Creating a prepared mental health workforce: comparative illustrations of implementation strategies

Abstract

BackgroundPsychotherapy implementation must contend with the task of preparing a mental health workforce to provide the highest quality services to as much of a service population as possible, in high-income as well as low-to-middle income countries.ObjectiveWe outline general challenges and solutions and investigate how well various implementation strategies would fit a clinical population.MethodsUsing a data set from a prior cluster randomised trial with a clinically diverse population and 33 intervention practices, we presented multiple illustrations comparing the ability of different implementation strategies to serve youth and families with procedures in which service providers were trained.FindingsA series of survival functions demonstrated that many common implementation strategies are unlikely to create a prepared workforce, given the large and diverse number of practices needed to be mastered by providers.Clinical implications‘Benchmark’ solutions that afforded superior coverage of the service population could be supported through paced learning approaches (ie, training interventions a little at a time) using extensible, modular intervention designs.

A pilot study to evaluate feasibility and acceptability of training mental health workers in India to select case‐specific intervention procedures within a dynamic modular treatment designed for a low‐resource setting

“…Consistent with theories of knowledge resource utilization 50 and paced learning, 21 our preliminary acceptability results suggest that adding decision support systems suited to anticipated challenges in the workflow may be a viable, confidence-building option -and may be especially so when "layered" on top of existing competencies. In this case, our study participants were relatively skilled at executing the chosen practices within the treatment, and thus our training targeted only the additional competency of problem classification and practice selection.…”

“…In addition to considering the various and changing needs of those receiving MH services, MHWs also have shifting needs as they develop professionally. Their competencies and preferences to deliver more complex interventions are likely to increase over time, 21 and they may tolerate more complexity as they become more experienced and confident with a treatment. That is, as long as the treatment complexity affords proportional perceived utility and satisfaction.…”

“…20 To our knowledge, however, no MH treatments used in LMICs have examined the possibility of fully delegating nonspecialized MHWs to assess and treat diverse clinical presentations. Coordinating multiple interventions for diverse clinical problems has been considerably challenging, 21 even in highly resourced systems with highly trained professionals, 22 resulting in frequent application of EBTs that do not match clinical presentations.…”

Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health

“…The mental health workforce is both insufficient in number and inadequately trained. 91 Youth of color and those from economically disadvantaged backgrounds are disproportionately affected by lack of access to high-quality care. 92 Significant investment to both recruit and train mental professionals to work with youth and families is necessary ensure that all youth in need have the opportunity for evidence-based care.…”

Identified needs of peripartum adolescents in Sub-Saharan Africa from 2013 to 2021: a mapping of domains for strengthening psychosocial interventions

“…We sought to better understand the prevalence and scope of concerns related to resources, family and social ecology, mental health services, medical services, education, and other problems in pregnant and parenting adolescents and young adults in SSA. The breadth of identified concerns in this population highlights the range of needed psychosocial intervention targets, findings that can inform the development of a sufficient service system along with education and training to adequately prepare the workforce [12].…”