Symposium 2 – May 17, 2013
Implementation of TF-CBT in Zambia: Perspectives from Local Supervisors & Counselors
Presenter: Margaret Kasoma
Author: Margaret Kasoma, Serenity Harm Reduction Programme Zambia (SHARPZ)
Abstract: Global mental health is receiving increasing attention given the high burden of mental health disease and in low and middle income countries (LMIC) and the fewer than 10% of individuals with need who receive treatment. One implementation strategy for scaling up care that has received a great deal of attention is task-shifting mental health care to lay counselors, who have little or no mental health experience. However, training lay counselors requires additional time, supervision and supports. In addition, most evidence-based practices (EBP) are developed in high-income countries, and transported to LMIC, which have different cultures and contexts.
This unique presentation focuses on the perspectives and experiences of a local counselor and now supervisor, Ms. Kasoma, on learning, implementing, and supervising a child mental health EBP (trauma-focused CBT) in Lusaka, Zambia over seven years. Ms. Kasoma first served as a counselor on a NIH-funded feasibility study and currently is a supervisor on a nearly completed USAID randomized trial.
Ms. Kasoma will speak to issues related to learning an EBP, counselor and consumer acceptability, monitoring counselor fidelity, and cultural adaptation and acceptability.
Organizational Implementation Barriers & Facilitators for Mental Health Programs in Zambia: A Mixed-Methods Study
Presenter: Laura Murray, PhD
Authors: Laura Murray, PhD,1 Rinad Beidas, PhD,2 Stephanie Skavenski, MPH, MSW,1 Shannon Dorsey, PhD,3 & John Mayeya4
1Johns Hopkins University Bloomberg School of Public Health; 2University of Pennsylvania; 3University of Washington; 4Ministry of Health, Zambia
Abstract: The Dissemination and Implementation (D&I) literature in low-resource countries (LRC) is often described as being in its infancy to that of the West (Thorncraft et al., 2009). Although the field of global mental health has now shown that various evidence-based practices (EBPs) are feasible, adaptable, and effective (e.g., Bolton et al., 2007), the uptake of these interventions by Ministry of Health (MoH), non-governmental (NGOs) or community-based organizations (CBOs) has been sluggish at best (despite no evidence that “psychosocial programming??? is effective, Bryant et al., 2012). It is likely that major barriers to uptake of EBPs include implementation factors.
Participants include 65 individuals who were part of a Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) feasibility and/or effectiveness pilot in Zambia. A mixed-methods design will include a sequential collection of qualitative, followed by quantitative data (Palinkas et al., 2011).
This study will examine how organizational structure impacts implementation factors, including adoption, appropriateness, feasibility, penetration, and sustainability (Proctor et al., 2011). A semi-structured interview will be followed by administration of the DOOR and ORC. Results will be discussed across different organizational levels including JHU, CBOs, NGOs, and the MoH. Policy implications and future research ideas will be discussed related to implementation dilemmas.
Mixed Methods Assessment of Implementation Barriers & Facilitators for Mental Health Programs in Zambia: Provider Level Themes
Presenter: Rinad Beidas, PhD
Authors: Rinad Beidas, PhD,1 Laura Murray, PhD,2 Shannon Dorsey, PhD,3 Stephanie Skavenski, MSW, MPH,2 Margaret Kasoma,4 & John Mayeya5
1University of Pennsylvania; 2Johns Hopkins University Bloomberg School of Public Health; 3University of Washington; 4Serenity Harm Reduction Programme Zambia (SHARPZ); 5Ministry of Health
Abstract: A better understanding of the implementation factors involved in the uptake of mental health programming in low-resource countries (LRC) is needed. Although the field of global mental health has now shown that various evidence-based treatments (EBTs) are feasible, adaptable and effective (Bolton et al., 2003; 2007; Rahman et al., 2008), the uptake of these interventions by locally-based organizations has been sluggish at best. It is likely that major barriers to uptake of EBPs include implementation factors. To our knowledge, no study has been conducted globally around barriers and facilitators of implementation of evidence-based mental health practices. Participants will include 65 individuals who were part of a TF-CBT feasibility and effectiveness pilot in Zambia. The goal of this study is to qualitatively and quantitatively examine implementation factors, including acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability (Proctor et al., 2011). This study will employ mixed-methods, specifically the semi-structured interviews and the EBPAS-50 to examine stakeholders perspectives and attitudes on implementation of evidence-based mental health programming in Zambia. This presentation will focus on themes related to the ecological level of the individual-provider level.