A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries☆,☆☆
Section snippets
Intervention Development
Development of CETA was based on a literature review of EBT and other common elements approaches. For LMIC, development required consideration of two main challenges. First, given the unavailability of a skilled mental health workforce in LMIC, developing CETA materials and the training involved using a simple, concrete format to ensure that local lay counselors with little or no previous mental health training could learn and implement the components. Second, as reliance on higher-level mental
Performance of Supervisors and Counselors
The five supervisors (Iraq = 2; Thailand = 3) all showed adequate uptake of the model in the training evidenced by skills demonstrated in role-plays, “catching” errors of counselors, and being able to explain how to do a component or redirect a counselor in a role-play. Supervision calls were done via Skype (no video) when possible, or mobile phones, when Internet was weak. One supervisor in Iraq attended all scheduled supervision calls with the U.S.-based trainers; a second supervisor missed two
Discussion
A growing research base demonstrates that EBTs are transportable, adaptable, acceptable, and effective in LMICs (e.g., Bolton et al., 2007, Patel et al., 2011, Rahman et al., 2008, Verdeli et al., 2008). This paper describes a common elements approach, CETA developed specifically for use with lay counselors in LMIC. We chose this approach for LMIC for three reasons. First, CETA is flexible and developed to guide the management of comorbidity within a single treatment approach (e.g., Mansell et
Conclusion
A common elements approach, CETA, offers promise for scaling up delivery of mental health services for individuals with need in LMIC. We hope that this paper adds to the limited literature describing treatment development, training, and supervision processes implementing EBT in LMIC. The pilot of CETA in two sites suggests that local supervisors and counselors can learn the elements and decision-making rules with ongoing supervision, further supporting the idea of task shifting. The preliminary
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The authors wish to thank our local partners: Heartland Alliance in Iraq and in Thailand Social Action for Women, Assistance Association for Political Prisoners–Burma, Mae Tao Clinic, and Burma Border Projects. We also extend gratitude to the local counselors and clients for their participation and for allowing us to learn from and with them. We extend special thanks to our supervisors with whom we have developed both collegial relationships as well as friendships. Our warm appreciation to Dr. Maythem Alyasiry, Dr. Amir Haydary, Dr. Htin Zaw, Ko Kyaw Soe Win, and Ko Myo. We also thank Dr. Mark van Ommeren for his thoughtful comments on the manuscript.
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This work was supported by the USAID Victims of Torture Program Associate Cooperative Agreement No.DFD-A-00-08-00308-00. Additional support for the preparation of this article was provided by: NIMH K23 Grant (MH077532; LM), NIMH R34 MH081764 (SD), Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI) (LM & SD).