4 - (IOP 1) Bridging the Divide in Access to Trauma-focused Cognitive Behavioral Therapy (TF-CBT) Through Task-shifting: A Systematic Review of Lay Counselor-delivered TF-CBT

Childhood trauma is linked to poor mental health outcomes throughout the lifespan (McLaughlin et al., 2012). While 60-80% of youth in the US experience trauma (Turner et al., 2010), up to 80% of youth in need of mental health services do not receive care (Kataoka et al., 2002). This treatment gap is driven by the mental health workforce shortage, which is concentrated in low-resource communities and disproportionately affects racial minoritized and low-income youth (Cummings et al., 2013), who face higher trauma exposure and lower access to care (López et al., 2015). Task-shifting (i.e., training lay counselors to deliver evidence-based treatments) is one solution to bridge this treatment gap. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2017) is the most well-researched trauma-focused treatment for youth and has shown to be effective when delivered by lay counselors (e.g., Murray et al., 2015). However, no systematic reviews have synthesized the process and strategies to support lay counselor-delivered TF-CBT, which could enhance dissemination of this modality.

This presentation will report findings from a pre-registered systematic review characterizing treatment modifications and implementation strategies used to support lay counselor delivery of TF-CBT. Results will describe 1) the process of identifying and operationalizing modifications, 2) TF-CBT modifications, and 3) implementation strategies (e.g., training and supervision) to support lay counselor delivery. In June 2024, a literature search was conducted across PsycINFO, PubMed, MEDLINE, and PILOTS databases. Grey literature was identified through Google Scholar and ProQuest. Articles were screened based on preregistered inclusion criteria. A narrative synthesis was conducted to sort findings by research question.

Our review identified ten trials (21 articles) describing modifications or implementation strategies for lay counselor-delivered TF-CBT. All trials implemented culturally tailored versions of TF-CBT in low and middle-income countries. The process of tailoring TF-CBT relied on input from local experts through multiphasic researcher-community collaborations. TF-CBT modifications were contextual (e.g., multiple sessions per week) or surface-level content (e.g., language) to improve fit with the local setting. Implementation strategies enhanced training and supervision (e.g., local trainers, ongoing training), resolved implementation barriers (e.g., workload adjustments), and supported counselor wellbeing (e.g., protocol for non-mental health needs). The absence of core treatment modifications indicates that TF-CBT is acceptable, appropriate, and feasible for lay counselor delivery. Moreover, findings suggest that lay counselor-delivered TF-CBT in low-resource settings can be successfully implemented through peripheral modifications, bolstering training and supervision, and fostering community-academic collaborations. By elucidating strategies to extend the reach of TF-CBT, this work holds promise for closing the mental health treatment gap, interrupting the negative sequelae of trauma, and promoting health equity.