Improving the scalability of psychological treatments in developing countries: An evaluation of peer-led therapy quality assessment in Goa, India

Abstract

Psychological treatments delivered by lay therapists, with little or no previous mental health training, have been shown to be effective in treating a range of mental health problems. In low resource settings, the dearth of available experts to assess therapy quality potentially leads to a bottleneck in scaling up lay therapist delivered psychological treatments. Peer-led supervision and the assessment of therapy quality may be one solution to address this barrier. The purpose of this study was two-fold: 1) to assess lay therapist quality ratings compared to expert supervisors in a multisite study where lay therapists delivered two locally developed, psychological treatments for harmful and dependent drinking and severe depression; 2) assess the acceptability and feasibility of peer-led supervision compared to expert-led supervision. We developed two scales, one for each treatment, to compare lay therapist and expert ratings on audio-taped treatment sessions (n = 189). Our findings confirmed our primary hypothesis of increased levels of agreement between peer and expert ratings over three consecutive time periods as demonstrated by a decrease in the differences in mean therapy quality rating scores. This study highlights that lay therapists can be trained to effectively assess each other's therapy sessions as well as experts, and that peer-led supervision is acceptable for lay therapists, thus, enhancing the scalability of psychological treatments in low-resource settings.

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

“…Further details of the recruitment, training, and competency of the lay counselors are published elsewhere (Patel et al., 2014; Singla et al., 2014) and briefly summarized here. Lay counselors were recruited through advertisements in newspapers and a local television channel.…”

“…During the pilot study, group supervision was led by a peer lay counselor rather than an expert although an expert always attended and was available if needed (Singla et al., 2014). On average, lay counselors were 25.9 years of age with 15 years of education.…”

The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial

“…A detailed description of counsellor selection and training is provided elsewhere 19, 26. An international expert in behavioural activation (SD) trained and provided ongoing supervision for five local specialists, who in turn provided onsite training and supervision for lay counsellors.…”

“…An international expert in behavioural activation (SD) trained and provided ongoing supervision for five local specialists, who in turn provided onsite training and supervision for lay counsellors. Training of lay counsellors involved a 3 week participatory workshop covering both HAP and CAP treatments, followed by an internship phase of 6 months, in which trainee counsellors delivered the treatment to eligible patients in primary health-care clinics, combined with peer-led group supervision as the trainees gained experience in delivery of the treatment 26 . 11 counsellors who met competency standards as assessed by standardised roleplays and therapy quality measures participated in the trial.…”

“…11 counsellors who met competency standards as assessed by standardised roleplays and therapy quality measures participated in the trial. They received weekly peer-led supervision in groups of four to six that involved rating of a randomly selected (using a random selection strategy stratified by counsellor and phase of session) 10% of recorded sessions on the HAP Therapy Quality Scale (TQS) 26 and individual supervision twice monthly. HAP delivery costs included patient contact and counsellor training, supervision, and salary.…”