BACKGROUND The mental health treatment gap-the difference between those with mental health need and those who receive treatment-is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. METHODS BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites' counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences' sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. DISCUSSION The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. TRIAL REGISTRATION Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396.

中文翻译：

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推进在资源贫乏地区（BASIC）成功实施任务转移型精神卫生保健：逐步楔形聚类随机试验的方案。

背景技术在低收入和中等收入国家，精神保健治疗差距（有精神保健需求的人与接受治疗的人之间的差异）很大。任务转移已被用于解决精神卫生专业人员的短缺，越来越多的研究表明通过任务转移提供的精神卫生干预措施的有效性。但是，很少有研究集中在如何嵌入，支持和维持任务转移到可能扩大规模的政府资助系统中。建立和维持对儿童的干预（BASIC）研究的目的是检查实施政策和做法，这些政策和做法通过教师的交付来预测教育部门对儿童的心理接受，忠诚和维持，并通过社区卫生志愿者的交付来对健康部门进行干预。 。方法BASIC是一项II类混合实施效果试验。该研究设计是阶梯式楔形，整群随机试验，涉及40个学校和学校周围40个社区的7个序列。报名人数包括120名教师，120名社区卫生志愿者，多达80名现场负责人以及多达1280名青年及其主要监护人之一。基于证据的心理健康干预是针对创伤的认知行为疗法的局部改编版本，称为Pamoja Tunaweza。本地咨询师在Pamoja Tunaweza接受过专业的培训，并由当地的培训师进行监督，他们在提供干预措施方面经验丰富，并参与了技能培训的培训师模型。在第一个步骤完成实施后，将与最初实施地点的顾问和领导进行深入访谈。这些发现被用于通知后续序列站点的实施便利的交付。我们使用包括定性比较分析在内的混合方法方法来确定必要和足够的实施政策和实践，这些政策和实践可预测感兴趣的3种实施结果：采用，保真度和可持续性。我们还研究了教育和卫生部门的儿童心理健康状况和干预费用。讨论BASIC研究将提供有关如何在已经为儿童和青少年服务的政府系统中支持实施任务转移的精神卫生保健的知识。来自BASIC的有关实施策略和实践的知识可以促进在资源匮乏的情况下实施科学。试验注册试验注册：ClinicalTrials.gov标识符：NCT03243396。注册于2017年8月9日，https：//clinicaltrials.gov/ct2/show/NCT03243396。