A novel digital platform for measurement-based peer supervision of non-specialist providers conducting brief psychological interventions

PROJECT SUMMARY There is a critical shortage of mental health specialists (i.e., psychiatrists, psychologists, licensed mental health counselors) and a growing mental health crisis in the US. Task sharing, whereby highly qualified health workers share specific tasks non-specialist providers (NSPs) with less training and fewer qualifications in order to make more efficient use of the available human resources, is an approach that can scale and address unmet mental health needs, particularly in hard-to-reach communities with limited to no access to specialist care. We propose a comprehensive solution to support a task sharing approach for delivering high quality brief psychosocial interventions. Our proposed digital platform is designed to support measurement-based peer supervision (MBPS), which includes the ability for NSPs to record therapy sessions, rate them using a validated quality scale, and review ratings safely and securely with peers in moderated group discussions. We developed and successfully demonstrated acceptability, usability, and potential feasibility of digitally-enabled MBPS to support NSP performance and quality of care in Phase I. The goal of this Phase II project is to enhance and evaluate the efficacy of this digitally-enabled MBPS tool with NSPs working directly in communities. We will address this goal with three specific aims. In Aim 1, we will build an enhanced version of the digital platform based on Phase I feedback and direct input from NSPs. In Aim 2, we will conduct a mixed methods evaluation of digitally-enabled MBPS with 50 target end users, i.e., NSPs recruited from a large health system in Texas and recently trained in behavioral activation. During this period, NSPs will engage in mock sessions with standardized patients. Primary outcomes of interest will be NSP competency in delivering behavioral activation therapy and counselor self-efficacy. In Aim 3, we will conduct a cost analysis for the system under different implementation rollout and volume assumptions. Results from these analyses will be reviewed with stakeholders and will be used to develop a cost calculator to inform the development and comparison of sustainability models. The proposed digitized MBPS workflow would allow quantitative data on therapy quality to be collected at scale which, in turn, could be used for a wide range of analyses, including measuring the effectiveness of types, cadences, or duration of therapy, as well as building tools using predictive analytics. Results of this Phase II work can provide important insights to guide the implementation and scaling of effective delivery of psychosocial interventions and program quality improvement, with the long-term goal of improving mental health outcomes in hard-to-reach communities that can benefit the most from NSP-led support.