Table 1 Components of the ASPIRE intervention package
Theoretical framework (intervention) | Lazarus and Folkman’s coping theory (Lazarus and Folkman, 1984) informs the problem-solving therapy (PST) approach: problem-solving for problems that can be solved and emotion-focused coping for problems that can’t be solved |
|---|---|
Delivering agents | • Training in generic counselling skills and 2–5 years of counselling experience |
Structure of intervention package | Four sessions of blended multi-component counselling intervention, to be delivered weekly. Participants have a 6-week window to complete all sessions before timing out of the intervention. |
Structure of sessions | |
Session #1 (participants in both arms receive this) | • Conduct screening/assessment of mental health • Provide feedback on results of screening/assessment • Increase knowledge of how depression and/or alcohol use impacts on adolescents • MI to build rapport and develop readiness to change (for alcohol) • Behavioral activation for strategies to address symptoms of depression |
Session #2 (intervention arm only) | • Patient check-in using MI • Build the rationale for PST o Explain the structure and rationale for PST o Establish positive problem orientation • Teach the steps of PST • First problem-solving exercise with counsellor and homework |
Session #3 (intervention arm only) | • Patient check-in using MI • Review practice exercises from session 2 and discuss challenges • Coping with negative thoughts: explain how to cope with problems that are not important • Second problem-solving exercise with counsellor and an exercise • Emotional regulation • Explain how to cope with “big” feelings such as anger • Practice emotional regulation techniques • Third problem-solving exercise with counsellor and homework |
Session #4 (intervention arm only) | • Patient check-in using MI • Review practice exercises from session 3 and discuss challenges • Advance process of acceptance: teach how to deal with problems that are important and cannot be solved • Fourth problem-solving exercise with counsellor and recap • Bringing it all together |
ASPIRE training | |
Structure and format of training | • Forty hours of formal training (the equivalent of five working days) • Mixture of didactic teaching and experiential group activities including skills rehearsal exercises and role plays • Counselling proficiency assessed during role plays using a competency checklist |
Training content | • Understanding common mental disorders (CMDs) • Principles of counselling (including confidentiality) • Screening participants for hazardous/harmful alcohol use and depression • Delivery of the blended multi-component counselling intervention • Ethics: recognizing and managing distressed participants and referral for additional care |
Characteristics of supervisor | • Psychological counsellor, registered with the HPCSA • Five years previous counselling experience in cognitive-behavioral therapy-based brief interventions • Three years previous experience in delivering MI-PST and training healthcare workers • Conduct guided by the professional standards and ethics–Professional Board for Psychology and the HPCSA |
Structure of supervision and debriefing | • In-person or telephonic individual supervision and debriefing conducted once a week • Telephonic supervision and debriefing used during community unrest, gang violence • Brief communication via text or WhatsApp messaging to address challenges in real-time in between weekly scheduled supervision and debriefing sessions • Supervision and debriefing of up to an hour per session and structured as follows: o Debriefing: brief check-in, followed by reflection on recent experiences at work and/or home, how these experiences were dealt with emotionally and practically (coping) and identifying opportunities for growth o Clinical supervision: counsellors present new cases and/or discuss patient progress including feedback, suggestions or recommendations by supervisor where needed in addition to reviewing counselling session notes o Addressing challenges: discuss logistical and counselling delivery challenges, and brainstorm solutions o Counselling fidelity feedback: provide counsellors with structured feedback on their counselling proficiency using a counselling fidelity checklist (audio tapes of counselling sessions assessed prior to supervision by supervisor). Brief skills rehearsal exercises or role playing to improve and solidify counselling aspects with average to low scores on the fidelity checklist. |
Supervisor training and support | • Trained to use a structured approach to supervision • Weekly in-person or telephonic supervision provided by a psychologist to assess adherence to the supervision approach and discuss ways of overcoming any logistical and systemic challenges to provision of supervision and debriefing • Weekly in-person or telephonic debriefing provided by a psychologist, including reflecting on recent experiences at work and/or home, how these experiences were dealt with emotionally and practically (coping) and identifying opportunities for growth |