Training and Supervising Lay Providers in Kenya: Strategies and Mixed-Methods Outcomes☆☆☆

ObjectiveTraining lay providers to deliver mental health interventions is both effective and cost-effective. However, more research is needed to document training and supervision procedures and to collect lay providers’ feedback.MethodsThis study documents training and supervision from a randomized controlled trial of the Shamiri intervention, a four-session, school-based intervention that significantly reduced symptoms of anxiety and depression in Kenyan adolescents. We delivered a 10-hour training to 13 lay providers, M (SD)_age = 21.00 (1.95), %_female = 61.54. We also hosted 30-minute supervision meetings twice weekly. Training and supervision were delivered primarily by undergraduates. Independent raters coded session recordings for fidelity and quality of services, and we collected quantitative and qualitative feedback from lay providers.ResultsReliability and mean ratings for all six of our fidelity and quality measures (delivering required content, adhering to specified details, thoroughness, skillfulness, clarity, and purity) were very good to excellent. Lay provider quantitative ratings of training were also overwhelmingly positive, with an overall satisfaction rating of 6.46/7.00. We identified central qualitative themes in lay provider comments: Generally, comments about training style, content, and personal interactions were overwhelmingly positive, and many lay providers reported personal growth. Comments about timing and location of training were mixed.ConclusionsThis study provides preliminary evidence that a very brief training delivered primarily by undergraduates can teach high school-graduate lay providers to deliver effective mental health interventions. Additionally, we discuss lessons learned and implications for future research, including the importance of considering local context when planning and of continuously collecting and addressing lay provider feedback.     

Using Force: Australian Newspaper Depictions of Contacts Between the Police and Persons Experiencing Mental Illness

The media creates and sustains knowledge about socially relevant issues such as crime, mental illness, and policing. Past research suggests that while the media portrayal of the police is undoubtedly complex, their portrayal of people experiencing mental illness remains mainly negative. The depiction of their encounters in the mass media is of considerable interest because of the influential role the media has on public opinion and debate; however, there is a lack of current research in this area. This study aimed to examine media items in the major newspapers across Australia between January 2006 and December 2007 (n = 77) to investigate their portrayal of this interface. The dominant themes encountered in the initial analysis depicted people experiencing mental illness as dangerous and a threat to the public, where the mental health system has failed to manage them adequately. Further analyses found that people experiencing mental illness were stigmatised in a third of the media items reviewed and were represented significantly more negatively in these encounters than the police. Implications of these findings and some suggestions regarding possible strategies that could improve socially responsible media reporting and public discourse on mental illness are proposed.     

Biological Explanations and Stigmatizing Attitudes: Using Essentialism and Perceived Dangerousness to Predict Antistigma Intervention Effectiveness

ABSTRACT

The theory of essentialism suggests that biological explanations of stigmatized behavior may not be effective at decreasing stigmatizing attitudes. The effects of biological explanations on stigmatizing attitudes were the topic of two experiments. In the first experiment, participants (N = 243) perceived a biological explanation as a less effective in relation to dangerousness and social distancing attitudes about mental illness than about homosexuality. The second experiment (N = 113) compared the effect of biological and free choice explanations on stigmatizing attitudes about abnormal sexual and eating behaviors. The results indicated that a biological explanation increased belief in essentialism and was most effective for attitudes related to anger and blame. These results suggest that the effectiveness of biological explanations as an antistigma tool varies according to the attitude and stigmatized group.     

Ready, Willing, and Able: Developing a Support System to Promote Implementation of School-Based Prevention Programs

While the number and scope of evidence‐based health, education, and mental health services continues to grow, the movement of these practices into schools and other practice settings remains a complex and haphazard process. The purpose of this paper is to describe and present initial support for a prevention support system designed to promote high‐quality implementation of whole school prevention initiatives in elementary and middle schools. The function and strategies of a school‐based prevention support system are discussed, including key structures and activities undertaken to identify, select, and provide technical assistance to school personnel. Data collected over a 5 year period are presented, including evidence of successful implementation support for 5 different evidence‐based programs implemented with fidelity at 12 schools and preliminary evidence of goal attainment. Findings suggest the ongoing collection of information related to organizational readiness assists in the adoption and implementation of effective practices and initiatives and provide valuable insight into the development of results‐oriented approaches to prevention service delivery. Problems, progress, and lessons learned through this process are discussed to frame future research and action steps for this school‐based prevention support system. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Exploring the Use of the Interactive Systems Framework to Guide School Mental Health Services in Post‐disaster Contexts: Building Community Capacity for Trauma‐Focused Interventions

Over the past two decades schools have been identified as the de facto mental health system for youth. Therefore, improving and expanding school mental health (SMH) has become a pressing agenda item for researchers, practitioners, policy makers, and funders. Advancing this agenda includes not only translating intervention research into practice within schools, but building capacities for these interventions to occur. The interactive systems framework (ISF) of Wandersman and colleagues, and the focus of this special issue, provides guidance in bridging the gap between research and practice through multisystem capacity building. There is some evidence that application of the ISF has helped to build capacity for SMH in states, but this evidence is preliminary. In addition, application of the ISF has not occurred in SMH at the community level or in relation to the specific stresses a community undergoes in relation to a disaster. The purpose of this article was to conduct a preliminary attempt to connect these three areas—the ISF, SMH and strengthening SMH through the ISF to better address impacts of a community level disaster; in this case, we explore the impacts of Hurricane Katrina on New Orleans schools, their students and families, and SMH programming within them. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

免费师范生职业认同感与生命意义的关系

该研究采用师范生职业认同感量表和生命态度剖面图(LAP)中的"生命意义的追寻与肯定"分量表,对258名一至三年级的免费师范生进行问卷调查,探讨免费师范生职业认同感与生命意义的关系。结果表明,免费师范生职业认同感及其各因子均与生命意义及其各因子呈显著正相关;高中低不同职业认同感组的生命意义及其各因子的组别效应显著;免费师范生职业认同感的职业效能、职业意愿与期望、职业价值三因子是生命意义的显著预测变量。     

听觉通道下负数的低水平加工引起注意的SNARC效应

采用刺激探测任务,探讨了听觉通道下负数的低水平加工能否引起注意的SNARC效应。结果表明:(1)负数的低水平加工能够产生注意的SNARC效应,即线索为绝对值小的负数时,被试对左耳目标反应更快;线索为绝对值大的负数时,被试对右耳目标反应更快。(2)负数的加工所引起听觉空间注意的转移并不依赖于负数所在的情境,而仅通过其绝对值大小与空间表征发生关联。这一结论与视觉条件下所得到的结论不一致,并支持了系统发生论假说。     

On paradoxes and the experience of duality

Abstract

Opposing attitudes, emotions, or perceptions of self and other that set the stage for experiences of duality influence our interactions and self–other schemas. The experience of duality that has been conceptualised as “conflict,” “self state,” and “paradox" in psychoanalytic theory has been extensively considered, particularly in terms of its manifestation in transference–countertransference relations and in the analytic material from patients' experiences. They have not, however, been compared and contrasted as entities that lead to similar kinds of experience. Scant attention has been paid, moreover, to paradox as a mental organisation that underlies certain experiences of duality. The concept of paradox has thus been emphasised and developed in this paper.     

Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis

Individuals decide to use healthcare when the expected benefits outweigh the perceived costs. One of these cost factors in this decision can be stigma. So far, it has not been researched how former soldiers of the German Armed Forces with a service-induced mental illness perceive stigma and how it influences their healthcare use. As stigma is shaped by the socio-cultural context, the setting of the potential healthcare use must be considered. Narrative interviews were conducted with 33 former soldiers with mental health problems. The data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. The relationship between stigma and healthcare use was analyzed. Occupational discrimination and social exclusion were experienced in both in the military and civilian context, but stigma functioned differently in each context. In the military context, former soldiers’ self-stigma of mentally ill individuals being weak was in stark contrast to their internalized military standards. This contrast let them avoid disclosure and subsequent healthcare use. In civilian context, the participants perceived 2 different stigma costs: mental illness stigma and former soldier stigma (i.e., stigmatization because of their military past). Both were perceived as barriers to healthcare use. A model, illustrating these different stigma costs in the different contexts, was developed. Further research on the link between stigma and healthcare use of this group is urgently needed.     

The Performance of the AUDIT-C and the Examination of Risks Associated With Postdeployment Alcohol Misuse in Air Force Medical Service Personnel

This study assessed the performance of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) in diagnosing a postdeployment alcohol disorder in a cohort of Air Force Medical Services personnel (N = 13,353). The prevalence of alcohol disorders in this population of previously deployed military healthcare personnel was 1.26% based on medical record data. Assessing the AUDIT-C as a screening tool, the following characteristics were found: sensitivity was 23.81%, specificity was 91.48%, positive predictive value was 3.44%, and negative predictive value was 98.95%. The positive and negative likelihood ratios were 2.80 and 0.83, respectively. Classification accuracy of the AUDIT-C was improved by accounting for officer status and female gender. The area under the receiver operating characteristic curve was 0.69 for the multivariable model, indicating poor to fair classification accuracy. However, this model was significantly improved over the univariate model. Thus, taking rank and gender into account when conducting screening may improve the utility of the AUDIT-C.