xhosa population and high case volumes; and counsellor-related factors such as the constant disruption of work and supervision schedules caused by fulfilling patient-tracking duties and appointment availability issues. Moving forward, the ASPIRE principal investigators must strategically address the unique challenges that the adolescents, counsellors, and the counsellor supervisor experienced because of the conditions, design, structure, and the limited workforce of the ASPIRE counselling programme to improve the intervention for future trials.
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    Open Access
    Supporting middle-cadre health care workers in Malawi: lessons learned during implementation of the PALM PLUS package
    (BioMed Central, 2014-05-12) Sodhi, Sumeet; Banda, Hastings; Kathyola, Damson; Joshua, Martias; Richardson, Faye; Mah, Emmay; MacGregor, Hayley; Kanike, Emmanuel; Thompson, Sandy; Fairall, Lara; Bateman, Eric; Zwarenstein, Merrick; Schull, Michael J
    Background: The government of Malawi is committed to the broad rollout of antiretroviral treatment in Malawi in the public health sector; however one of the primary challenges has been the shortage of trained health care workers. The Practical Approach to Lung Health Plus HIV/AIDS in Malawi (PALM PLUS) package is an innovative guideline and training intervention that supports primary care middle-cadre health care workers to provide front-line integrated primary care. The purpose of this paper is to describe the lessons learned in implementing the PALM PLUS package. Methods: A clinical tool, based on algorithm- and symptom-based guidelines was adapted to the Malawian context. An accompanying training program based on educational outreach principles was developed and a cascade training approach was used for implementation of the PALM PLUS package in 30 health centres, targeting clinical officers, medical assistants, and nurses. Lessons learned were identified during program implementation through engagement with collaborating partners and program participants and review of program evaluation findings. Results: Key lessons learned for successful program implementation of the PALM PLUS package include the importance of building networks for peer-based support, ensuring adequate training capacity, making linkages with continuing professional development accreditation and providing modest in-service training budgets. The main limiting factors to implementation were turnover of staff and desire for financial training allowances. Conclusions: The PALM PLUS approach is a potential model for supporting mid-level health care workers to provide front-line integrated primary care in low and middle income countries, and may be useful for future task-shifting initiatives.
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    Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial
    (BioMed Central, 2016-02-11) Hanlon, Charlotte; Alem, Atalay; Medhin, Girmay; Shibre, Teshome; Ejigu, Dawit A; Negussie, Hanna; Dewey, Michael; Wissow, Lawrence; Prince, Martin; Susser, Ezra; Lund, Crick; Fekadu, Abebaw
    Background: Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design: A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and costeffectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion: Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation’s mental health Gap Action Programme to scale-up mental health care globally.