Background:Identifying implementation determinants, also referred to as barriers and facilitators, is considered a critical component of implementation science. There are many emerging methods for identifying implementation determinants, yet very few evaluations of how these methods complement or diverge from one another. The objective of this report is to compare three methods for identifying determinants in the context of the Novel Methods for Implementing Measurement-Based Care with Youth in Low-Resource Environments study. Methods:Rapid evidence synthesis involves a targeted review of empirical literature. Rapid ethnographic assessment uses site visits, interviews, and observations to develop an insider's perspective. Design probes engage participants in prompted activities (e.g., journaling, taking photos) to surface insights from their lived experience. We compared convergence of determinants identified by each method using a Jaccard plot and pairwise Jaccard indices. Results:All three methods combined produced a list of 42 determinants. Rapid evidence synthesis surfaced 29 (69%) determinants, including 8 solely identified by this method. Rapid ethnographic assessment surfaced 35 (83%) determinants, with 4 solely identified by this method. Design probes surfaced 23 (66%) determinants and did not surface any unique determinants. A total of 14 (33%) determinants were identified by all methods. Pairwise Jaccard indices indicated the strongest convergence between rapid ethnographic assessment and design probes (J = .66) and rapid evidence synthesis and rapid ethnographic assessment (J = .52). Convergence between rapid evidence synthesis and design probes (J = .37) was more modest. Discussion:This study describes the convergence of implementation determinants surfaced using three methods. We found substantial overlap between methods, with one third of determinants surfaced by all three methods. Despite this overlap, each method added unique insights. Rapid evidence synthesis surfaced determinants from the literature and theory that were less likely to be identified by rapid ethnographic assessment or design probes. Rapid ethnographic assessment had the highest yield of determinants. Design probes highlighted participant-driven perspectives that overlapped substantially with rapid ethnographic assessment; notably, design probes did not surface any new determinants. These results reinforce the complementary nature of multi-method determinant assessment while highlighting tradeoffs researchers must weigh when selecting determinant identification methods. Trial registration:Clinicaltrials.gov. NCT05644756. Registered 11/18/2022. This trial was retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT05644756.

Background To advance implementation of evidence-based interventions in healthcare, research teams need methods that center engagement, inclusivity, and creativity. We address this challenge by exploring design probes for implementation research. Design probes are packaged materials given to users that prompt them to asynchronously capture data about their context and experience, subsequently reflecting upon aspects of that data salient to the topic of study. This study had three objectives: (1) explore the potential utility of design probes in implementation research, (2) describe researcher and participant experiences with design probes, and (3) generate considerations for leveraging design probes to enhance engagement in implementation research. Method We used a multi-informant, multimethod approach. For objective 1, we undertook a literature scan and elicited expert (n = 8) input to explore how, when, and why design probes could be used in implementation research. For objective 2, we pilot tested the method with practitioners (n = 22) in an implementation research project exploring barriers and facilitators to implementing measurement-based care in community mental health settings. For objective 3, we sought feedback about the method in focus groups with youth (n = 8) and practitioners (n = 9). Results The literature scan and expert input identified five scenarios in which design probes may enhance implementation research, including enhancing engagement among implementation partners, accessing hard-to-reach populations, and identifying partner-centered implementation strategies. Our pilot experience demonstrated that design probes are feasible for implementation research from the perspective of research teams and participants. Focus group findings indicated that design probes hold promise for engaging youth but may have variable appeal and utility with practitioners. Conclusions We explore design probes for implementation research at a time of critical need for partner engagement. Future research will examine feasibility and value of design probes in a range of implementation initiatives.

Social risk factors, or adverse conditions in which people are born, grow, live, and age (1), contribute to greater mental health problems (2,3) and lower treatment engagement worldwide (4). The prevalence and impact of social risk factors (SRFs) are particularly pronounced in low-to-middle income countries (LMICs); however, strategies to address SRFs alongside mental health treatments have not been systematically studied. Building on an NIMH-funded project (BASIC; 5), we invited participants ranging from children and guardians who received and lay counselors that delivered an adapted form of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; 6) in western Kenya to complete qualitative interviews. In these interviews, we examined both the experience of SRFs and how lay counselors address SRFs within TF-CBT. Results from the qualitative analysis reveal that in the face of SRFs, counselors were already addressing SRFs, though typically by using their own personal resources. Participants also identified a variety of strategies that do not require extensive financial support. Overall, the experience of SRFs and strategies to address SRFs reported in this paper may support the engagement in and effectiveness of evidence-based practices in Kenya and globally.

Eighty percent of the world's youth live in low- and middle-income countries (LMICs), yet access to trauma-focused mental health care in these settings remains limited despite a high burden of mental health disorders and trauma exposure among youth. Task-shifting models that train lay counselors to deliver evidence-based treatments can expand access to care, yet delivering trauma-focused treatment may increase counselors' vulnerability to secondary traumatic stress (STS). Organization-level support may play an important role in sustaining counselor well-being, yet little is known about which organizational factors are protective (i.e., contribute to low STS) in resource-limited settings. Data came from an implementation-effectiveness trial for an adapted trauma-focused cognitive behavioral therapy in western Kenya, to examine organizational factors linked to low STS among two groups of lay counselors: community health volunteers (CHVs; N = 120) and teachers (N = 117). Counselors completed surveys following training and treatment delivery that assessed supervisory relationships, leadership, implementation climate, feasibility, and organizational climate. We applied Coincidence Analysis, a configurational method, to identify organization-level determinants of low STS. Among CHVs, a solution with three pathways was identified for low STS: high supervision relationship; high implementation climate with high implementation leadership; and high feasibility with high transactional leadership. Among teachers, a different solution with three pathways emerged: high implementation climate; high supervisory relationship with a positive organizational climate via perceived work environment; and low transactional leadership with high transformational leadership. No single organizational factor was necessary for low STS. Instead, multiple configurations were sufficient, and these differed across provider roles and their organizational contexts. These findings suggest that organizational strategies to prevent or mitigate STS should be tailored to provider roles and settings. As task-shifting models expand in LMICs, centering lay counselors' well-being within organizational management and treatment development will be critical to sustaining the workforce and ensuring quality trauma-focused care.

Children with conduct problems and elevated callous-unemotional (CU) traits whose parents participate in parent management training (PMT) start and end treatment with higher levels of conduct problems than those with conduct problems alone and face a higher risk of negative outcomes. Because these children have deficits in emotion recognition and empathy, incorporating an emotion-focused intervention into PMT may enhance child outcomes. This study describes the development and evaluation of a brief parent-focused emotion-coaching (EC) intervention combined with an evidence-based PMT program, Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), for use with clinic-referred children (3-7 years) with conduct problems and elevated CU traits (N = 43; M age = 6.08 years, SD = 1.39, 83.7% male). We employed a treatment deployment (i.e., effectiveness) model to inform the EC content and integrate it with HNC. HNC-EC is one of a growing number of interventions targeting known developmental mechanisms related to child CU traits. We examined parent and child outcomes from a pilot randomized controlled trial comparing HNC-EC and HNC. Parent-report, direct observation, and laboratory measures were employed at baseline, mid-treatment, and post-treatment. Intention-to-treat and completer analyses demonstrated that both HNC and HNC-EC led to significant improvements in children's conduct problems and CU traits. There were relatively few differences between the two groups; however, those differences favored HNC-EC in the domains of conduct problems, emotion recognition, parenting, and parent adjustment. Findings support the effectiveness of both HNC and HNC-EC in addressing the needs of this high-risk population, and suggest the added benefit of incorporating EC into PMT.

Community mental health (CMH) clinicians are at high risk of developing burnout, which can lead to poor clinician well-being, worse quality patient-care, and employee turnover. However, little is known about strategies CMH agencies and supervisors are currently implementing or could implement, to reduce clinician burnout. This mixed methods study gathered perspectives from 141 CMH clinicians participating in a state-funded evidence-based treatment training initiative called cognitive behavioral therapy plus, on strategies for addressing clinician burnout. Questions related to burnout were added to the cognitive behavioral therapy plus 2022-2023 pretraining evaluation survey. Using a modified free-list technique in an online survey, participants suggested agency or supervisor solutions they felt would be helpful to reduce their burnout and answered a follow-up question indicating whether each solution was currently being implemented by their agency/supervisor. Thirty-three distinct burnout strategies spanning six domains-client-related, structural support, teams, emotional support, other supervisor support, and self-care-emerged through qualitative content analysis. Next, qualitative data were "quantitized" and were examined using confidence intervals to estimate the prevalence of the offered solutions. Encouragingly, many of the top-endorsed strategies (e.g., supervision sessions, morale/team-building, flexible work arrangement) were reported as being currently implemented. Manageable caseload emerged as a top-endorsed strategy, yet not currently implemented across many CMH agencies. Still, many low-cost and potentially feasible strategies emerged (e.g., check-ins, engaged supervisors, supervisor encouragement to take breaks or practice general self-care). Implications for policy and future research are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study evaluated 1) foundational helping competencies for Non-Specialist Providers (NSPs) trained in a transdiagnostic CBT-based intervention (PRO-ACT) for adolescents with anxiety and depression in Nairobi, Kenya and 2) preliminary clinical outcomes for adolescents receiving PRO-ACT. Seventeen NSPs were trained and assessed using role plays at pre-training, post-training, and post-supervision using the Enhancing Assessment of Common Therapeutic Factors (ENACT) tool, via a pre-post design (no control group). Eighteen adolescents were enrolled, received 4-6 PRO-ACT sessions, and assessed using the Patient Health Questionnaire-9 (PHQ-9) and Revised Children's Anxiety and Depression Scale (RCADS-25). There were no significant changes in NSPs' competencies from pre- to post-training. From pre-training to post-supervision, NSPs' Level 1 (Potentially harmful) scores significantly decreased (-1.12 items; 95% CI: -2.10, -0.15; p = 0.026) and Level 3 or 4 ("Basic" or "Advanced competency") significantly increased (2.12; 95% CI: 1.21, 3.04; p < 0.001). Adolescents had no significant change in mean PHQ-9 scores. RCADS scores decreased significantly for depression (-3.00 points; 95% CI: -5.45, -0.55; p = 0.020) and anxiety (-3.39 points; 95% CI: -6.17, -0.61; p = 0.020). NSPs' foundational helping competencies improved significantly during clinical supervision. Client outcomes were promising, warranting a larger rigorous trial.

Task-sharing approaches have shown promise in low-resource settings, yet few culturally adapted interventions have been systematically evaluated for forcibly displaced populations. Since 2016, over 1.7 million Venezuelans have migrated to Peru, facing significant barriers to healthcare and elevated risks of anxiety, depression, and post-traumatic stress disorder (PTSD). This protocol describes COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence). COMPASS is a transdiagnostic, open-source cognitive behavioral therapy program co-designed with forcibly displaced populations. This protocol describes the procedures for an ongoing randomized pilot trial with n = 90 forcibly displaced Venezuelan people (Clinicaltrials.gov: NCT06635486). COMPASS guides, or lay providers, trained through an intensive apprenticeship model, will deliver 6-12 weekly remote sessions. Primary outcomes include changes in anxiety, depression, and PTSD symptoms, assessed with validated Spanish-language measures. Secondary outcomes include feasibility (recruitment, retention, fidelity) and acceptability (therapist and participant ratings). Exploratory outcomes will examine integration, migration experiences, and demographic moderators of intervention effectiveness. Analyses will follow the intention-to-treat principle, using descriptive statistics and regression models to evaluate symptom trajectories across baseline, post-intervention, and 3- and 6-month follow-ups. This study represents the first effectiveness evaluation of an open-source, lay-delivered CBT program tailored for forcibly displaced people in Peru. Findings will inform feasibility, acceptability, and preliminary effectiveness of COMPASS, with potential to expand scalable, culturally relevant mental health services for forcibly displaced populations in resource-constrained settings worldwide.

Background Clinicians need supports beyond training to deliver evidence-based treatments with fidelity. Workplace-based clinical supervision often is a commonly provided support in community mental health, yet too few studies have empirically examined supervision and its impact on clinician fidelity and treatment delivery. Method Building on a Washington State-funded evidence-based treatment initiative (CBT+), we conducted a randomized controlled trial (RCT), testing two supervision conditions delivered by workplace-based supervisors (supervisors employed by community mental health organizations). The RCT followed a supervision-as-usual (SAU) phase for comparison. The treatment of focus was trauma-focused cognitive behavioral therapy (TF-CBT). Clinicians ( N = 238) from 25 organizations participated in the study across the SAU baseline and RCT phases. In the RCT phase, clinicians were randomized to either symptom and fidelity monitoring (SFM) or SFM and behavioral rehearsal (SFM + BR). For BR, clinicians engaged in a short role play of an upcoming treatment element. Supervisors delivered both conditions, with regular study monitoring for drift. Clinicians audiorecorded therapy sessions with enrolled clients, and masked coders coded a subset of recordings for adherence to TF-CBT. One hundred and thirty-three clinicians had recorded TF-CBT session data for 258 youth. We examined six adherence outcomes, including potential moderators. Results Results of generalized estimating equations indicated that there were no real differences on adherence outcomes for experimental conditions (SFM, SFM + BR) compared to SAU. Adherence scores in the baseline SAU phase and the RCT conditions were high. Only one interaction was significant. Conclusions Contrary to our hypotheses, we did not see improvements in adherence with the RCT conditions. However, nonsignificant findings seem best explained by clinicians’ acceptable/high adherence in SAU. This study was conducted within the context of a long-standing, state-funded EBT initiative, in which clinicians and their supervisors receive training and support, and in which participating community mental health organizations have adopted and supported TF-CBT. ClinicalTrials.gov ID NCT01800266

Feasibility, the degree to which an innovation is successfully carried out in a given setting, is key to whether an intervention will be implemented as planned and is connected to implementation success and service outcomes. In settings with limited resources, feasibility may be a particularly important determinant of whether an intervention is adopted and/or sustained over time. However, there is limited consensus on how to define, measure, and report feasibility in research conducted in community mental health settings. Following guidance from Arksey and O'Malley (2005), Levac et al. (2010), and Westphaln et al. (2021), the current scoping review aims to synthesize how trials conducted in community mental health settings describe the rationale, definition, measurement approach, and results of feasibility. The search included articles from Medline, PsycInfo, CENTRAL, Global Health, and Global Index Medicus and was conducted in September 2023. Included articles referenced feasibility and had each of the following: (1) delivery of an evidence-based psychotherapy (EBP) in a community mental health setting, (2) participants with elevated mental health symptomatology, and (3) implementation and/or clinical outcomes. Through data extraction, data synthesis, and qualitative content analysis, the authors identified feasibility definitions, measures, results, and explanations as well as intervention characteristics. Sixty-one articles across 20 countries were included. Articles included a wide range of EBPs delivered to individuals across the life span in community mental health settings. While all studies reported some level of feasibility of an intervention or trial, only 60.7% described a rationale for examining feasibility, 11.5% defined feasibility, 73.8% measured feasibility, and 67.2% reported descriptive statistics to accompany the level of feasibility found. Our results highlight the lack of clear and consistent rationales, definitions, measurement approaches, and results of feasibility in research conducted in community mental health settings. To improve the conceptualization and study of feasibility, we propose guidelines for future researchers to consider when examining feasibility. The guidelines include providing a clear definition of feasibility (i.e., the extent to which an EBP is possible in a certain context; Proctor et al., 2011), combining reflective and formative measures of feasibility to assess how feasible an intervention is and why it is deemed feasible (respectively), considering when in the implementation process researchers are engaged, involving multiple voices in the measures of feasibility, and exploring the impact of feasibility on other implementation outcomes as well as clinical outcomes.

Adolescents and young adults with HIV (AYH) are at greater risk for mental health conditions. Provision of mental health services to AYH is limited by an overburdened and untrained workforce, and psychological interventions ill-adapted for adolescent HIV care. Brief, transdiagnostic psychological interventions delivered in the HIV clinics may address some of these challenges. We will evaluate the PRO-ACT intervention in a hybrid type 1 cluster randomized clinical trial (NCT06247527) in 30 HIV clinics in 3 counties in Kenya. PRO-ACT is a cognitive behavioral therapy with 5 modules: Psychoeducation, Relaxation, prOblem-solving, behavioral Activation and Cognitive coping, delivered to AYH by trained health providers without specialist mental health training in 4-6 sessions within 6 months. We performed stratified randomization with matching to balance for county and facility size to assign 5 intervention (PRO-ACT) and 5 control (standard of care) clinics in each of the 3 counties. Screening of AYH ages 16-24 years will be conducted using the 9-item patient health questionnaire (PHQ-9). Up to 300 AYH with psychological distress (PHQ-9 score>4) will be enrolled in each arm. Further assessments will include the 5-item ASK suicide screening questions (ASQ), 7-item Generalized Anxiety Disorder (GAD-7), 20-item Child and Adolescent Trauma Screen (CATS)/PTSD Checklist for DSM-5 (PCL-5), self-reported treatment adherence, and HIV viral loads. Follow-up assessments will be conducted at month 3, 6, 9 and 12. Mixed methods will be used to measure implementation outcomes, cost-effectiveness, and characterize determinants of implementation. Primary analysis of PRO-ACT effectiveness will be conducted at month 6 (near term treatment effect), and month 12 (treatment effect sustainability) comparing PHQ-9 mean scores between treatment and control groups. Secondary analyses will compare GAD-7, CATS/PCL-5, adherence and viral suppression between the groups. The study will inform integration efforts of holistic mental health services in HIV care.

OBJECTIVE:This study examined youth-serving community mental health clinicians' multicultural counseling knowledge and awareness and their perceived barriers and facilitators in discussing race and racism with clients. Additionally, the study explored how clinicians' knowledge and awareness were related to their reports of barriers and facilitators in addressing race and racism. METHODS:The current study is a mixed-method study of 119 youth-serving community mental health clinicians across Washington State. We explore qualitative themes in clinicians' reports of perceived barriers and facilitators in broaching topics of race and racism. We also examine if reported barriers and facilitators correlate with the Multicultural Counseling Knowledge and Awareness Scale. RESULTS:Qualitative themes emerged at the client-, clinician-, organizational-, and societal-levels. Barriers included clinicians not engaging in racism-related discussions unless clients initiated them, clinicians' discomfort or lack of confidence, and clinicians' perceptions of harm or limitations because of their racial identification. Clinicians were more willing to broach topics of race or racism with older clients, with stronger perceptions of rapport, and when topics were broached earlier in therapy. There was no statistically significant correlation between the count of perceived barriers or facilitators' and clinicians' multicultural counseling knowledge and awareness. CONCLUSION:Qualitative and quantitative data highlight considerations for assessing and supporting clinicians' cultural humility. Enhancing multicultural competency and humility can help clinicians recognize their strengths and limitations, fostering a deeper understanding of clients' cultural backgrounds. Encouraging clinicians to facilitate open discussions about race and racism is a key step in this process.

IntroductionCommon mental disorders (CMDs) are prevalent among adolescent girls and young women (AGYW) in high HIV-burden settings. However, mental health is underprioritized within HIV interventions targeting AGYW. We conducted a qualitative study to explore AGYW and healthcare providers' perceptions of mental health service delivery within HIV clinics.MethodsBetween 16th February and 14th June 2021, we conducted in-depth interviews with AGYW receiving HIV services and healthcare providers from eight clinics in Central Kenya. Eligible AGYW were aged 16-25 years and reported mild-to-moderate CMD symptoms, determined by the Self-Reporting Questionnaire 20-item (SRQ-20) mental health screening tool. Eligible providers currently provided HIV or mental health services. Interviews explored AGYW's experiences with CMDs and factors influencing mental health service delivery by providers within HIV clinics. We analyzed data deductively and inductively using thematic analysis and organized findings using the socio-ecological model.ResultsMedian age among AGYW (n = 20) was 21 years (IQR:18-24), and SRQ-20 screening score was 9 (IQR: 8-11). Providers (n = 10) comprised seven females; and included six HIV and four mental healthcare providers. AGYW described experiences of CMDs due to multi-level risk factors, including HIV stigma, financial problems, and relationship challenges. AGYW reported a high demand for mental health services but described a systemic lack of access. Convenience and positive experiences with providers facilitated AGYW's access to services. Conversely, HIV care providers felt less confident in delivering mental health services due to inadequate mental health training compared to mental healthcare providers. Providers also reported inadequate training, poor referral systems, and unclear guidelines that hindered service delivery. AGYW and providers endorsed mental health service integration within HIV clinics to potentially reduce referral burden for AGYW and improve service quality.ConclusionsOur findings highlight gaps in mental health service delivery among AGYW receiving HIV services. Integrated service delivery within HIV clinics could improve AGYW's access to mental health services.

Children with conduct problems and elevated callous-unemotional (CU) traits show poor prognosis. We describe a new parenting intervention that combines a behaviorally focused parenting management training intervention (i.e., "Helping the Noncompliant Child" [HNC]; McMahon & Forehand, 2003) with an emotion coaching (EC) intervention (Katz et al., 2020) for young children (3-7 years) with conduct problems and elevated CU traits. The new integrated intervention (HNC-EC) targets the emotional deficits and parenting difficulties in this subgroup of children with conduct problems. Because the two interventions have different theoretical orientations, several conceptually based decisions were made during treatment development to facilitate integration. We describe the emotional and parenting processes targeted by the combined HNC-EC intervention, provide an overview of its content, and describe decision points where differences between basic principles of HNC and EC were addressed.

Background:Cognitive behavioral therapy (CBT), an umbrella term for therapeutic techniques guided by cognitive behavioral theory, is an evidence-based approach for many psychiatric conditions in youth. A stronger dose of CBT delivery is thought to improve youth clinical outcomes. While a critical indicator of care quality, measuring the use of CBT techniques feasibly and affordably is challenging. Certain CBT techniques (e.g., more concrete and observable) may be easier to measure than others using low-cost methods, such as clinician self-report; however, this has not been studied. Method:To assess the concordance of three methods of measuring CBT technique use with direct observation (DO), clinicians from 27 community agencies (n = 126; M age = 37.7 years, SD = 12.8; 76% female) were randomized 1:1:1 to a self-report, chart-stimulated recall (CSR; semistructured interviews with the chart available), or behavioral rehearsal (BR; simulated role-plays) condition. In previous work using a global score aggregating 12 CBT techniques, only BR produced scores that did not differ from DO. This secondary analysis examined the concordance of these alternate methods with DO for each discrete CBT technique, testing for differential concordance across cognitive techniques (e.g., cognitive education) compared to behavioral techniques (e.g., behavioral activation). Results:Results of three-level mixed effects regression models indicated that BR scores did not differ significantly from DO for any techniques, and for nine techniques, neither did CSR (all ps > .05). Contrastingly, self-report scores differed from DO for all but one technique, with greater concordance for behavioral than cognitive techniques (z = -3.29, p < .001). Conclusions:Unlike previous findings using an aggregate score, we found that both BR and CSR did not differ significantly from DO for most techniques tested. These findings have implications within implementation research and usual care settings; they support multiple viable measurement methods that are less resource-intensive than DO.

This study describes an alternative to face-to-face training method for community health volunteers (CHVs) as used by a collaborative group from the University of Nairobi, University of Washington and the Nairobi Metropolitan Mental Health Team during the COVID-19 lockdown in Kenya. This qualitative study describes the experiences of 17 CHVs enrolled in a training study, required to utilize different digital platforms (Google Meet or Jitsi) as a training forum for the first time. Verbatim extracts of the participants' daily experiences are extracted from a series of write-ups in the group WhatsApp just before the training. Daily failures and success experiences in joining a Google meet or Jitsi are recorded. Then, 17 participants, 10 women and 7 men, aged between 21 and 51 years (mean = 33), owning a smartphone, were enrolled in the study. None had used Jitsi or Google meet before. Different challenges were reported in login to either and a final decision to use Jitsi, which became the training platform. Training CHVs to deliver a psychosocial intervention using smartphones is possible. However, the trainer must establish appropriate and affordable methods when resources are constrained.

Implementation science and human-centered design (HCD) offer useful frameworks and methods for considering and designing for individuals’ needs and preferences when implementing new interventions or technologies in global health. When used in tandem, the two approaches may blend creative and partnered research methods with a focus on the factors necessary to design, implement, and sustain interventions. However, research is needed that describes the process of blending these two approaches and explores the experiences of community partners. This study builds from a stepped-wedge cluster-randomized trial in Western Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy (TF-CBT). Mobile phones emerged as a tool to supervise lay counselors from afar; however, their use was characterized by unique challenges. Informed by human-centered design and implementation science, we first engaged lay counselors (n=24) and supervisors (n=3) in individual semi-structured interviews then hosted an in-person participatory workshop to “co-design” solutions to optimize the use of mobile phone supervision. Lay counselors participated in focus group discussions regarding their experiences in the workshop. Focus group transcripts were analyzed using thematic analysis. We describe our approach as well as focus group discussion results. Counselors felt the workshop was a valuable experience to learn new strategies from their colleagues, and they enjoyed the “collaborative spirit” that emerged as they worked together. Counselors felt that varying small and large group discussions fostered participation by creating opportunities for more people to engage and share their thoughts. Counselors suggested the approach be improved by providing more tangible materials (e.g., hand-outs) and more closely following a schedule of activities. It is important to also center stakeholders’ experiences as partners in the research process. Though counselors largely expressed positive sentiments, they also shared valuable suggestions for how to improve participatory research practices in the future.

Introduction: Predictors of neurodevelopment among children who are HIV-exposed uninfected (CHEU) are poorly understood.Methods: Mothers with and without HIV and their children were enrolled during 6-week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1-year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site.Results: At 1-year evaluation, CHEU (n = 709) and children who are HIV-unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate-to-severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: -1.38, 95% CI: -2.05, -0.71), food insecurity was associated with lower social scores (adjusted coeff: -0.37, 95% CI: -0.73, -0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: -0.76, 95% CI: -1.40, -0.13) and gross motor scores (adjusted coeff: -1.07, 95% CI: -1.81, -0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: -0.51, 95% CI: -1.01, -0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: -0.45, 95% CI: -0.87, -0.03) or a deceased or absent father (adjusted coeff: -0.81, 95% CI: -1.58, -0.05), respectively.Conclusions: Biologic and social factors were associated with child neurodevelopment. Despite socio-demographic differences between CHEU and CHUU, 1-year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between CHEU and CHUU.

The present study investigated the acceptability, feasibility, and potential effectiveness of using theater as an interdisciplinary tool to train mental health clinicians to discuss race and racism with Black youth clients. The training was developed using findings from a statewide survey of clinicians' perceived barriers and facilitators to discussing race and racism. Development survey data were analyzed to generate didactic content that addressed common misperceptions and to develop scripted performances of interactions between a therapist and two Black youth clients. Mental health clinicians and clinical supervisors (N = 23) from community mental health organizations viewed and responded to the videos of the scripted scenes before the training. Black clinician collaborators co-presented didactic information and facilitated small-group breakouts. Trained actors improvised participant suggestions in the large group, and breakouts allowed for debriefing, discussing, and practicing through improvisation with actors. The training was evaluated with a pre- and posttraining survey. Training significantly improved multicultural counseling self-efficacy (measured by the Multicultural Counseling Self-Efficacy Scale-Racial Diversity form; t[13] = -5.83, p < .001), decreased concerns about counseling Black clients (measured by the Concerns About Counseling Racial Minority Clients scale; t[13] = 7.05, p < .001), and improved intentions to discuss race and racism with Black clients specifically, t(13) = -6.11, p < .001, as well as all clients of color, t(13) = -3.16, p = .008. Qualitative and quantitative measures converged to suggest that the training was highly acceptable (M = 4.7, SD = 0.6) and appropriate (M = 4.7, SD = 0.6). We end with clinical implications.

Introduction A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach. Method Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis. Results Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility. Conclusion Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya. Plain Language Summary A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.