Randomized controlled trials of evidence-based psychotherapies in low- and middle-income countries (LMIC) have shown that Western-developed interventions can be appropriately adapted and correctly implemented by a range of providers, including non-mental health professionals, to meet the needs of people suffering from common mental disorders. Despite this evidence and specific policy calls for evidence-based programs, the scale-up and sustainability of these types of evidence-based treatments in LMIC has been virtually non- existent. To start to address this, the ASPIRE-MHS proposal seeks to identify strategies and costs associated with bringing to scale a transdiagnostic psychotherapy program for common mental disorders in Myanmar. The transdiagnostic program, Common Elements Treatment Approach (CETA), provides the basis for establishing sustainability through the use a single therapy that can be used by non-mental health professionals to treat multiple common mental disorders with different severity, an approach that is more cost- effective implementing the more common single-disorder focused psychotherapy treatments. The proposed research study capitalizes on a the prior efficacy trial of CETA among Myanmar people living on the border in Thailand conducted through a collaborative US-Myanmar investigation team, which will work together to rigorously evaluate the scale up and integration of CETA within 19 organizations representing 7 different organizational types in Myanmar. ASPIRE-MHS will generate a roadmap, including the relevant measurement tools, to assess organizational readiness to implement evidence-based mental health services and to monitor organizational progress to achieving service sustainability. ASPIRE-MHS will generate data on time and resources needed to integrate and sustain a transdiagnostic mental health program into diverse care systems in a LMIC setting to reduce the burden of common mental disorders. These materials will be available for adaptation in other LMIC settings. By using a disrupted time-series study design, we will study a multi-stage implementation cycle, from readiness through adoption and into sustainability, to evaluate the integration and sustainability of the CETA program into schools, primary care clinics, non-governmental organizations, and government military hospital and care centers, using a range of providers including teachers, community health workers, nurses, doctors, and psychiatrists.
The specific aims of this research component are: 1) To evaluate the stages of implementation and related effectiveness of organizational interventions aimed at enhancing sustainability of CETA; 2) To examine mediators and moderators associated with sustainability; and 3) To characterize the paths to sustainability across organization types. Through mimicking real world scale up and sustainability scenarios likely found in other LMIC, ASPIRE-MHS is well poised to make a major contribution to informing global mental health in the process, barriers, and facilitators to scaling up and sustaining evidence- based mental health services across diverse service settings and provider types in a LMIC setting.