Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study

Milton L Wainberg; Maria Lídia Gouveia; Melissa Ann Stockton; Paulino Feliciano; Antonio Suleman; Jennifer J Mootz; Milena Mello; Andre Fiks Salem; M Claire Greene; Charl Bezuidenhout; Phuti Ngwepe; Kathryn L Lovero; Palmira Fortunato Dos Santos; Simone H Schriger; David S Mandell; Rogerio Mulumba; Anibal Neves Anube; Dirceu Mabunda; Flavio Mandlate; Francine Cournos; Jean-Marie Alves-Bradford; Terriann Nicholson; Bianca Kann; Wilza Fumo; Cristiane S Duarte; Jair de Jesus Mari; Marcelo F Mello; Ana O Mocumbi; Maria A Oquendo; Myrna M Weissman

doi:10.1136/ebmental-2020-300199

Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study

Evid Based Ment Health. 2021 Feb;24(1):19-24. doi: 10.1136/ebmental-2020-300199. Epub 2020 Nov 11.

Authors

Milton L Wainberg^{1

2}, Maria Lídia Gouveia³, Melissa Ann Stockton¹, Paulino Feliciano⁴, Antonio Suleman⁴, Jennifer J Mootz^{1

2}, Milena Mello^{1

2}, Andre Fiks Salem^{1

2}, M Claire Greene⁵, Charl Bezuidenhout⁶, Phuti Ngwepe⁶, Kathryn L Lovero¹, Palmira Fortunato Dos Santos³, Simone H Schriger⁷, David S Mandell⁸, Rogerio Mulumba⁹, Anibal Neves Anube¹⁰, Dirceu Mabunda¹¹, Flavio Mandlate³, Francine Cournos^{1

5}, Jean-Marie Alves-Bradford^{1

2}, Terriann Nicholson^{1

2}, Bianca Kann^{12

2}, Wilza Fumo³, Cristiane S Duarte^{1

2}, Jair de Jesus Mari¹³, Marcelo F Mello¹⁴, Ana O Mocumbi^{15

16}, Maria A Oquendo¹⁷, Myrna M Weissman^{1

2}

Affiliations

¹ Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
² New York State Psychiatric Institute, New York, New York, USA.
³ Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique.
⁴ Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique.
⁵ Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.
⁶ Research Unit, Foundation for Professional Development, Pretoria, South Africa.
⁷ Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁸ University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁹ Hospital Psiquiátrico de Nampula, Nampula, Mozambique.
¹⁰ Docente da Faculdade de Ciências de Saúde-UniLúrio, Hospital Psiquiátrico de Nampula, Nampula, Mozambique.
¹¹ Mavalane General Hospital, Maputo, Mozambique.
¹² Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA biancakann1@gmail.com.
¹³ Department of Psychiatry and Medical Psychology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil.
¹⁴ UNIFESP, Sao Paulo, São Paulo, Brazil.
¹⁵ Universidade Eduardo Mondlane, Maputo, Mozambique.
¹⁶ Doenças Não Transmissíveis, Instituto Nacional de Saúde, Maputo, Mozambique.
¹⁷ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Abstract

Objective: To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.

Design and setting: The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.

Main outcome measures: We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs.

Results: PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.

Conclusions: The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

Keywords: adult psychiatry; anxiety disorders; depression & mood disorders; schizophrenia & psychotic disorders; substance misuse.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Humans
Implementation Science
Mental Disorders* / therapy
Mental Health Services*
Psychotherapy
Technology

Abstract

Publication types

MeSH terms

Grants and funding