Perspectives of Lay Counselors Delivering a Brief Depression Treatment in the United States: A Mixed Methods Investigation

Abstract Background: Task sharing is an implementation strategy which increases access to services by training and supporting treatment delivery by nonspecialists. Such an approach has demonstrated effectiveness for depression and other mental health outcomes; however, few studies have examined lay counselors’ perspectives of the acceptability, feasibility, and appropriateness of delivering mental health interventions. We examine quantitative and qualitative reports of lay counselors’ experiences delivering a brief structured behavioral intervention for depression (called “Do More, Feel Better” [DMFB]) to older adults. Methods: All lay counselors (N = 4) who delivered DMFB completed quantitative measures assessing their perceptions of acceptability, feasibility, and appropriateness, and participated in a focus group, which provided insight into the quantitative ratings using an explanatory sequential mixed methods approach. Qualitative data were analyzed using thematic analysis and were double coded.Results: Lay counselors endorsed high acceptability, feasibility, and appropriateness of DMFB, with qualitative results providing some insight into specific barriers and facilitators which may be important to consider when planning to implement task sharing. Themes that emerged from qualitative data included supervision being highly acceptable and feasible, appropriateness of the intervention for lay counselors, and the feasibility of tailoring the intervention to clients. Lay counselors also expressed difficulty managing emotional investment in clients’ success and providing therapy during a pandemic and racial violence in the US.Conclusions: Our results can inform future implementation and sustainment of task sharing interventions to expand access to care.