Psychological ownership interventions increase interest in claiming government benefits.

Each year, eligible individuals forgo billions of dollars in financial assistance in the form of government benefits. To address this participation gap, we identify psychological ownership of government benefits as a factor that significantly influences individuals' interest in applying for government benefits. Psychological ownership refers to how much an individual feels that a target is their own. We propose that the more individuals feel that government benefits are their own, the less likely they are to perceive applying for them as an aversive ask for help, and thus, the more likely they are to pursue them. Three large-scale field experiments among low-income individuals demonstrate that higher psychological ownership framing of government benefits significantly increases participants' pursuit of benefits and outperforms other common psychological interventions. An additional experiment shows that this effect occurs because greater psychological ownership reduces people's general aversion to asking for assistance. Relative to control messages, these psychological ownership interventions increased interest in claiming government benefits by 20% to 128%. These results suggest that psychological ownership framing is an effective tool in the portfolio of potential behavioral science interventions and a simple way to stimulate interest in claiming benefits.

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis.

BACKGROUND: Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS: We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS: Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

Did COVID-19 change the interventions provided by oncology social workers in the epicenter of the pandemic? A natural experiment.

Background: Throughout history, the field of medical social work has been shaped by epidemics and pandemics. As COVID-19 rapidly overwhelmed the healthcare system in 2020, oncology departments found that space, staff, and funds were reallocated to address patient needs during the pandemic. Traditional outpatient services were required to operate with reduced resources, with special attention to additional measures to protect workers and patients from exposure to the virus. Little is known about how these changes affected the nature of the practice of oncology social work.Methods: We compared data on OSW interventions for three months (March-May) 2019 to the same period in 2020. Mount Sinai Downtown Cancer Center's Department of Social Work routinely collects data on services provided by social workers using a validated instrument. As NYC became the epicenter of the COVID-19 in March 2020, the comparison of these time periods creates a natural experiment to examine whether and how the presence of the virus impacted the services provided by OSWs.Findings: There was little difference in the number of encounters that took place between the two time periods (2186 encounters in 2019 and 2084 encounters in 2020); however, there were notable differences in the types of interventions. While interventions involving supportive counseling decreased in 2020, we identified a significant increase specific to bereavement counseling.Conclusion: The study shows a remarkable consistency in the volume and types of services provided by OSWs, in spite of the radical increase in stressors they experienced during the height of the COVID-19 pandemic. These findings suggest that the OSWs did not allow these stressors to interfere with their work with patients. This study demonstrates how routine use of an instrument to measure OSW interventions can be used to examine services provided over time and to evaluate potential influences of external factors.

[Promoting research competence in psychosocial medicine - A new curriculum for medical students]. / Wissenschaft verstehen und anwenden. Ein neues Curriculum für Medizinstudierende zur Entwicklung von Forschungskompetenz in der psychosozialen Medizin.

Promoting research competence in psychosocial medicine - A new curriculum for medical students Objectives: The objective of this study is the introduction and evaluation of a new graduate-students curriculum to enhance research competence in psychosocial medicine. Method: N = 57 students have participated in the curriculum to date. All participants completed questionnaires regarding teaching quality and pre-post changes in subjective research competence. Results: All items on teaching quality were scored significantly higher (p < 0.05) compared to data of three other comparable psychosocial seminars. In addition, a substantial increase in subjective research competence was found (p < 0.05). Conclusions: The presented curriculum provides an opportunity to strengthen research competence and evidence-based critical thinking of prospective physicians at an early stage. As a consequence of these encouraging results, the curriculum has been implemented permanently at the medical faculty in Heidelberg.

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes.

Approximately 20% of people will experience a depressive episode by adulthood, making adolescence an important developmental target for prevention. CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic, and Interpersonal Training), an online depression prevention intervention, has demonstrated efficacy in preventing depressive episodes among adolescents reporting elevated symptoms. Our study examines the effects of CATCH-IT compared to online health education (HE) on internalizing symptoms in adolescents at risk for depression. Participants, ages 13-18, were recruited across eight US health systems and were randomly assigned to CATCH-IT or HE. Assessments were completed at baseline, 2, 6, 12, 18, and 24 months. There were no significant differences between groups in change in depressive symptoms (b = -0.31 for CATCH-IT, b = -0.27 for HE, p = 0.80) or anxiety (b = -0.13 for CATCH-IT, b = -0.11 for HE, p = 0.79). Improvement in depressive symptoms was statistically significant (p < 0.05) for both groups (p = 0.004 for CATCH-IT, p = 0.009 for HE); improvement in anxiety was significant for CATCH-IT (p = 0.04) but not HE (p = 0.07). Parental depression and positive relationships with primary care physicians (PRPC) moderated the anxiety findings, and adolescents' externalizing symptoms and PRPC moderated the depression findings. This study demonstrates the long-term positive effects of both online programs on depressive symptoms and suggests that CATCH-IT demonstrates cross-over effects for anxiety as well.

"Who to Tell, How and When?": Development and Preliminary Feasibility of an Empowerment Intervention for People Living with Dementia Who are Fearful of Disclosing Their Diagnosis.

OBJECTIVE: This study describes the adaptation of Honest, Open, Proud (HOP), to develop an empowerment intervention supporting disclosure decision-making for dyads of people living with dementia and their chosen supporter. METHODS: Medical Research Council guidelines for developing complex interventions informed intervention development and feasibility testing. This included identifying the evidence base and theory (establishing HOP theory of change, a systematic review on decision-making in dementia, a stakeholder consultation), modelling the intervention materials with research experts (creation of version 1.0) and experts by experience (creation of version 2.0), and pilot testing the intervention recording participant observations and facilitator reflections. The final version of the intervention materials was developed with experts by experience of dementia where the accessibility of language and appropriate styles of facilitation were the focus. RESULTS: The concept of the intervention was strongly endorsed by respondents of the stakeholder consultation (209/226). Stakeholder preferences included face-to-face delivery, a manualized workbook approach and the inclusion of the primary carer during intervention delivery. Recruitment for intervention groups took place in non-NHS settings (2 small groups recruited) and NHS settings (no groups recruited). In non-NHS settings, 7 dyads agreed to take part in one of two intervention groups. Both intervention groups had over 70% attendance by participants (group 1: 72.2% group 2: 87.5%). CONCLUSION: The concept of an intervention to support diagnostic disclosure was endorsed by stakeholders; however, recruitment was challenging; the "who to tell, how and when?" intervention has the potential to fill a gap in the post-diagnostic pathway.

Psychosocial resources developed and trialled for Indigenous people with autism spectrum disorder and their caregivers: a systematic review and catalogue.

BACKGROUND: People with autism spectrum disorder (ASD) face many psychosocial challenges throughout life, highlighting the need for programs and resources promoting psychosocial wellbeing. Indigenous peoples with ASD and/or other neurodevelopmental disorders must overcome cultural and social barriers to access such supports. This study aimed to identify psychosocial programs and resources developed world-wide for this population by systematically reviewing research evaluating programs aiming to promote the psychosocial wellbeing of this population and/or their caregivers; and collating and reviewing resources developed to promote their psychosocial wellbeing. METHODS: Searches were last conducted in December 2019. The systematic review searched 28 electronic databases, and 25 electronic databases were searched for resources promoting psychosocial wellbeing. Additional published and unpublished studies were identified from relevant reviews, authors of eligible articles, and experts working in Indigenous Health. Articles and resources were screened for inclusion using pre-defined criteria. Articles included in the systematic review were assessed for quality using the Mixed Methods Assessment Tool. The diversity and paucity of outcomes reported precluded pooling of study findings for meta-analysis. RESULTS: Seven articles situated in the USA (2), Canada (3) and Australia (2); and eleven resources developed in Australia (9), Canada (1) and New Zealand (1) met inclusion criteria. All articles showed some promising findings for improving psychosocial wellbeing for Indigenous children with ASD and/or another neurodevelopmental disorder, and 5 of 7 evaluated the cultural adaptation of an existing evidence-based program for an Indigenous population. However, methodological quality was moderate or low (57% and 43% of articles respectively) and no studies had adult participants. The psychosocial wellbeing supports provided by the 11 resources included psychoeducation, community support, and services/workshops. CONCLUSIONS: Despite the paucity of research and resources found, important exemplars demonstrate that existing programs can be adapted to support Indigenous people with ASD and other neurodevelopmental disorders. While future policy should endeavour to facilitate Indigenous people's access to support services, and encourage researchers to develop and evaluate programs promoting psychosocial wellbeing for this population, given complexities of designing and evaluating new programs, careful and appropriate cultural adaptations of existing evidence-based programs would increase feasibility of ongoing research without compromising outcomes.

Psychosocial therapies in severe mental illness: update on evidence and recommendations.

PURPOSE OF REVIEW: To provide an overview of the update of the evidence-based and consensus-based German S3 guideline on psychosocial therapies for severe mental illnesses (SMI), with particular attention to current developments and future research tasks. RECENT FINDINGS: There has been a significant increase in studies on the effectiveness of psychosocial interventions in treatment of people with SMI. In the guideline a distinction is made between system-level interventions (e.g. multidisciplinary team-based psychiatric community care) and single-handed (nonteam-based) interventions (e.g. psychoeducation). Furthermore, principles of treatment (e.g. recovery-orientation) and self-help interventions (e.g. peer support) are addressed. The update of the guideline includes 33 recommendations and 12 statements. Compared with the first edition, there were upgrades in the recommendation of Supported Employment (A) and Supported Housing (A). Interventions such as peer support (B) and lifestyle interventions (A) were included for the first time. Developments are discussed in the context of most recent literature. Areas for further research are highlighted and fields for next updates such as antistigma interventions and supported parenting were identified. SUMMARY: The present guideline offers an important opportunity to further improve health services for people with SMI. However, guideline implementation is challenging.

Adapting wellbeing research tools for Aboriginal and Torres Strait Islander people with chronic kidney disease.

BACKGROUND: Chronic kidney disease is an increasingly common health problem for Aboriginal and Torres Strait Islander people. It is associated with multiple concurrent psychosocial stressors frequently resulting in negative impacts on emotional and social wellbeing. There is need for well-designed intervention studies to provide evidence of effective treatment for comorbid depression or other mental illness in this setting. Attention to early phase piloting and development work is recommended when testing complex interventions. This paper documents feasibility testing and adaptation of an existing culturally responsive brief wellbeing intervention, the Stay Strong App, and three commonly used wellbeing outcome measures, in preparation for a clinical trial testing effectiveness of the intervention. METHODS: The Stay Strong App, which has not been used in the setting of Chronic Kidney Disease before, is reviewed and adapted for people with comorbid wellbeing concerns through expert consensus between research team and an Expert Panel. The outcome measures (Kessler 10, Patient Health Questionnaire 9, and EuroQoL) are valid, reliable, and commonly used tools to assess various aspects of wellbeing, which have also not been used in this context before. Feasibility and acceptability are examined and developed through 3 stages: Pilot testing in a purposive sample of five haemodialysis patients and carers; translation of outcome measures through collaboration between the Aboriginal Interpreter Service, Aboriginal and Torres Strait Islander research officers and the research team; and conversion of translated outcome measures to electronic format. RESULTS: Research team and expert panel consensus led to adaptation of the Stay Strong App for renal patients through selective revision of words and images. Pilot testing identified challenges in delivery of the wellbeing measures leading to word changes and additional prompts, integration of audio translations in 11 local Indigenous languages within an interactive Outcome Measures App, and related research protocol changes. CONCLUSION: Modelling the complex intervention prior to full-scale testing provided important information about the design of both the outcome measures and the intervention. These changes are likely to better support success in conduct of the clinical trial and future implementation of the intervention in clinical settings.

Measuring the implementation strength of a perinatal mental health intervention delivered by peer volunteers in rural Pakistan.

The South Asian region, including Pakistan, reports one of the highest rates of perinatal depression. Effective task-shifting perinatal mental health interventions exist and are gaining attention of policy makers, as a potential solution to bridge the existing treatment gap. However, no specific indicators are available to gauge the level of implementation for such interventions in the South Asian region. The Thinking Healthy Programme Peer-delivered (THPP) is a perinatal mental health intervention delivered, at scale, by peer volunteers (PVs). An effectiveness trial for THPP based on 570 depressed pregnant women was conducted in rural Rawalpindi, Pakistan. In addition, we also examined the implementation processes of THPP in order to develop an index to gauge implementation strength of this intervention. The key components of this index are based on four important intervention processes related to service provision which include; i) the competence of PVs, ii) supervisions attended by PVs and iii) number and iv) duration of THPP sessions. We attempt to inform an implementation strength index which best correlates with reduced perinatal depression and disability at 6 months post childbirth. Knowledge of such an implementation strength index for a task-shifted perinatal depression intervention carries implications for scale up strategies.

Developing a smartphone application to support social connectedness and wellbeing in young people with cystic fibrosis.

BACKGROUND: Young people with cystic fibrosis (CF) may be at increased risk of social isolation and mental illness. This study aimed to design and evaluate the usability and acceptability of a smartphone application (app) to support the social connectedness and wellbeing of young people living with CF. METHODS: Young people with CF aged 12-17 years (N = 22) were recruited from two paediatric hospitals in Australia. Study participants tested the CF app for six weeks before responding to an online survey about the app's usability and acceptability. A subsample of participants (n = 20) discussed the app's strengths and weaknesses during 11 online group interviews. RESULTS: During the six-week testing period, 77% of participants used the app at least once a week and 82% accessed the app from a smartphone. Usability of the CF app was rated high. Most participants agreed the app was easy to use (86%) and felt comfortable using it (96%). Acceptability of the app was moderate. 77% of participants agreed they would recommend the app to others. Recommendations to improve the app's functionality and acceptability included locating the chatroom within the app rather than redirecting users to a web browser and allowing users to personalise images, wellness tips and videos. CONCLUSIONS: This study developed and tested a highly usable, and moderately acceptable, smartphone app to improve the psychosocial health of young people living with CF. Future research will test the efficacy of the CF app on users' social connectedness and wellbeing.

Use of role plays to assess therapist competency and its association with client outcomes in psychological interventions: A scoping review and competency research agenda.

A major challenge in scaling-up psychological interventions worldwide is how to evaluate competency among new workforces engaged in psychological services. One approach to measuring competency is through standardized role plays. Role plays have the benefits of standardization and reliance on observed behavior rather than written knowledge. However, role plays are also resource intensive and dependent upon inter-rater reliability. We undertook a two-part scoping review to describe how competency is conceptualized in studies evaluating the relationship of competency with client outcomes. We focused on use of role plays including achieving inter-rater reliability and the association with client outcomes. First, we identified 4 reviews encompassing 61 studies evaluating the association of competency with client outcomes. Second, we identified 39 competency evaluation tools, of which 21 were used in comparisons with client outcomes. Inter-rater reliability (intraclass correlation coefficient) was reported for 15 tools and ranged from 0.53 to 0.96 (mean ICC = 0.77). However, we found that none of the outcome comparison studies measured competency with standardized role plays. Instead, studies typically used therapy quality (i.e., session ratings with actual clients) as a proxy for competency. This reveals a gap in the evidence base for competency and its role in predicting client outcomes. We therefore propose a competency research agenda to develop an evidence-base for objective, standardized role plays to measure competency and its association with client outcomes. OPEN SCIENCE REGISTRATION #: https://osf.io/nqhu7/.

Psychometric examination of care quality measures in VA psychosocial rehabilitation and recovery centers (PRRCs).

The Veterans Health Administration (VHA) developed Psychosocial Rehabilitation and Recovery Centers (PRRCs) to enhance recovery-oriented mental health services to large populations of veterans diagnosed with serious mental illness (e.g., psychotic disorders, bipolar disorder) and significant functional challenges. Psychosocial Rehabilitation and Recovery Centers were designed to support a rehabilitation framework to help veterans obtain needed skills and support to integrate into meaningful, self-determined community roles. This study used data collected as part of VHA's development and implementation of a national system to monitor PRRC performance with the purpose of evaluating the psychometric properties and latent structure of outcome measures used in PRRCs. Baseline self-report data from 5,086 veterans and their assigned PRRC staff providers were collected and reviewed. Exploratory factor analyses were used to evaluate the psychometric properties of the Veteran-Rated Psychiatric Symptom Items (VR-PSI), the Clinician-Rated Psychiatric Symptom Items (CR-PSI), and the Internalized Stigma of Mental Illness 10-item scale (ISMI-10). Four latent factors were identified for the VR-PSI and CR-PSI for the total sample, while the ISMI-10 was reduced to 8-items to assess self-stigma as a unitary measure. All measures demonstrated good psychometric properties. This study provides initial support for the latent factor structures and psychometric properties of measures used to assess national VHA PRRC performance. Implications and limitations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Weighing People Rather Than Food: A Framework for Examining External Validity.

Research training in psychological science emphasizes common threats to internal validity, with no comparably systematic or rigorous treatment of external validity. Trade-offs between internal and external validity are well known in some areas (e.g., efficacy vs. effectiveness studies in clinical psychology), less so in others (e.g., forensic research on eyewitness identification, false memories, or confessions). We present a framework for examining external validity grounded in four domains-populations, settings, outcomes, and timeframes-that can be used to enhance the generalizability of findings. We discuss this framework and then illustrate its use by reviewing mindless eating interventions intended to help people lose weight. Research in this published literature seldom samples from appropriate populations (e.g., overweight or obese individuals) or measures appropriate outcomes (e.g., weight change) in appropriate settings (e.g., the home) over appropriate timeframes (e.g., sustained interventions with follow-up) to determine whether practical advice is empirically supported. In their applied work, we encourage psychological scientists to design studies, analyze data, and report findings with greater attention to external validity to demonstrate, rather than assume, the generalizability of findings to the intended populations, settings, outcomes, and timeframes. Editors and reviewers can hold investigators accountable for doing so.

Does the design of the NHS Diabetes Prevention Programme intervention have fidelity to the programme specification? A document analysis.

AIMS: To assess fidelity of the Healthier You: NHS Diabetes Prevention Programme (NHS-DPP), a behavioural intervention for people in England at high risk of developing type 2 diabetes, to the specified programme features. METHODS: Document analysis of the NHS-DPP programme specification, including National Institute for Health and Care Excellence (NICE) PH38 diabetes prevention guidance. This was compared with the intervention design (framework response documents and programme manuals) from all four independent providers delivering the NHS-DPP. Documents were coded using the Template for Intervention Description and Replication framework (describing service parameters) and the Behaviour Change Technique Taxonomy v1. RESULTS: Providers demonstrated good fidelity to service parameters of the NHS-DPP. The NHS-DPP specification indicated 19 unique behaviour change techniques. Framework responses for the four providers contained between 24 and 32 distinct behaviour change techniques, and programme manuals contained between 23 and 45 distinct behaviour change techniques, indicating variation in behaviour change content between providers' intervention documents. Thus, each provider planned to deliver 74% of the unique behaviour change techniques specified, and a large amount of behaviour change content not mandated. CONCLUSIONS: There is good fidelity to the specified service parameters of the NHS-DPP; however, the four providers planned to deliver approximately three-quarters of behaviour change techniques specified by the NHS-DPP. Given that behaviour change techniques are the 'active ingredients' of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS-DPP programme specification at the intervention design stage.

Peer supervision for assuring the quality of non-specialist provider delivered psychological intervention: Lessons from a trial for perinatal depression in Goa, India.

BACKGROUND: The aims of the current study were three-fold: i) to estimate the reliability and predictive validity of a therapy quality measure for use by peers; ii) to assess the extent to which peer delivery agents could be trained to evaluate their peers' counsellors as reliably as experts; and iii) to identify barriers and facilitators of several implemented models of peer supervision. METHODS: 26 peers (called 'Sakhis' in the study context), with no previous experience or formal training in mental health care delivery, were trained by experts to deliver the Thinking Healthy Program Peer-delivered (THPP) and conduct peer-led supervision. Using the Therapy Quality Scale (TQS)-an 18 item Likert scale (0-2) measuring both general and treatment-specific skills-both peers and experts independently rated 167 individual sessions to estimate: a) the psychometric properties of TQS; and b) the mean difference between peer and expert TQS ratings; these data were analyzed using SAS 9.3. This was complemented with qualitative data (two rounds of in-depth interviews with four experts and focus group discussions with all Sakhis) which were analyzed using framework analysis. RESULTS: We observed good internal consistency on TQS ratings among expert (α = 0.814) and Sakhis (α = 0.843) and good to excellent scores of inter-rater reliability among experts (ICC = 0.779) and Sakhis (ICC = 0.714). TQS ratings were not significantly related to patient depressive symptoms at 6-months post-child birth but were significantly related to patient activation scores (r = 0.375, p < 0.01 for treatment-specific skills and 0.313, p < 0.01 for general skills) at 3-months post-child birth, which in turn were significantly related to depressive symptom scores at 6-months post-child birth (r = -0.455, p < 0.001), highlighting a potential temporal pathway between therapy quality, patient behaviours and patient outcomes. Following additional training and with growing expertise, Sakhis eventually evaluated their peers' counselling sessions as reliably as experts-demonstrating no significant mean differences on general (t = -0.42, p > 0.05) or treatment-specific (t = -1.44, p > 0.05) subscale scores. Qualitative findings were also consistent between experts and Sakhis: barriers included peers' initial difficulties in rating the TQS and leading supervision which declined over time. Most Sakhis and experts reported the benefits of using a structured scale to rate therapy quality which in turn facilitated consistent and relevant feedback and motivation to ultimately improve Sakhis' counselling skills. In addition, most Sakhis and experts found that peer supervision methods were acceptable and feasible, particularly when linked to financial incentives and expert supervisor. CONCLUSION: With time, non-specialist or lay providers can be trained to implement peer supervision and assess therapy quality as reliably as experts using a psychometrically-sound measure. However, peer supervision with experts was more preferred than peer supervision without experts to facilitate structured, reliable feedback. Additional studies are required to address this challenge and test solutions to facilitate the dissemination of non-specialist delivered psychosocial interventions at a global level.

Autism spectrum disorder in under 19s: support and management

This guideline covers children and young people with autism spectrum disorder (across the full range of intellectual ability) from birth until their 19th birthday. It covers the different ways that health and social care professionals can provide support, treatment and help for children and young people with autism, and their families and carers, from the early years through to their transition into young adult life.