Session: Sustainable and Responsive Multi-problem CBT across Global Contexts
1 - (SYM 125) Implementation of a Technology-assisted Train-the-trainer Approach in Lusaka, Zambia: Increasing Local Acceptability, Sustainability, and Scaling of an Evidence-based CBT Treatment
Research Scientist Johns Hopkins University School of Public Health Baltimore, Maryland
Background. The scale-up and sustainability of evidence-based treatments (EBTs) in low- and middle-income countries (LMICs) are nearly impossible when utilizing an expert-delivered training approach since experts are scarce, costly, have limited time, often require a translator, and need to travel long distances for on-site trainings; barriers that are particularly problematic during public health crises such as COVID-19. Significant research points to certain mental health treatments as effective, acceptable, and feasible in LMIC when using a train-the-trainer (TTT) apprenticeship strategy and task-sharing approaches to treatment provision. Additionally, technology-based TTT approaches may result in comparable learning to face-to-face instruction in LMICs, increasing the potential scalability and sustainability of EBTs. Methods/Design. Implementation of a tech-assisted TTT strategy as part of a larger randomized controlled trial examining the effectiveness of a CBT-based EBT, the Common Elements Treatment Approach (CETA) delivered either in-person or via telephone in Lusaka, Zambia. Both training of trainers and counselor trainings leveraged an innovative technology-based learning platform. CETA trainers-in-training were identified from an existing cadre of Zambian counselors and were trained to be CETA trainers. Trainer-level competency was measured via standard ratings of trainings, knowledge tests, and clinical supervision. Results. All trainers-in-training (n=5) successfully conducted technology-hybrid CETA trainings to new non-professional counselors (n=46) to provide CETA to adolescent and young adult (AYA) clients. We enrolled AYA participants (n=400) across treatment arms (n=300 active treatment, n=100 TAU). In total, 241 of 300 active treatment arm completed CETA (80% retention) under trainer oversight. Trainers demonstrated adequate competency, fidelity, and CETA knowledge (comparable to live-trained) to oversee the clinical supervision of newly trained CETA providers and their provision of CETA treatment to study AYA clients, meeting criteria to be certified as CETA trainers. Conclusion. Findings highlight the utility of technology-assisted training of trainers and counselors to build local sustainable workforces for EBTs in LMIC contexts, with client-level treatment effectiveness. Qualitative findings also describe improved trainee and client-level acceptability with a CBT-based training and treatment model when delivered by local providers with shared lived experience.
