Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study

Christina M Cruz; Choden Dukpa; Juliana L Vanderburg; Abhishek K Rauniyar; Priscilla Giri; Surekha Bhattarai; Arpana Thapa; Karen Hampanda; Bradley N Gaynes; Molly M Lamb; Michael Matergia

doi:10.1007/s44192-022-00024-z

Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study

Discov Ment Health. 2022;2(1):21. doi: 10.1007/s44192-022-00024-z. Epub 2022 Oct 31.

Authors

Christina M Cruz^{1

2}, Choden Dukpa³, Juliana L Vanderburg², Abhishek K Rauniyar⁴, Priscilla Giri³, Surekha Bhattarai³, Arpana Thapa³, Karen Hampanda^{5

6}, Bradley N Gaynes^{1

7}, Molly M Lamb^#^{4

5}, Michael Matergia^#^{5

8}

Affiliations

¹ Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 USA.
² School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC USA.
³ Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India.
⁴ Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA.
⁵ Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA.
⁶ Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO USA.
⁷ Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, MacNider Bldg. Suite 304, CB#7160, 333 S. Columbia St., Chapel Hill, NC 27599 USA.
⁸ Broadleaf Health and Education Alliance, Stroudsburg, PA USA.

^# Contributed equally.

Abstract

Background: The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers', students', and caregivers' acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students.

Methods: In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, "education as mental health therapy" (Ed-MH). Measured with validated scales, teachers' and students' acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST.

Results: Teachers' quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children's measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers' ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out.

Conclusion: Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care.Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry-India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27.

Supplementary information: The online version contains supplementary material available at 10.1007/s44192-022-00024-z.

Keywords: Acceptability; Caregiver; Child mental health care; Community mental health; Global mental health; Primary school; School mental health; Student; Task-shifting; Teacher.