title: Improving the scalability of psychological treatments in developing countries: an evaluation of peer-led therapy quality assessment in Goa, India.
abstract: Psychological treatments delivered by lay therapists, with little or no previous mental health training, have been shown to be effective in treating a range of mental health problems. In low resource settings, the dearth of available experts to assess therapy quality potentially leads to a bottleneck in scaling up lay therapist delivered psychological treatments. Peer-led supervision and the assessment of therapy quality may be one solution to address this barrier. The purpose of this study was two-fold: 1) to assess lay therapist quality ratings compared to expert supervisors in a multisite study where lay therapists delivered two locally developed, psychological treatments for harmful and dependent drinking and severe depression; 2) assess the acceptability and feasibility of peer-led supervision compared to expert-led supervision. We developed two scales, one for each treatment, to compare lay therapist and expert ratings on audio-taped treatment sessions (n = 189). Our findings confirmed our primary hypothesis of increased levels of agreement between peer and expert ratings over three consecutive time periods as demonstrated by a decrease in the differences in mean therapy quality rating scores. This study highlights that lay therapists can be trained to effectively assess each other's therapy sessions as well as experts, and that peer-led supervision is acceptable for lay therapists, thus, enhancing the scalability of psychological treatments in low-resource settings.
authors: 1205 Ave Docteur Penfield, Department of Psychology, McGill University, Montreal, Quebec, H3A 1B1, Canada.
authors: Daisy R
authors: DR
authors: Singla
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India; Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom.
authors: Benedict
authors: B
authors: Weobong
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India; Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom.
authors: Abhijit
authors: A
authors: Nadkarni
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India.
authors: Neerja
authors: N
authors: Chowdhary
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India.
authors: Sachin
authors: S
authors: Shinde
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India.
authors: Arpita
authors: A
authors: Anand
authors: Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
authors: Christopher G
authors: CG
authors: Fairburn
authors: University of Colorado, Boulder, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
authors: Sona
authors: S
authors: Dimijdan
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India; Department of Psychology, 2 South, University of Bath, Bath, BA2 7AY, United Kingdom.
authors: Richard
authors: R
authors: Velleman
authors: Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom.
authors: Helen
authors: H
authors: Weiss
authors: Sangath, H No 451 (168), Survey No 50/31, Succour, Porvorim, Bardez, Goa 403501, India; Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India. Electronic address: vikram.patel@lshtm.ac.uk.
authors: Vikram
authors: V
authors: Patel
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D003150:Community Health Workers; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D011613:Psychotherapy / Q000379:methods*; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome
keywords: Competency; Lay therapists; Peers; Supervision; Therapy quality