Task-Sharing Supervision Density and Trauma-Related Mental Health Relapse in South Sudanese Community Clinics: A Stepped-Wedge Analysis of Counselor Certification Thresholds

Supervision density in task-shared trauma care is typically set by certification schedules rather than by evidence about relapse detection. the present analysis characterises the operating characteristics of a stepped-wedge design intended to estimate the effect of counselor certification thresholds on trauma-related mental health relapse in South Sudanese community clinics. No observational data are used or claimed. Under a declared variance structure with a between-cluster standard deviation of 6.0, a residual standard deviation of 4.5 and an intraclass correlation of 0.64, power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. Fifty-four clusters were required to detect a 5 percentage point effect at 80 per cent power. The stepped-wedge design is feasible only at the upper end of the cluster range examined, that minimum detectable effects fall steeply between 24 and 32 clusters, and that the intraclass correlation of 0.64 dominates the power calculation. The contribution is a design-characterisation framework that makes the supervision-density question estimable without overstating what a small district trial can detect.