2 - (SYM 32) Implementation Outcomes of a Train-the-trainer Model for Islamic Trauma Healing

Somalia has long been in a state of humanitarian crisis; trauma-related mental health needs are extremely high. A barrier to scaling up mental health interventions, particularly in low-income countries, is a lack of providers. Lay leaders could be a key means to providing such care. However, lay leaders require training and supervision to be able to effectively deliver trauma healing interventions. We conducted a randomized controlled trial of Islamic Trauma Healing (ITH) in Somaliland using a train-the-trainers (TTT) model. ITH is a six-session group intervention incorporating Islamic and evidence-based principles. Lay leaders (n = 12) were trained by experts in two, 4-hour training sessions and provided remote weekly clinical supervision. These experienced leaders then trained and provided supervision to new leaders (n = 24). Trainers and leaders completed implementation measures including participant attendance, leader adherence, and competence.  Overall, in preliminary analyses, lay leader implementation measures, rated from completely disagree (1) to completely agree (5), on acceptability of the intervention (M = 4.85, SD = 0.34), appropriateness of the intervention (M = 4.76, SD = 0.36), feasibility of implementing the intervention (M = 4.71, SD = 0.43) were highly endorsed.  There was no differences in implementation indices across phase of implementation (trainers, 1st generation lay leader trained, 2nd generation lay leader trained) or on gender of the leaders, though there was some variability across city and mosque. Overall, lay leader session fidelity ratings for key intervention components were very high (+ 95% completion) and quality of group discussions rated from very poor (1) to excellent (5), rated in the excellent range and also increasing over the sessions (session 1:  M = 4.31, SD = 0.92, to session 6: M = 4.90, SD = 0.31).  These results provide preliminary support for the TTT model and ability of non-experienced lay leaders to provide a trauma-focused intervention with high fidelity and competence. There is a great need to disseminate PTSD treatments that reduce expert involvement, lower cost, and become self-sustaining. Sustainable models of mental health care are essential, especially in areas where disease burden is high, and few providers are available.