Scaling Up Task-Shared Depression Care in Texas: Evaluating the Preliminary Effectiveness and Acceptability of a...

Digital technologies hold promise for building capacity of non-specialist providers to scale-up access to depression care. This study evaluated the preliminary effectiveness and acceptability of a digital program to train non-specialists in the delivery of an evidence-based behavioral activation (BA) intervention for depression.

Non-specialist providers without prior mental health counseling experience employed within the Baylor Scott & White Health system in Texas were recruited to complete a two-course digital training, and knowledge assessments-at baseline and follow up-to determine preliminary effectiveness. Acceptability and feasability were assessed through focus groups.

Of 73 non-specialist providers enrolled in the program, 42 completed both courses. Intent-to-treat analysis showed pre-post improvement in knowledge assessment scores (mean difference = 5.4; 95% CI: 1.6, 9.2; t(53) = 2.87, p = 0.006). Subgroup analyses demonstrated that participants who fully completed the training had pre-post improvement in knowledge scores (mean difference = 6.8; 95% CI = 2.8, 10.8; t(39) = 3.46, p = 0.001), whereas those who did not start or who only partially completed the training did not show improved knowledge scores. Framework analysis of the focus groups revealed four themes: training program evaluation, participant feedback and improvements, communication strategies, and support and resources.

This digital program shows potential for building skills and knowledge of non-specialist providers in delivering BA. Continued efforts are needed to support these providers in practice, and ensure quality through supervision.

The program offers a scalable solution to expanding the behavioral health workforce, representing an opportunity to overcome the significant mental health workforce shortages and ensuring access to quality mental health services.