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Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.

Jerene, D LU ; Biru, M LU ; Teklu, A ; Rehman, T ; Ruff, A and Wissow, L (2017) In Global Mental Health 4. p.1-12
Abstract
Background.
Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.
Methods.
Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained... (More)
Background.
Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.
Methods.
Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained providers.
Results.
Extent of sustained impact: Trained providers demonstrated modest but better agreement with standardized screeners (greater sensitivity with similar specificity). They were more likely to request that patients with mental health problems return to see them v. making a referral. Factors promoting sustainability (reported in semi-structured interviews): provider belief that the treatments they had learned were effective. New interactions with on-site mental health staff were a source of ongoing learning and encouragement. Factors diminishing sustainability: providers feelings of isolation when mental health partners left for work elsewhere, failure to incorporate mental health indicators into administrative data, to re-stock staff education materials, and to build formal mechanisms for generalist-mental health staff interaction.
Conclusions.
An intervention seen as feasible and effective, and promotion of relationships across professional lines, helped generalists sustain new skills. Failure to address key system context issues made use of the skills unsustainable as external supports ended. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Global Mental Health
volume
4
article number
e24
pages
1 - 12
publisher
Cambridge University Press
ISSN
2054-4251
DOI
10.1017/gmh.2017.21
project
LUC3 - Lund University Child Centered Care
language
English
LU publication?
yes
id
e16d337d-0939-427b-98bb-dfaccc660f0f
date added to LUP
2019-06-28 09:54:01
date last changed
2020-02-03 11:47:11
@article{e16d337d-0939-427b-98bb-dfaccc660f0f,
  abstract     = {{Background.<br/>Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.<br/>Methods.<br/>Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained providers.<br/>Results.<br/>Extent of sustained impact: Trained providers demonstrated modest but better agreement with standardized screeners (greater sensitivity with similar specificity). They were more likely to request that patients with mental health problems return to see them v. making a referral. Factors promoting sustainability (reported in semi-structured interviews): provider belief that the treatments they had learned were effective. New interactions with on-site mental health staff were a source of ongoing learning and encouragement. Factors diminishing sustainability: providers feelings of isolation when mental health partners left for work elsewhere, failure to incorporate mental health indicators into administrative data, to re-stock staff education materials, and to build formal mechanisms for generalist-mental health staff interaction.<br/>Conclusions.<br/>An intervention seen as feasible and effective, and promotion of relationships across professional lines, helped generalists sustain new skills. Failure to address key system context issues made use of the skills unsustainable as external supports ended.}},
  author       = {{Jerene, D and Biru, M and Teklu, A and Rehman, T and Ruff, A and Wissow, L}},
  issn         = {{2054-4251}},
  language     = {{eng}},
  month        = {{12}},
  pages        = {{1--12}},
  publisher    = {{Cambridge University Press}},
  series       = {{Global Mental Health}},
  title        = {{Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.}},
  url          = {{http://dx.doi.org/10.1017/gmh.2017.21}},
  doi          = {{10.1017/gmh.2017.21}},
  volume       = {{4}},
  year         = {{2017}},
}