Category: Cultural Diversity / Vulnerable Populations

Symposium

A Train-the-Trainer Strategy for Low-Resource Contexts to Promote Scale-Up and Sustainability

Saturday, November 18
9:45 AM - 10:45 AM
Location: Aqua Salon A & B, Level 3, Aqua Level

Keywords: Implementation | Training / Training Directors | Transdiagnostic
Presentation Type: Symposium

Background: There is growing evidence for the effectiveness of CBT delivered in low-resource countries by lay counselors. However, implementation strategies for EBT training are under-developed and expensive, relying heavily on training and oversight by mental health professionals from high-income countries. It is critical to begin to test strategies for broader training and support of counselors that maintains quality, offers more rapid scale up, with greater likelihood of sustainment. Our research team developed a Train-the-Trainer (TTT) approach for an evidence-based transdiagnostic CBT (Common Elements Treatment Approach; CETA) that has been tested in two disparate settings—Southern Iraq and Myanmar.  


Methods: Select local CETA supervisors in each country participated in a week-long TTT training led by US-based experts and then 8 were selected to (4 per country) to receive distance training preparation support. Local trainers conducted two trainings per country for counselors (N=125). Following a cascading model, the first clinical training in each country was co-led by local trainers and a US-based expert. The second clinical training in each country was led by local trainers only. All counselors completed a 33-item objective CETA knowledge test. Client outcomes for counselors trained by local trainers was benchmarked against client outcomes under the expert trainer (ET) model.


Results: Treatment effect sizes were reduced from the ET model to the TTT; with variation by country. In Myanmar: depression 1.16 (ET) vs. .51 (TTT), PTS: 1.19 (ET) vs. .66 (TTT). In Iraq: Depression, 1.78 (ET) vs. 1.27 (TTT), PTS 2.38 (ET) vs. 1.61 (TTT). On knowledge, counselors demonstrated significant improvement from the pre-training scores, with an average improvement of 26.2% in Iraq (pp


Conclusions: These findings suggest that local trainers were able to impart CETA knowledge and skill to retain treatment effectiveness, with some country differences, likely due to educational and contextual differences (e.g., safety). TTT cascading implementation approaches are urgent in LMICs to address significant barriers to scale-up and sustainability. 

Maytham Al-Yasiry

Specialist Psychiatrist, Lecturer
Babylon University /College of Medicine

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A Train-the-Trainer Strategy for Low-Resource Contexts to Promote Scale-Up and Sustainability



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