Training and Supervising Lay-providers in Low-income Settings: A Mixed-methods Study of Task-sharing from the Shamiri Randomized Controlled Trial

Akash Wasil, Katherine E. Venturo-Conerly, Sarah Gillespie, Tom L Osborn, and John R. Weisz. Submitted. Using Ideographic Measurement to Complement Standardized Symptom Questionnaires: Assessing Top Problems and Internalizing Symptoms in Kenyan Adolescents. PsyArXiv. Publisher's Version Abstract

Children and adolescents in non-western settings and low-resource environments may experience distinctive problems and psychiatric symptoms. Researchers and policymakers often aim to understand those problems and symptoms using standardized nomothetic assessment tools. These tools tend to be validated on western samples and may “miss” problems that are prevalent and important in non-western cultures. Brief, low-cost, idiographic assessment tools may help identify these concerns, usefully complementing traditional measurements. To examine this idea, we applied the Top Problems Assessment (Weisz et al., 2011) and two standardized measures of depression and anxiety to 100 adolescents from Kibera, a resource-poor urban settlement in Kenya. Data were collected from early June to July of 2018. The Top Problems Assessment asked students to identify their three most important problems. We then a) applied thematic analysis (Braun & Clark, 2006) to identify the most frequently reported types of problems and b) analyzed the depressive and anxiety symptoms most frequently endorsed on the standardized measures. Standardized assessment revealed that worrying and difficulty concentrating were the most commonly reported symptoms. On the Top Problems Assessment, 61% of the sample reported a social problem, 38% a cognitive problem, and 35% an economic problem. By contrast, emotional and behavioral problems assessed via the standardized measures were reported as top problems by only 17% of the sample. The Top Problems Assessment yielded specific problems faced by Kenyan youth that may not have emerged through a routine assessment using standardized measures. Our findings are the first to demonstrate that the Top Problems Assessment can be used to identify locally relevant concerns that may be missed by commonly used standardized measures. Overall, our findings suggest that idiographic assessments like the Top Problems Assessment can produce culturally relevant information and usefully complement standardized measurement tools.

Tom L. Osborn, Akash R. Wasil, Katherine E. Venturo-Conerly, Jessica L. Schleider, and John R. Weisz. 6/1/2020. “Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya.” Behavior Therapy, 51, 4, Pp. 601-615. Publisher's Version

osbornshamiri2019_bt.pdf

Katherine E. Venturo-Conerly, Tom L Osborn, Rediet Alemu, Elizabeth Roe, Micaela Rodriguez, Jenny Gan, Susana Arango G, Akash R. Wasil, Christine Wasanga, and John R Weisz. Submitted. “School-based, Lay-provider-delivered Single-session Interventions Reduced Anxiety in Kenyan Adolescents: Outcomes from A Randomized Controlled Trial”.

Tom L Osborn, Stephanie Campbell, David Ndetei, and John R. Weisz. Submitted. Network Analysis Reveals Central Symptoms of Adolescent Depression and Anxiety in Sub-Saharan Africa. PsyArXiv. Publisher's Version Abstract

Adolescent depression and anxiety—which are linked with many negative life outcomes—are prevalent around the world, particularly in low-income countries such as those in Sub Saharan Africa (SSA). We used network analysis to examine the topology, stability, and centrality of depression and anxiety symptoms. We analyzed data from a large community sample (N = 2,192) of Kenyan adolescents aged 13-18, using the Patient Health Questionnaire and the Generalized Anxiety Disorder Screener. We identified the central symptoms of the depression and anxiety symptom networks, and we compared the structure and connectivity of these networks between low-symptom and elevated-symptom sub-samples. Our findings indicate the most central depression symptoms were “self-blame” and “depressed mood”, while the strongest depression symptom associations were “self-blame” ––“depressed mood” and “trouble concentrating” ––“little interest/pleasure”. Similarly, the most central anxiety symptoms were “too much worry” and “uncontrollable worry”, while strongest anxiety symptom associations were “too much worry” ––“uncontrollable worry” and “trouble relaxing” ––“restlessness”. We found a statistical difference in the network structure between low-symptom and elevated-symptom adolescents. The low-symptom sample had higher network connectivity scores for both depression (global strength difference = 0.30; low-symptom = 0.49; high-symptom = 0.19; p = .003) and anxiety symptoms (global strength difference = 1.04; low-symptom = 1.57; high-symptom = 0.53; p < .001). This is the first report that uses network analysis techniques to identify central symptoms of adolescent depression and anxiety in SSA. Our findings illustrate how network analysis may inform understanding of psychopathology within cultures and suggest promising treatment targets.

Katherine E. Venturo-Conerly, Akash Wasil, Tom L Osborn, John R. Weisz, and Payton J. Jones. Submitted. Internalizing Symptoms and Social Support Among Kenyan Adolescents: A Network Analysis. PsyArXiv. Publisher's Version

Katherine E. Venturo-Conerly, Elizabeth Roe, Akash Wasil, and Tom L Osborn. Submitted. Training and Supervising Lay-providers in Low-income Settings: A Mixed-methods Study of Task-sharing from the Shamiri Randomized Controlled Trial. Open Science Framework. Publisher's Version Abstract

Objective: Training lay-providers to deliver mental health interventions is both effective and cost-effective. However, more research is needed to document training and supervision procedures and to collect lay-providers’ feedback. We analyzed the acceptability of a 10-hour lay-provider training and supervision delivered primarily by undergraduates. We also tested lay-provider fidelity and quality. Methods: This study documents training and supervision from an RCT of the Shamiri intervention, a 4-session, school-based intervention which significantly reduced symptoms of anxiety and depression in Kenyan adolescents. We delivered a 10-hour training to 13 lay providers (M(SD)age=21.00(1.95), %female=61.54). We also hosted 30-minute supervision meetings twice weekly. Independent raters coded session recordings for fidelity and quality. We also collected quantitative and qualitative feedback from lay-providers. Results: Reliability and mean ratings for all six of our fidelity and quality measures (delivering required content, adhering to specified details, thoroughness, skillfulness, clarity, and purity) were very good to excellent. Lay-provider quantitative ratings of training were also overwhelmingly positive, with an overall satisfaction rating of 6.46/7.00. We identified central qualitative themes in lay provider comments: Generally, comments about training style, content, and personal interactions were overwhelmingly positive, and many lay-providers reported personal growth. Comments about timing and location were mixed. Conclusions: This study provides preliminary evidence that a very brief training delivered primarily by undergraduates can teach high-school-graduate lay-providers to deliver effective mental health interventions. Additionally, we discuss lessons-learned and implications for future research, including the importance of considering local context when planning and of continuously collecting and addressing lay-provider feedback.

Tom L. Osborn

A.B, Psychology (High Honors)
Harvard College Class of 2020

Training and Supervising Lay-providers in Low-income Settings: A Mixed-methods Study of Task-sharing from the Shamiri Randomized Controlled Trial

Citation:

Abstract:

Recent Publications

Tom L. Osborn

A.B, Psychology (High Honors) Harvard College Class of 2020

Citation:

Abstract:

Recent Publications

A.B, Psychology (High Honors)
Harvard College Class of 2020