Purpose As the demand for mental health services increases, new models of care are necessary to address shortages of mental health professionals. Research in low- and middle-income countries has shown that lay individuals with limited formal education and no experience with mental health service delivery can be trained as providers; however, research in this model is limited in the United States. This study sought to assess the feasibility of training lay individuals to deliver Behavioral Activation (BA) to Spanish-speaking Latinos using the BA for Latinos Treatment Manual (i.e. the BA Manual). Design/methodology/approach Using a pilot feasibility trial, the authors trained four women who worked as receptionists at a community-based organization in Camden, New Jersey as community health workers (CHWs). CHWs attended three days of training and delivered BA sessions under supervision to Spanish-speaking Latinas with mild to moderate depression or anxiety. Findings Using the Pragmatic BA Fidelity tool, CHWs and their supervisors assessed high levels of fidelity in the delivery of the intervention. However, due to challenges with scheduling, CHWs completed only four of the planned six sessions. All participants expressed satisfaction with the intervention. Research limitations/implications This study suggests the feasibility of training lay individuals to deliver the BA intervention in community-based settings; however, modifications are necessary before moving to efficacy testing. The study was supported through pilot funding, which required us to focus on a limited number of outcomes. Based on the methods proposed by Teresi et al. (2022), the authors designed this study to focus specifically on fidelity to the intervention and acceptability of the intervention to diverse stakeholders. The authors were not able to address factors such as recruitment and retention of interventionists or more detailed assessment of recipients’ adherence to/engagement with the intervention. Further research will be necessary to address these components of intervention fidelity. Practical implications Given the small scale and exploratory nature of this study, the findings should not be interpreted as evidence of effectiveness but rather as an indication of whether the approach can be implemented and refined. The fact that both CHWs and their supervisors were confused about the number and timing of sessions, suggests that more time should be spent on training these participants on the BA model to enhance intervention fidelity. The next phase of this research will involve revising the training schedule, reviewing the translation of the intervention manual, and creating reporting templates to ensure consistency with the intervention’s aims. The authors expect these changes to significantly improve fidelity to the BA model, which the authors plan to test with a larger sample size. Social implications The fact that service recipients benefited from the program (i.e. decreased depression/anxiety symptoms and high satisfaction with the program) suggests that this approach may represent a promising direction for expanding access to culturally appropriate services, particularly in settings where traditional resources are limited. After further feasibility testing, the study team plans to conduct a pilot test with sufficient sample size to randomize recipients to service delivery either from a CHW or a mental health professional. Although the stakeholders in the present study identified few problems with either the training or service delivery, a larger pilot study that would train and compare these aspects of the intervention for lay individuals versus professional therapists is likely to identify more specific areas for improvement. Originality/value This study provides preliminary evidence of the feasibility of training lay individuals to deliver a BA intervention. The next phase of the research will incorporate findings from this study to test the model in a larger sample.
Bagchi et al. (Mon,) studied this question.