Creating a Sustainable Future: Task-shifting for Adolescent Mental Health Care
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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.