What is it about?
In this research article we explore integrating mental health care into low and middle income communities through task-shifting in Community Based Rehabilitation (CBR). Please see the World Health Organizations 2010 CBR guideline for further information on the CBR model. As there are currently a limited number of practitioners to attend to international health care needs task-shifting aims to move some of the roles of the professional into the community itself, distributing care, decreasing dependency on the professional, and developing awareness on where the professional is most valuable. Through this integration model access to care may be increased and culturally unique strengths can be harnessed to support triggering effective mechanisms within unique mental health interventions. In shifting some tasks out of the professional role, we define what skills mental health workers need in order for these tasks to be executed both safely and effectively. This review examined what skills mental health workers are currently using and being trained to consolidate knowledge which is currently scattered across time, continents, systems and fields.
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Why is it important?
This consolidation provides guidance for CBR worker training program designers to draw on empiricism to access the current international knowledge base. It highlights both strengths and challenges to task-shifting mental health care in Community Based Rehabilitation settings. This manuscript also reports on the current state of knowledge regarding the potential for CBR workers to effectively provide mental health care and highlights mechanisms and contexts which may be linked to effective and ineffective intervention. This work aims to inform the development of CBR worker skills and empower community members towards healing.
Perspectives
This consolidation provides rich information to support policy and program design. Developers can use the list of skills as a base when developing training. The thematic analysis can be used as a checklist to review if these factors have been considered when rolling-out new programs or reviewing programs’ current functionality. The context-mechanism-outcome triads can be accessed like a library by searching for a particular context, resource, response or outcome to increase familiarity in the triad which has unfolded in other international interventions with this similar variable. As practitioners we can begin to challenge our own biases and invest in increasing trust for community member skills as evidence of effectiveness is promising. We can work to increase the bi-directional flow of information and harness new skills and responsibilities from within the population we aim to support. The findings suggest that instead of increasing client load on highly trained professionals, we may focus on increasing impact through building strong and supportive supervisory relationships.
Lauren Deimling Johns
University of Dublin Trinity College
Read the Original
This page is a summary of: Community-based mental health intervention skills: Task shifting in low- and middle-income settings., International Perspectives in Psychology, October 2018, American Psychological Association (APA),
DOI: 10.1037/ipp0000097.
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Resources
Realist Review Data Extraction Tables
There is a global need to provide human resources for health in low- and middleincome countries. To increase access to care, task shifting has been implemented in community-based rehabilitation (CBR) programs where skills and responsibilities are transferred to local people with shorter and more focused training. Through realist review and synthesis, this research aimed to consolidate the literature when considering (a) what skills CBR workers are reportedly using and/or being trained in relating to mental health, (b) how different settings affect how these task shifting programs work, and (c) the evidence of effectiveness when community health workers come from within the community itself. A total of 11 databases (PubMed, ABI/Inform Global, CINAHL, Cochrane, Emerald, Google Scholar, PsycINFO, SAGE, Science Direct, Scopus, and Web of Science) were systematically searched for specific terms relating to mental health, CBR, and low- and middle-income country. A total of 27 publications were identified as fitting the criteria (four qualitative, 20 quantitative including 10 randomized controlled trials, and three noninvestigatory editorials). Attached are the data extraction tables for this Realist Methodology research in Psychology. This data lead to the development of a Program Theory: When task shifting mental health intervention skills collaboration, harnessing resources available within the community, and the provision of ongoing supervision interact to influence awareness gains, social bonding, the building of trust, and the development of skills and understanding within the community itself. This effects intervention buy-in, overall effectiveness and sustainability, and mental health symptoms and local empowerment.
Mental health intervention in Community Based Rehabilitation Settings
Currently many rural communities are dependent on urban environments or foreign organizations for the provision of health care and rehabilitation services. This research investigated the options for task-shifting care into lower economic status communities in order to increase access to care and empower the historically impoverished. It walks policy and program developers through skills being used to provide mental health care in Community Based Rehabilitation settings and consolidates what mechanisms and contexts contribute to successful and unsuccessful outcomes. This research hopes to influence building equitable and sustainable mental health care systems which successfully support well-being.
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