Introduction to Marbar – Africa Study.

[Audio] Introduction to Marbar-Africa.. Introduction to Marbar – Africa Study..

[Audio] Good morning, everyone! I am Prof. Anne Obondo, an associate professor in the Department of Psychiatry, UoN, and a practicing psychiatric social worker in the same Department. I would like to take this opportunity to welcome you all to this learning health systems course organized by Marbar Africa study team, and to thank you for accepting to be part of this study. We look forward to a beneficial and interactive engagement and learning from each other in this process. Best wishes.

[Audio] Marbar Africa is a routine outcomes monitoring (ROM) system in healthcare for improving patient-centered, high-quality care, improving patient outcomes, and reducing health disparities. It is designed to enhance psychotherapy outcomes within public healthcare. ROM was originally developed in Ecuador in 2022 and later tested in Colombia and Mexico. It has proven feasible, acceptable, and effective in enhancing service quality and patient outcomes. Routine outcomes monitoring (ROM) is a good practice to document the quality of routine health services delivered in specialist facilities. In LMICs, such a system for quality assurance of psychological interventions is still missing. In LMICs, there is a lag in implementation of (ROM) systems in public mental health care due to the absence of advanced, culturally validated measurement tools. Therefore, implementing ROM systems to monitor outcomes and feed them back to clinicians and service users can improve engagement in treatment and may improve outcomes in LMICs.

[Audio] In Africa, it will address the persistent gap in mental health care caused by the lack of systematic tools to measure service quality and outcomes, making it especially valuable for managing the high volume of patients in public hospitals, which is currently challenging. In Kenya, although talk therapy is routinely offered, there is no mechanism to track psychotherapy effectiveness. The existing hospital systems, such as those at Kenyatta National Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital, and Kisumu County Hospital, are limited to billing and drug ordering rather than clinical monitoring. Currently, there are no ROM systems in tertiary and specialist mental health systems in Kenya. It not only documents patient treatment process and outcomes for service quality improvement, but also promotes providers' competency in using data to improve clinical decision-making and better support patient care.

[Audio] Mental health system problems 1. Every clinician has a different style of practice, e.g., solo practice (lack of collaborative and patient-centered care) 2. Systems are not well organized, e.g., there is lack of collaboration across specialties and functions 3. Patient volume is large – a high number of patients is a challenge in monitoring and providing quality care. 4. We do not use the data we generate to understand patient improvement.

[Audio] Marbar Africa will improve three areas of practice-based research a) Practice facilitation and communication of psychotherapeutic decisions. b) Clinicians will gain scientific knowledge of patient outcomes improvement and application of the psychotherapy process. c) Clinicians will be able to improve the sustainability of service to patients, patient safety, and engagement in treatment..

[Audio] Why is the ROM system important? Routine Outcome Monitoring (ROM) systematically collects data through standardized questionnaires in psychological therapy to track treatment progress. Without ROM, proper data collection, storage, protection, and analysis are lacking in our public facilities. Improved healthcare data management has benefits that include enhanced patient care, more accurate diagnosis, and increased efficiency in the healthcare system. ROM can be applied at different levels, to inform clinicians about their own practice, for peer supervision, to audit mental health services, and even to generate or modify policies at the national level, and to communicate information to third parties like insurers and funders. In LMICs where data on mental health services may be restricted to the number of patients and appointments, promotion of a MarBar system may provide valuable information about the real-time change in patients..

[Audio] What do we propose? We propose to test the development, acceptability and feasibility of a routine monitoring system that would enable mental health practitioners and clients to be informed about the progress made during psychological interventions offered to them in public hospitals in Kenya We propose to develop ROM as a tool towards practice-based evidence, as it allows the systematic collection of data to respond to clinically relevant questions to advance psychotherapy research and to build a MarBar-Africa a Routine Outcome Monitoring (ROM) system for mental health in Kenya. Our long-term goal is to implement MarBar in all public hospitals and treatment facilities as a mental health electronic medical record (EMR) system and use data for intervention and psychopathology research, and to understand what type of treatments benefit what types of patients..

[Audio] Specific Objectives 1 To adapt and extend the Marbar ROM system developed in Ecuador to Kenya in a South–South learning partnership. In addition, translate key outcome tools and field testing of the web-based application, clinician Standard Operating Procedures (SOPs), and staff training in the use of Marbar Africa. 2. To test the acceptability, feasibility, and short-term sustainability of Marbar Africa over 6 months in Kisumu and Nairobi. 3. To carry out an exploratory analysis of trajectories of distress, improvement of functioning, and quality of life of study participants to identify characteristics of patients and treatments of those who successfully remitted from those who did not..

[Audio] Methodology. Study design. This is a feasibility & acceptability study of a ROM system using routine psychotherapy services. Basically, a naturalistic study. Study sites. Kenyatta National Hospital at Department of Mental Health in Nairobi. We intend to recruit 150 participants at this site. Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu County Referral Hospital in Kisumu. We intend to recruit a total of 70 participants at these sites. Study population of interest. Providers: These are any health providers embedded in the study site that offer talk therapy and schedule clients for follow-ups. They may include Psychiatrists, Nurse counselors, psychologists, social workers, or even lay persons. They will test, use, and give feedback on the dashboard. Patients: These are clients aged 18 to 65 years seeking psychotherapy services along with psychiatric management in the study sites. We will recruit both inpatients and outpatients, but anticipate more outpatients. They will be engaged on the dashboard, and their progress and outcome will be tracked. Caregivers: Are those who are actively involved in assisting a patient to seek outpatient mental health intervention and provide needed care at home, e.g., accompanying the patient to the hospital, medication management, and providing basic needs and emotional support..

[Audio] MarBar- Africa Study Team 1. Research team Professor Manasi Kumar, a clinical psychologist and the overall Principal Investigator in the study from New York University, New York (USA). Professor Caleb Othieno, a psychiatrist and the Kisumu site Principal Investigator from Maseno University, Kisumu (Kenya). Professor Anne Obondo, a psychiatric social worker and Nairobi site Principal Investigator from the University of Nairobi (Kenya). Professor Clara Paz, a psychotherapist and Co-Investigator from the University of De las Americas (Ecuador) Professor Fredrik Falkenstrom, a clinical psychologist and Co-Investigator from Linnaeus University (Sweden) Professor Keng-Yen Huang, a psychiatric epidemiologist and research scientist with skills in evidence-based practice from New York University, New York (USA). She is a Co-Investigator in the MarBar – Africa Study..

[Audio] 2. Collaborators Dr. Ian Kanyanya is a Senior Medical Specialist in Psychiatry with vast experience in the management of psychiatric disorders. He is based at Kenyatta National Hospital, which is one of the study sites, and is currently the head of the Mental Health Department. Dr. Tom Nyangwara Mboya, a consultant psychiatrist at Kisumu County Referral Hospital. He has the expertise in leadership, training, and motivation necessary to successfully carry out the work in Kisumu County Hospital, a study site for the Marbar–Africa. Professor Louis Castonguay, a psychotherapist and researcher with an interest in evidence-based research designed to foster clinician collaboration in psychotherapy conducted in naturalistic settings..

[Audio] 3. Pre – and post–doc researchers. Dr. Catherine Musyoka is a clinical psychologist/lecturer and early-career researcher at the University of Nairobi. She is a postdoc researcher in the Marbar–Africa study in Nairobi. Dr. Obadia Yator, a clinical psychologist and early-career researcher in Nairobi. He is a certified IPT trainer and a therapist. In Marbar, Africa, he is a postdoc researcher. Nandini Chaudhry, PhD student based at New York University Grossman School of Medicine. In the Marbar study, she works closely with Vincent, Darius, and Peter, who are research assistants and an ICT consultant, respectively. Dr. Anne Mwendwa is a pediatrician and a doctoral student at the University of Nairobi, and a lecturer at the Medical Training Centre. She is the Principal Investigator in her research project and a mentee in the Marbar study. Dr. Aloyce Mylomi is a medical doctor and clinical psychologist. He is a mentee in the Marbar Africa study, interested in how practice-based research is conceptualized, and is assisting in the literature and scoping review..

[Audio] 4. Advisory board members. The advisory board members in this study are policy, practice, and research stakeholders from various backgrounds, including nurses, community-based workers, public health workers, NGO managers, clinicians, educators, clinical psychologists, and medical doctors. They contribute valuable insights for advancing the study by offering guidance and providing feedback on the utility of the Marbar dashboard We had two meetings in Kisumu and Nairobi, where we shared objectives and plans for the study with them, and they provided valuable and useful feedback on the way forward. They are very useful in this study, and we will continue to engage them..