Methods of training lay individuals in the use of evidence-based services for the management of mental and behavioral health disorders: a scoping review

Objective: – This scoping review’s objective was to describe how lay individuals have been trained to deliver evidence-based services to manage mental and behavioral health disorders. Introduction: – Health service delivery by lay individuals is commonly used for managing mental and behavioral health disorders in low-resource settings. Prior systematic reviews have examined the characteristics of lay health workers, the types of services they provide, and the efficacy of their services; however, a significant gap exists in documenting the training these individuals receive. Eligibility criteria: – Participants were lay individuals trained to provide services to community residents, excluding individuals with formal training in health service delivery and delivery in residential settings. The concept was training programs for the delivery of evidence-based services to individuals and excluded services involving pharmacology. The context was mental and behavioral health disorders, excluding cognitive deficits. Methods: – Our search included MEDLINE, CINAHL, APA PsycINFO, Scopus, Web of Science, and gray literature sources. The search included articles published between 1960 and November 2024 that were in English or Spanish or had English translations available. Data analysis used a mix of descriptive and qualitative approaches. Since missing data in the existing literature were considered a finding itself, we did not contact authors to provide information on elements missing from the data extraction form. Results: – After completing the evidence selection process, we extracted data from 204 studies. Included studies used a wide variety of terms to describe lay health workers. Consistent with prior literature, this scoping review identified 2 categories of lay individuals who have been trained to deliver mental and behavioral health services: general lay health workers (described as trusted community members) and peer workers (lay individuals with personal experience of mental and behavioral health disorders). The number of studies has increased over time, with the first paper published in 1974. Overall, the largest percentage of studies (41.3%) were conducted in the United States. Comparing the literature conducted in low- and middle-income countries with those in high-income countries, the general lay health worker model predominated in low- and middle-income countries, while the peer model was more common in high-income countries. The most common psychotherapeutic techniques that lay health workers were trained to deliver were cognitive behavior therapy, motivational interviewing, and behavioral activation; however, one-quarter of the studies did not indicate which techniques were taught in the training. Due to missing data and variations in design, it was difficult to estimate the time spent training lay individuals for the chosen interventions or to develop a definitive profile of the demographic characteristics of lay health workers/peers. Finally, only 27 studies (13.2%) mentioned stigma reduction as part of the training. Conclusions: – There has been great variability in the training of lay individuals to provide mental and behavioral health services. This leaves many gaps in the literature and will make it hard to draw conclusions regarding best practices. Future research can use the information reported in this scoping review to identify relevant studies and to complement existing data reporting templates (eg, Template for Intervention Description and Replication [TIDieR]) to assess the evidence for best practices in training lay individuals for mental and behavioral health service delivery. Review registration: – OSF https://osf.io/eaqcr/overview