Teacher and caregiver perceptions of family engagement in teacher-led task-shifted child mental health care in a low-and-middle-income country

ABSTRACT

The mental health needs of children in low-and-middle income countries (LMICs) often go unmet due to a lack of qualified mental health professionals. Task-shifting the provision of mental health services to teachers may facilitate access to care. Family engagement in task-shifting may support mental health outcomes but is understudied in this context. The current study explored teacher and caregiver perceptions of family engagement within a teacher-led, task-shifted mental health intervention in an LMIC. Primary school teachers from five schools in Darjeeling, India delivered evidence-based, indicated mental health care to children with mental health needs throughout the school day. We conducted semi-structured interviews (SSIs) with teachers (n=17) and caregivers (n=21). SSIs were coded for themes related to family engagement. Teachers and caregivers were compared based on perceived levels of engagement. Participants reported three patterns of engagement: families who fully engaged; families who felt positively about teachers but displayed little engagement; and families with limited engagement. Barriers included logistical challenges and misconceptions about the programme. Many teachers implicated family engagement as a facilitator of the programme, suggesting that family involvement may support intervention outcomes. Future work could involve the development of an intervention component to better facilitate engagement in this context.

Trial registration: Clinical Trials Registry India identifier: CTRI/2018/01/011471.

KEYWORDS:

• Task-shifting
• global mental health
• family engagement
• child mental health
• LMIC

Acknowledgements

We profusely thank Roshan Rai, Executive Director, and Ashesh Rai, Assistant Director, of Darjeeling Ladenla Road Prerna (DLRP); Nima Choden, Dhiraj Rai, Maryam Subba, and Satyam Tamang, community health workers of DLRP; Radha Khawas, former research assistant at DLRP; and Fatima Salman of the Atlantic Council for their support of the implementation of the teacher-led task-shifted children’s mental health care studied in this manuscript. We humbly thank the Mariwala Health Initiative for their generous support of DLRP.

Author contributions

CMC, KH, and MM designed the study. BNG was involved in study design. PG and SB delivered the teacher training, provided supervision, and collected data. CMC, AAG, and MM provided umbrella supervision to PG and SB as they provided supervision to the teachers. JV, PF, and MML performed data analysis. JV, SB, CMC, MML, KH, PG, AAG, and MM were involved in data interpretation. JV, SB, and CMC drafted the manuscript. All authors revised and approved the final version of the manuscript before submission.

Data availability statement

Due to the connectedness of the Darjeeling community and the relatively small sample size of teachers and caregivers associated with the mental health intervention, participants of this study did not agree for their data to be shared publicly. Accordingly, supporting data is not available.

Disclosure statement

This research studies family engagement, one element of a larger teacher-led task-shifted alternative system of children’s mental health care. CMC, PG, and MM hold the copyright to the training and intervention materials for the larger teacher-led task-shifted alternative system of children’s mental health care. They have disclosed this interest fully to Taylor & Francis.

Ethics and consent

The research protocol and all informed consent forms were approved by the University of North Carolina at Chapel Hill Institutional Review Board and a Darjeeling-based Ethics Committee.

Schools: The Research Administrator individually called principals of local schools to gauge interest. Interested principals then discussed among their teachers the teachers’ willingness to deliver the intervention and participate in the study.

Teachers: All eligible, interested teachers in schools agreeing to participate met individually with study representatives to review study protocols and voluntarily sign a written informed consent

Caregivers: All eligible, interested caregivers of children selected to participate in the programme met individually with study representatives to review study protocols and voluntarily sign a written informed consent.

Paper context

To begin to bridge the LMIC child mental health care gap, teachers may be able to deliver task-shifted mental health care to children in schools. Family engagement in such a system of care may facilitate this approach. Following a task-shifted mental health intervention, seventeen teachers and twenty-one caregivers completed semi-structured interviews and discussed family engagement in the programme. Despite barriers, family engagement may be a key component of intervention success. Sustainable methods to foster family engagement in child mental health care in LMICs are warranted.

Trial registration

The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27

Additional information

Funding

The research in this publication was made possible through the American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award for Junior Faculty and Child and Adolescent Psychiatry Fellows, supported by AACAP; its contents are the responsibility of the authors and do not necessarily reflect the official views of AACAP.