<p>Narrative Exposure Therapy (NET) shows promise for addressing trauma among refugee populations when delivered by lay counselors, but implementation barriers in real-world settings remain understudied. This study examined the implementation of a lay counselor NET training program in a U.S. refugee community, focusing on barriers that led to halting scale-up efforts before community delivery. Community members (<i>n</i> = 23) participated in a three-day NET training followed by supervision sessions. Implementation barriers and facilitators were assessed through semi-structured interviews with trainees (<i>n</i> = 10) and trainers (<i>n</i> = 3), analyzed using rapid qualitative analysis guided by an implementation science framework. Pre-training surveys provided participant demographic and psychosocial context. Despite initial enthusiasm and participants’ strong psychosocial functioning, multiple implementation barriers emerged that prevented progression to community service delivery. Only four of 23 trainees (17%) continued to supervision. And none progressed to independent practice. Key barriers included unresolved trauma among trainees, time constraints due to competing work responsibilities, unclear expectations about post-training requirements, and lack of compensation structures. The research team made the decision to halt implementation due to safety and feasibility concerns. The decision to halt scale-up highlights critical implementation considerations for trauma-focused lay counselor programs. Essential requirements include rigorous screening for emotional readiness, clear communication about complete training pathways, integration of NET delivery into existing job roles, and sustainable compensation and support structures. This study demonstrates the importance of systematic implementation monitoring and data-driven decisions about program continuation in community mental health initiatives.</p>

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When to Halt Implementation: Barriers in a Lay Counselor Narrative Exposure Therapy Training Program

  • Armenda Bialas,
  • Danie Meyer,
  • Jonathan Orr,
  • Amenah Arman,
  • Mary Helen O’Connor,
  • Ashli Owen-Smith

摘要

Narrative Exposure Therapy (NET) shows promise for addressing trauma among refugee populations when delivered by lay counselors, but implementation barriers in real-world settings remain understudied. This study examined the implementation of a lay counselor NET training program in a U.S. refugee community, focusing on barriers that led to halting scale-up efforts before community delivery. Community members (n = 23) participated in a three-day NET training followed by supervision sessions. Implementation barriers and facilitators were assessed through semi-structured interviews with trainees (n = 10) and trainers (n = 3), analyzed using rapid qualitative analysis guided by an implementation science framework. Pre-training surveys provided participant demographic and psychosocial context. Despite initial enthusiasm and participants’ strong psychosocial functioning, multiple implementation barriers emerged that prevented progression to community service delivery. Only four of 23 trainees (17%) continued to supervision. And none progressed to independent practice. Key barriers included unresolved trauma among trainees, time constraints due to competing work responsibilities, unclear expectations about post-training requirements, and lack of compensation structures. The research team made the decision to halt implementation due to safety and feasibility concerns. The decision to halt scale-up highlights critical implementation considerations for trauma-focused lay counselor programs. Essential requirements include rigorous screening for emotional readiness, clear communication about complete training pathways, integration of NET delivery into existing job roles, and sustainable compensation and support structures. This study demonstrates the importance of systematic implementation monitoring and data-driven decisions about program continuation in community mental health initiatives.