Task-Shifting Child Mental Health Care to Teachers Globally
Abstract
Task-shifting is a form of care in which non-professional (“lay”) individuals are trained to deliver health care under supervision. In mental health care, evidence is building for the efficacy of lay counselors to improve mental health symptoms and outcomes for individuals requiring indicated levels of care, especially relevant for lower-resources areas of the world where mental health care access to mental health care is particularly poor. In this talk, we will examine the evidence for task-shifting mental health care to lay counselors, largely studied for the adult population. We will then explore early evidence that task-shifting mental health care may also be efficacious for adolescents and children, with a special focus on the growing evidence supporting an early signal of the efficacy of Tealeaf (Teachers Leading the Frontlines). Tealeaf is a task-shifting system of care in which teachers deliver indicated mental health care to their elementary school students. Within Tealeaf, teachers deliver a novel modality of therapy called “education as mental health therapy” (Ed-MH). Ed-MH therapeutic techniques are evidence-based in mental health but also aligned with teaching processes and classroom behavior management, turning moments of informal support they already provide students into doses of formal care.
Speaker Bio
Christina M. Cruz, MD, EdM is an Assistant Professor and has expertise in medicine, business, and education. She completed her medical and education degrees at Harvard and her undergraduate business degree from the Wharton School at Penn, Summa cum Laude. She completed her General Psychiatry Residency and Child and Adolescent Psychiatry Fellowship at UNC. She founded and is the Principal Investigator of the Global Child Mental Health Collaborative at UNC, a partnership of 6 organizations and experts in psychiatry, family medicine, social work, epidemiology, public health, anthropology, political science, and civil society engagement working together to improve child mental health outcomes through alternative systems of care.
While a practicing inpatient-teaching child and adolescent psychiatrist, Dr. Cruz is predominantly a global mental health researcher. With collaborators in Colorado and Darjeeling, India, she created a care model, Tealeaf (Teachers Leading the Frontlines – Mental Health), where elementary school teachers are trained and coached to deliver a therapy they invented, “education as mental health therapy” (Ed-MH). Ed-MH distills CBT and DBT techniques for teachers to use in their already occurring interaction with students, turning moments of informal support they already have with students into doses of formal care. Transdiagnostic, Ed-MH allows teachers to care for any diagnosis. Versus a comparator in Darjeeling, the chances of children’s symptoms resolving were 56% after 1 year of care, greater than a first trial of an SSRI. Tealeaf is in the middle of a 4-year Type 1 hybrid effectiveness-implementation trial in Darjeeling. Based on its efficacy, Tealeaf is already scaling to the public schools of Manila, Philippines, soon reaching up to 20,000 children in need. Finally, through support from the UNC Suicide Prevention Institute, Tealeaf has been brought to the US, currently being adapted to the North Carolina middle school context as upstream suicide prevention.
