Background: One promising approach to expanding access to evidence-based mental health programs (EBPs) in low-resource settings is task-shifting delivery of interventions that are typically led by licensed professionals to people with less extensive qualifications and training. These paraprofessionals are trained to deliver interventions with the support of experienced supervisors. However, training in EBPs typically involves one-time expert-led workshops that are not readily available. This format is also resource- and time-intensive, which limits scalability and sustainability. Further, the effectiveness of the workshop model is limited because it can result in (a) cognitive overload, and (b) learning loss due to time delays between training and implementation. To improve access to EBPs, effective, sustainable, and scalable implementation strategies are needed to deliver EBPs in low-resource settings.
Based on cognitivist and experiential learning theory, the Just-in-Time Training (JITT) approach provides only the training necessary, at the time that it is necessary, to produce competent program delivery. JITT originated in the manufacturing industry and has more recently been applied to healthcare delivery, but it has yet to be rigorously evaluated as a strategy to implement mental health EBPs.
Our Project: We have developed a multi-level JITT implementation strategy (JITT-EBP) that aims to equip paraprofessionals to implement an EBP with fidelity using methods that are sustainable in low-resource communities. JITT-EBP integrates (a) self-directed, on-demand, online training modules for paraprofessionals and their local supervisors, (b) synchronous evidence-based supervision strategies, and (c) an apprenticeship delivery model in which EBPs are co-led by an experienced and a novice paraprofessional, providing opportunity for in-the-moment training and support. Our hypothesis is that the use of JITT-EBP will result in EBP fidelity and youth clinical outcomes that are as good as those observed with usual EBP training, but with higher feasibility, acceptability, appropriateness, and perceived sustainability in low-resource settings. We are currently evaluating the implementation outcomes of JITT-EBP compared to usual training practices.