In June 2020, the University of Washington Global Mental Health Program (UW GMH) invited pilot study applications that support its mission and priorities of contributing to reducing the burden of mental disorders in low resource settings globally and developing, testing, and building the capacity to deliver contextually-appropriate and sustainable models for mental health intervention with local and global partners. We are thrilled to announce the two recipients of this years UW GMH Pilot Awards. Congratulations Drs. Velloza and Wagenaar!
Simulated patient encounters to improve provider training for the treatment of common mental disorders among adolescents in Kenyan HIV clinics
PI: Jennifer Velloza (far left)
Co-I: Jared Baeten, Pam Kohler, Shannon Dorsey and Kenneth Ngure (pictured L to R)
Adolescent girls and young women (AGYW) seeking HIV prevention and treatment services are at high risk for co-occurring common mental disorders, including depression, anxiety, and traumatic stress and HIV. The Kenyan Ministry of Health recommends an integrated approach to mental health and HIV service delivery, including regular screening for common mental disorders in HIV clinics, problem-solving therapy (PST) as a first-line intervention, and referrals for specialized care as needed. However, few Kenyan AGYW actually receive mental health care services while at HIV clinics and HIV providers often report feeling unprepared to provide adolescent-friendly mental health services. Simulated patient encounters (SPEs) offer an innovative strategy to train and supervise providers around mental health service delivery in low-resource settings. In an SPE approach, standardized patient actors work with providers in mock clinical encounters for training and evaluation. SPEs can improve provider training and also provide accurate, acceptable, and cost-effective fidelity measures for mental health service delivery. We propose to develop an SPE training strategy, including patient case scripts for AGYW patient actors and checklists to assess provider competencies, and we will test the impact of our SPE training on rates of mental health service delivery for Kenyan AGYW in HIV clinic settings.
Provider training and supervision are critical to the scale-up of mental health services and the implementation of task-shared models of mental health care delivery with non-specialist providers. AGYW have unique physiological, developmental, and psychosocial needs and any integrated mental health and HIV services for this population must consider approaches that are non-judgmental, considerate, and adolescent-friendly. This study will be the first to assess the impact of an SPE training strategy on HIV provider training and mental health care delivery for Kenyan AGYW in public HIV clinics. Our findings will lead to a future, larger-scale study to test the SPE strategy on improved provider competencies and AGYW mental health and HIV outcomes in clinic settings over time. This work has the potential to inform an HIV provider SPE training model for adolescent-friendly mental health service delivery in Kenya and other resource-limited settings, to ultimately reduce the prevalence and severity of common mental disorders among AGYW.
STARS-Seattle: Addressing refugee and immigrant youth mental health in the time of COVID-19 using a digital psychological intervention
PI: Bradley H Wagenaar (far left)
Co-I: Katherine T Foster and Carmen Gonzalez (middle, L to R)
Scientific Advisors: Pamela Collins, Patricia Arean and Chitra Hanstad (far right, L to R)
Adolescent mental health in the US is a concern, especially given the currently unfolding mental health consequences of the COVID-19 pandemic. Young adult suicide rates are at a 20-year high, and federal emotional distress hotlines have seen a 1000% increase in calls during the pandemic compared to last year. Youth from immigrant and refugee families face particular stressors like forced migration, traumatic events, and discrimination, which can increase the risk of mental disorders. Youth from these backgrounds also face barriers to mental healthcare including lack of services, stigma, language, cost, and concerns about confidentiality.
Digital interventions exist to address this gap, but most do not follow an evidence base. The (STARS: Sustainable Technology for Adolescents to Reduce Stress) project was developed by clinical psychologists and includes evidence-based modules that focus on psychoeducation, behavioral activation, emotional regulation, and others, with the aim of reducing symptoms of common mental disorders and improving overall functioning. The goal of the STARS project is to take the lessons learned from low and middle income countries and rigorously adapt them to our local context, using qualitative research techniques in which young adults in Seattle directly participate in the development of the intervention. This global-to-local method represents a different approach than many global health initiatives, and if successful will increase the availability of acceptable and user-friendly mental health treatment among young adults in some of Seattle’s marginalized communities.