Community health worker implementation of transdiagnostic evidence-based treatment in Spanish: Advancing mental health equity for Latine parents

This K08 proposal will address a critical need for evaluating and understanding the implementation of community health worker (CHW) mental health models to increase evidence-based treatment (EBT) in populations who are less likely to receive mental healthcare. The Common Elements Treatment Approach (CETA) is an effective transdiagnostic EBT designed to be delivered by lay providers with little to no prior mental health training (i.e., CHWs). CHWs have demonstrated effectiveness in delivering CETA and other EBTs globally, but there is little evidence to guide domestic implementation of these models. The goal of this project is to evaluate the implementation of CHW delivered CETA with Spanish-speaking Latino parents to establish initial feasibility and proof of concept prior to expanding study of CHW EBT models across a variety of other populations and settings. In Aim 1, the PI will collaborate with stakeholders to refine CETA fit for the local context and population by using ADAPT-ITT, an implementation framework for EBT refinement. Aim 2 will use mixed methods to assess multilevel implementation determinants during the CETA training period, which includes initial CHW implementation with training cases, and use this information for ethics-driven implementation planning. Aim 3 is to conduct a randomized feasibility pilot of CHW-delivered CETA in Spanish with Latino parents to examine intervention acceptability and feasibility; feasibility of recruitment, randomization, and measurement procedures; and treatment engagement. Participants will be randomized to receive CETA immediately or after a 5 month delay. Administrative data (i.e., patient attendance, retention), patient-report data (i.e., validated mental health symptom measures pre-, during-, and post-treatment), and provider-report data (i.e., fidelity) will be used to evaluate feasibility. Dr. Gustafson’s long-term career goal is to evaluate, adapt, and implement CHW mental health models to increase the availability of mental health treatment for populations with unmet mental health needs. To meet her career objectives and the aims of this research project, the applicant requires additional training in: 1) community-engaged clinical trials; 2) implementation science; and 3) ethics related to implementing CHW mental health models. Supported by an interdisciplinary team of experts and an institutional environment invested in supporting innovative initiatives to improve the mental health of all communities, this K08 will launch the PI into a successful career as an independent clinical scientist. This project will also provide necessary data for Dr. Gustafson’s future R01 submission of a large-scale effectiveness-implementation trial of CHW-delivered EBT across multiple clinics and settings.