title: Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale.
abstract: Lack of reliable and valid measures of therapist competence is a barrier to dissemination and implementation of psychological treatments in global mental health. We developed the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale for training and supervision across settings varied by culture and access to mental health resources. We employed a four-step process in Nepal: (1) Item generation: We extracted 1081 items (grouped into 104 domains) from 56 existing tools; role-plays with Nepali therapists generated 11 additional domains. (2) Item relevance: From the 115 domains, Nepali therapists selected 49 domains of therapeutic importance and high comprehensibility. (3) Item utility: We piloted the ENACT scale through rating role-play videotapes, patient session transcripts, and live observations of primary care workers in trainings for psychological treatments and the Mental Health Gap Action Programme (mhGAP). (4) Inter-rater reliability was acceptable for experts (intraclass correlation coefficient, ICC(2,7) = 0.88 (95% confidence interval (CI) 0.81-0.93), N = 7) and non-specialists (ICC(1,3) = 0.67 (95% CI 0.60-0.73), N = 34). In sum, the ENACT scale is an 18-item assessment for common factors in psychological treatments, including task-sharing initiatives with non-specialists across cultural settings. Further research is needed to evaluate applications for therapy quality and association with patient outcomes.
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal; Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC, United States; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, United States; Duke Global Health Institute, Duke University, Durham, United States. Electronic address: brandon.kohrt@duke.edu.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Kohrt
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Research and Development, HealthNet TPO, Amsterdam, The Netherlands.
authors.forename: Mark J D
authors.initials: MJ
authors.lastname: Jordans
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal; Duke Global Health Institute, Duke University, Durham, United States.
authors.forename: Sauharda
authors.initials: S
authors.lastname: Rai
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
authors.forename: Pragya
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
authors.forename: Nagendra P
authors.initials: NP
authors.lastname: Luitel
authors.affiliation: Duke Global Health Institute, Duke University, Durham, United States.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Ramaiya
authors.affiliation: Department of Psychology, McGill University, Montreal Quebec, Canada.
authors.forename: Daisy R
authors.initials: DR
authors.lastname: Singla
authors.affiliation: Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom; Public Health Foundation of India, New Delhi, India; Sangath Center, Alto Porvorim Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D014943:Global Health; D006282:Health Personnel / Q000523:psychology / Q000592:standards; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D010865:Pilot Projects; D011613:Psychotherapy / Q000193:education* / Q000592:standards*; D015203:Reproducibility of Results
keywords: Competence; Culture; Global health; Measurement; Psychotherapy; Training
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