Research indicates that evidence-based mental health treatments can be delivered via task-shifting, in which non-professionals deliver care under supervision. However, the potential promise of task-shifting to reduce the mental health treatment gap goes unrealized without empirical guidance on scalable and sustainable methods to supervise lay counselors. Given the rise in access to digital technology worldwide, opportunities may exist to leverage technology to supervise lay counselors. To maximize acceptability and feasibility in low-resource settings, research on mobile technology supervision should be rooted in the needs of lay counselors and supervisors. This project builds on a current NIMH-funded study, ?Building and Sustaining Interventions for Children (BASIC): Task-Sharing Mental Health Care in Low-Resource Settings? (R01MH112633), which aims to test the effectiveness and implementation of Trauma-focused Cognitive Behavioral Therapy (TF-CBT) in two government-supported systems in Kenya: Education (via teachers) and Health Extension (via community health volunteers). Mobile technology (i.e., WhatsApp) emerged as a frequently used supervision support for some counselors during the BASIC trial. This project capitalizes on an unexpected, naturally occurring phenomenon within an already funded trial, and draws from human-centered design (HCD) techniques to gain lay counselor and supervisor perspectives on using mobile technology to conduct clinical supervision.
Study aims are to: (1a) Investigate the ways mobile technology is currently being used to support supervision; (1b) identify barriers and facilitators of technology-mediated supervision. We conduct qualitative interviews with supervisors and lay counselors to answer research questions in Aim 1. (2) Engage stakeholders to redesign supervision processes to leverage mobile technology. We employ HCD techniques, such as brainstorming and roleplaying, in an in-person collaborative meeting with supervisors and lay counselors to systematically develop and select three most optimal workflows to inform implementation of mobile technology supervision in Aim 3. (3) Examine the acceptability, feasibility, and usability of mobile technology supervision, as well as perceptions of effectiveness in a pilot trial. We examine differences in these outcomes among lay counselors receiving supervision exclusively via mobile technology, compared to counselors receiving standard in-person supervision. Study findings can help inform the potential for greater reliance on lower-cost, existing mobile technology to provide clinical supervision in low-resource settings.
The potential promise of task-shifting to reduce the mental health treatment gap goes unrealized without empirical guidance on scalable and sustainable methods to supervise lay counselors. This project utilizes human-centered design techniques to gain lay counselor and supervisor perspectives and redesign supervision processes to leverage mobile technology as a potentially sustainable and scalable alternative to in- person supervision. The redesigned supervision processes are tested in a pilot trial that examines the acceptability, feasibility, usability, and perceived effectiveness of mobile technology supervision.
