Effectiveness of Lay Counselor Delivery of a Common Elements CBT Approach

Friday 4:00 – 5:15 Symposium II

Presentor: Shannon Dorsey

Shannon Dorsey, University of Washington; Laura Murray, Johns Hopkins University; Michael D Pullmann, University of Washington; Emily Haroz, Johns Hopkins University; Jeremy Kane, Johns Hopkins University; Paul Bolton, Johns Hopkins University



Perhaps nowhere are efficiency and effectiveness more important than in low and middle income countries, where the burden of mental disorders is large, comorbidity is common, and there is a dearth of mental health professionals. To achieve scale up, innovative approaches that move beyond a reliance both on professionals and on singularly-focused disorders is critical.

The Common Elements Treatment Approach (CETA), a modular treatment designed to address Posttraumatic Stress (PTS), depression, and anxiety was developed for delivery by lay counselors with little to no formal mental health training. Lay counselors and their local supervisors were trained in decision making for module selection and module dose. We will report on two completed RCTs which both showed high effect sizes: Thai Burma border with Burmese refugees (N = 347; ES: 1.19 PTS, 1.16 depression, 0.79 anxiety) and in Southern Iraq (N=149; ES: 2.40 PTS, 1.82 depression, 1.60 anxiety). Clinical outcomes will be reviewed as the “litmus test??? for effectiveness of implementation strategies

[use of lay counselors; modular approach]. We will present analytic breakdown on lay counselor decision making for CETA module selection and dose.

Beyond Training and Moving to Sustainability Globally: A Train-the-Trainer Approach for Low-Resource Contexts

Friday 4:00 – 5:15 Symposium II

Presentor: Laura Murray

Laura Murray, Johns Hopkins University; Shannon Dorsey, University of Washington; Emily Haroz, Johns Hopkins University; Catherine Lee, Johns Hopkins University; Amanda Nguyen, Johns Hopkins University; Paul Bolton, Johns Hopkins University



Global mental health has been receiving increasing attention, with accumulating evidence for the effectiveness of CBT and other EBT delivered in low-resource countries, by lay counselors. However, to date, implementation strategies for EBT training are slow and expensive, relying heavily on training and oversight by mental health professionals from high-income countries. Now that clear evidence exists for the effectiveness of CBT and other EBT, it is critical to begin to test strategies for broader training and support of counselors that maintains quality, but is cheaper and faster. Scale up requires a more viable, affordable, and sustainable approach.

Building on effectiveness of the Common Elements Treatment Approach, our research team developed a Train-the-Trainer (TTT) approach that has been tested in two disparate settings—Southern Iraq and Myanmar.  We will describe the TTT approach and outcomes including knowledge of counselors and trainers across both settings. As the ultimate litmus test of the effectiveness of the TTT strategy, client outcomes for counselors trained by local trainers (Myanmar: n=328) showed similar results when benchmarked against client outcomes under the expert trainer model (Myanmar: n=187). We discuss implications for next steps to scale-up mental health care in low-resource settings.

Taking Global Local: Evaluating Training of Washington State Clinicians in a Modularized CBT Approach Designed for Low-Resource Settings

Friday 4:00 – 5:15 Symposium II

Presentor: Dr. Maria Monroe-DeVita

Maria Monroe-DeVita, Ph.D., University of Washington, Department of Psychiatry; Roselyn Peterson, BA, University of Washington, Department of Psychiatry; Doyanne Darnell, Ph.D., University of Washington Harborview Medical Center; Lucy Berliner, MSW, University of Washington Harborview Center for Sexual Assault and Traumatic Stress (HCSATS); Shannon Dorsey, Ph.D., University of Washington Department of Psychology; Laura Murray, Ph.D., Johns Hopkins Bloomberg School of Public Health



Objective: The Common Elements Treatment Approach (CETA) is a modularized cognitive behavioral treatment to address posttraumatic stress, anxiety, and depression among people in low-to-middle-income countries. CETA is efficient, low-cost, accessible, and utilized by clinicians from diverse backgrounds. Implementation in U.S. community mental health seems prudent. We present data exploring the feasibility and benefits of training clinicians in CETA.  

Method:  In 2014, 45 clinicians and 13 supervisors from 9 community mental health agencies in Washington participated in CETA training. Clinicians evaluated themselves pre- and post-training on 17 core CETA skills. Participants present cases in bi-weekly consultation for 6 months and consultants assess the quality of each case presentation. Participants will evaluate their CETA skills after consultation is complete.

Results: Before training, common counseling skills such as “identifying clients at risk for suicide and to what extent??? were most highly rated (M=3.86, SD=.88).  Most poorly rated skills were specific to CETA. Self-perception of all skills improved after training. This presentation will include consultation data and a discussion of encountered implementation successes and challenges.

Conclusions: Low-cost and accessible interventions such as CETA hold promise for community mental health. Post-training data will provide insight into the impact of ongoing consultation on CETA skills.