Common Elements Treatment Approach (CETA) System of Care
**Summary description:** CETA is an evidenced based, transdiagnostic system of care based on cognitive behavioral therapy that provides a) a multi-problem assessment, b) a triage system, c) safety planning/suicide prevention, d) flexible treatment options from wellness and prevention through moderate and severe mental and behavioral health conditions, e) option for M&E, measurement-based care results. CETA has proven to be effective in reducing mental health problems (e.g., depression, anxiety, post-traumatic stress, etc.), intimate partner violence, and substance misuse.
**Access to the intervention manual:** The manual is sent out when there is interest for review and feedback. Groups who sign up for training get it prior to training for printing, and then have access to ongong manuals.
**Access to training:** The manual is sent out when there is interest for review and feedback. Groups who sign up for training get it prior to training for printing, and then have access to ongong manuals.
**Intended users/ Implementers:** Non-specialist providers refers to lay-workers, MHPSS practitioners etc. please specify any other groups; We also train MH professionals, volunteers, PCPs, nurses…etc. We have criteria that lay out who might work best in different systems.
**Therapeutic strategies:** Engagement and psychoeducation, cognitive coping and restructuring, behavioral activation, confronting fears and trauma memories (gradual exposure), harm reduction strategies and motivational interviewing techniques, problem solving, anxiety management, and caregiver skills.
**Intervention format:** For CETA, a) the assessment can be done in person, via tele-health, in groups or individual, via technology...etc. b) people are seen individually and/or in groups for 1-12 sessions on a weekly (or bi-weekly) basis either in-person or remotely depending on their level of need (i.e, precision-based care). Sessions last for 20-60+ minutes and include a weekly client monitoring form to assess changes in mental and behavioral health symptoms. Practice of skills in between sessions is strongly encouraged. CETA Psychosocial Support (CPSS) program is a shorter intervention adapted from CETA and can be delivered individually or in groups for mild symptoms, secondary prevention, screening and referrals. If someone needs full MH treatment (moderate to severe MH issues), the average number of sessions is 8.
**Target population:** Adults and children with mild to severe mental and behavioral health conditions
**Significant effects found on symptoms of:** The CETA intervention has shown significant outcomes in depression, anxiety, functional impairment, suicide/safety, PTS, substance use and violence. Our assessment has gone through validation in numerous countries and found to be able to effectively replace large batteries.
**Key innovative or differentiating features of this intervention:** CETA is a flexible transdiagnostic approach that spans the life course and can be adapted and integrated within different settings, including health systems, schools, community day settings, shelters, and virtually. It is unique in that it is the only end-to-end system of care that is evidence-based. CETA is also unique in its address of so many different mental/behavioral health problems.
**Summary of Evidence:** Several clinical RCTs have been conducted with CETA and found effective in reducing depression, PTS, impaired functioning, anxiety, substance use, IPV, and aggression.Trials have been done in: a) Mae Sot, Thailand with adult Burmese refugees showing decreased PTS, depression, and dysfunction, b) In Iraq with adults exposed to systematic violence showing reduced PTSD, c) Zambia - adults (couples) along with one child in the house; outcomes focused on substance use and IPV, also showed reduction in depression, PTS, anxiety,etc. d) Zambia adults affected by HIV and alcohol, e) Zambia with AYA reduction of broad internalizing and externalizing symptoms, f) Ukraine - veterans and IDP for full CETA, g) Ukraine - CPSS (psychosocial treatment for veterans and IDPs), h) border of Ethiopia and Somali with children in refugee camp showing reduced internalizing, externalizing, and posttraumatic stress symptoms and improved well-being.
**Different populations where the intervention has been used:** Populations exposed to violent traumatic events, refugees and displaced adults, men and women with interpersonal violence and using substances, health workers, people living with HIV/Diabetes/TF and other physical health issues, perinatal women and their family members, and communities in LMIC and HIC settings.
**Restrictions or requirements for its use:** Given that CETA addresses things like suicide and PTSD, we require proper training by a CETA trainer, and ongoing supervision/support to competency to assure safety to all those poulations that are recipients.
**Requirements / qualifications for trainers and supervisors:** Supervisors are certified at the provider level first, while at the same time being coached to supervise. They need to demonstrate appropriate supervisory skills and are certified. CETA trainers need to be certified as both a provider and supervisor, and then are selected to go through a train-the-trainer program. At this point they know the CETA system of care, and can coach in small groups....the TTT focuses on how do you train in a larger group, and a lot of implementation science and training management (how to decide/review trainees, consultation with groups on implementation, training logistics, scheduling of element-training, setting up supervision groups, how to teach others to provide and supervise CETA, how to interpret the assessment, etc.)
We are flexible on this. At a bare minimum for supervisors, they have to demonstrate the ability to provide CETA well and with fidelity, as well as show leadership and teaching abilities that supervisors need.
For trainers, they need to be certified as a provider and supervisor - and demonstrate an ability to speak and lead a large group, teach differnet levels and types of trainees, think flexibly about how to schedule training of different elements, read an audience, organizational skills...etc. Then they need to do a Train-the-trainer, and complete 1-2 co-trainings witha certified CETA trainers.
**Examples of implementation outside of RCT contexts:** CETA has been adapted and implemented in many countries including, Brazil, Chile, Germany, India, Kazakhstan, Lebanon, Lesotho, Liberia, Malawi, Mexico, Moldova,Mozambique, Myanmar, Namibia, Papua New Guniea, Peru, Sierra Leone, South Africa, Syria, Thailand, United States, Uganda, Ukraine, Zambia.
Information provided by Laura Murray on 14 June 2024. She is the author/developer.
