A Supervision Framework for Task-Shared Mental Health Workers: Implications for Clinical Trials and Beyond

The authors describe a supervision model that integrates elements of clinical supervision into categories that are suitable for use in task-shared trauma interventions in low-resource settings. Key Findings Supervision of nonspecialist mental health workers (NHWs) in most low-resource settings is still primarily unstructured, with poor evidence on the quality and quantity of supervision required to enable adequate delivery of mental health care. The supervision framework described in this article has 3 domains—process supervision, direct supervision, and needs-based supervision—that form a holistic approach to ensure the accurate delivery of intervention components and to support nonspecialists working in the context of trauma. The framework focuses on intervention fidelity and logistical support, encourages skill enhancement through ongoing appraisal of clinical skills and successful delivery of intervention components, and emphasizes the need to address experiences of vicarious trauma that pose a significant threat to NHWs working among populations with histories of trauma. Key Implications This framework may serve as a guide for future clinical trials of mental health interventions in low-resource settings and their eventual implementation. Future work should evaluate the adaptation of supervision frameworks used in clinical trials to the implementation of mental health interventions, including a detailed cost-benefit evaluation for the proposed supervision framework. ABSTRACT The rise in task-shared interventions that address the mental health treatment gap in low- and middle-income countries (LMICs) has highlighted the need for additional support and supervision of nonspecialist mental health workers (NHWs). The supervision of NHWs in most resource-limited settings is still primarily disorganized, without clear guidelines that provide the necessary structure for supervision. The need for supervision is even greater for NHWs working in the context of trauma, not only to provide training and ensure adequate delivery of care but also to provide support to minimize the psychological impact of their work. In South Africa, women face intersecting epidemics of HIV, intimate partner violence, and sexual trauma. This syndemic highlights the importance of integrating mental health treatment in HIV care, especially in settings like South Africa, where mental health services are limited. In this context, our group developed and is evaluating the effectiveness of ImpACT+, a task-shared coping intervention to improve clinical and mental health outcomes among HIV-infected women with sexual trauma in South Africa. We describe the ImpACT+ supervision model that is currently being implemented in the context of a hybrid effectiveness-implementation clinical trial. Combining experiences from clinical psychology, task-shared interventions, and trauma-informed care, the supervision model integrates formal elements of clinical supervision into categories that are suitable for use in task-shared trauma interventions in low-resource settings. To the best of our knowledge, such a trauma-informed supervision approach has not been widely documented in the literature, particularly in task-shared interventions in LMICs. In this article, we describe the ImpACT+ intervention, provide an overview of the supervision model, and provide illustrative examples of how the supervision model has been implemented.