{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:54:54Z","timestamp":1781848494615,"version":"3.54.5"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Mental health inequities persist in underserved communities due to systemic barriers to care. Healthy Roads, a mental wellness support program developed by the mobile clinic The Family Van, adapted the World Health Organization\u2019s Problem Management Plus (PM+) curriculum to address these disparities with support from Partners In Health. PM+ is a brief, evidence-based psychological intervention designed for trained non-specialists to deliver in low-resource settings. This community case study describes the adaptation, implementation, and early lessons learned from delivering PM+ with trained community health workers (CHWs) among racially and linguistically diverse communities in Boston, Massachusetts. Data were collected from 49 participants who engaged in 173 sessions between January 2021 and December 2023. Quantitative outcomes were measured using the Psychological Outcomes Profiles (PSYCHLOPS) tool, alongside qualitative insights from session notes and client feedback. Participants who completed the program experienced a 25.4% reduction in mental health distress 95% CI [13.1, 37.9%], with those attending at least one session experiencing an 11.4% reduction 95% CI [5.8, 17.0%]. This program also demonstrates how community-based mental health initiatives can contribute to broader systems of collaborative learning where frontline providers, participants, community members, and institutional partners jointly adapt and refine program delivery to inform equitable adaptation and dissemination of mental health practices. As the first adaptation of PM\u202f+\u202fin a community-based mobile clinic in the United States, Healthy Roads offers implementation insights for community health programs on building a mental health workforce reflective of the community, centering community expertise, adapting program delivery for cultural relevance, and ensuring proper staffing to sustain quality care.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1800509","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:48:03Z","timestamp":1781848083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Advancing mental health equity: a community-based adaptation of problem management plus (PM+) on a mobile health clinic"],"prefix":"10.3389","volume":"14","author":[{"given":"Josephina","family":"Lin","sequence":"first","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piper","family":"Derenoncourt","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainelle","family":"Walker-White","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Oriol","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Department of Global Health and Social Medicine, Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Beth Israel Deaconess Medical Center","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Palazuelos","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Brigham and Women\u2019s Hospital","place":["Boston, MA, United States"]},{"name":"Partners In Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Raviola","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Partners In Health","place":["Boston, MA, United States"]},{"name":"Massachusetts General Hospital","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Brigham and Women\u2019s Hospital","place":["Boston, MA, United States"]},{"name":"Partners In Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mollie","family":"Williams","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, MA, United States"]},{"name":"Department of Global Health and Social Medicine, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref1","volume-title":"GBD Compare","year":"2022"},{"key":"ref2","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1001\/jama.2018.0158","article-title":"The state of US health, 1990\u20132016: burden of diseases, injuries, and risk factors among US states","volume":"319","author":"Murray","year":"2018","journal-title":"JAMA J Am Med Assoc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.26633\/rpsp.2018.165","article-title":"Mental health in the Americas: an overview of the treatment gap","volume":"42","author":"Kohn","year":"2018","journal-title":"Rev Panam Salud Publica"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.brat.2016.06.004","article-title":"Addressing the treatment gap: a key challenge for extending evidence-based psychosocial interventions","volume":"88","author":"Kazdin","year":"2017","journal-title":"Behav Res Ther"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1176\/appi.focus.20190028","article-title":"Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States","volume":"18","author":"Mongelli","year":"2020","journal-title":"Focus (Madison)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1093\/tbm\/ibac033","article-title":"Developing an equitable intervention approach for communities of color: mental health and co-occurring physical health concerns in the context of the COVID-19 pandemic","volume":"12","author":"Chavez","year":"2022","journal-title":"Transl Behav Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1001\/jama.2023.23508","article-title":"Nationwide survey reflects state of US behavioral and mental health","volume":"330","author":"Harris","year":"2023","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"620","DOI":"10.3390\/ijerph22040620","article-title":"Trauma, mental health workforce shortages, and health equity: a crisis in public health","volume":"22","author":"Ballout","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e078091","DOI":"10.1136\/bmjopen-2023-078091","article-title":"Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan","volume":"14","author":"Keyan","year":"2024","journal-title":"BMJ Open"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"48","DOI":"10.4103\/INTV.INTV_38_20","article-title":"Cultural adaptation of a low-intensity group psychological intervention for Syrian refugees","volume":"19","author":"Akhtar","year":"2021","journal-title":"Intervention"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/14733140412331383913","article-title":"A client-generated psychometric instrument: the development of \u2018PSYCHLOPS\u2019","volume":"4","author":"Ashworth","year":"2004","journal-title":"Couns Psychother Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1037\/fsh0000886","article-title":"Increasing access to behavioral healthcare: examples of task-shifting in two U.S. government healthcare systems","volume":"42","author":"Kanzler","year":"2025","journal-title":"Fam Syst Heal"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.glohj.2021.07.001","article-title":"Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings","volume":"5","author":"Lange","year":"2021","journal-title":"Glob Health J"},{"key":"ref15","first-page":"48","article-title":"Task sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review","author":"Hoeft","year":"2019"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13063-024-07980-7","article-title":"Effectiveness and cost -effectiveness of a transdiagnostic intervention for alcohol misuse and psychological distress in humanitarian settings: study protocol for a randomised controlled trial in Uganda","volume":"25","author":"Boor","year":"2024","journal-title":"Trials"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0287269","article-title":"Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: protocol of a pilot randomized control trial","volume":"19","author":"Falgas-bague","year":"2024","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"75","DOI":"10.4103\/INTV.INTV_28_20","article-title":"Living six hours away from mental health specialists: enabling access to psychosocial mental health services through the implementation of problem management plus delivered by community health workers in rural Chiapas, Mexico","volume":"19","author":"Rodriguez-Cuevas","year":"2021","journal-title":"Intervention"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1016\/S0140-6736(24)01809-9","article-title":"Effectiveness, cost-effectiveness, and positive externalities of integrated chronic care for adults with major depressive disorder in Malawi (IC3D): a stepped-wedge, cluster-randomised, controlled trial","volume":"404","author":"Mcbain","year":"2024","journal-title":"Lancet"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"58","DOI":"10.4103\/INTV.INTV_41_20","article-title":"Adapting problem management plus for implementation: lessons learned from public sector settings across Rwanda, Peru, Mexico and Malawi","volume":"19","author":"Coleman","year":"2021","journal-title":"Intervention"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e91","DOI":"10.1192\/bjo.2024.55","article-title":"A scoping review of the literature on the application and usefulness of the problem management plus (PM+) intervention around the world","volume":"10","author":"Mwangala","year":"2024","journal-title":"BJPsych Open"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2002027","DOI":"10.1080\/20008198.2021.2002027","article-title":"Feasibility and acceptability of problem management plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial","volume":"13","author":"Spaaij","year":"2022","journal-title":"Eur J Psychotraumatol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e50","DOI":"10.1017\/S2045796024000519","article-title":"The effectiveness of problem management plus at 1-year follow-up for Syrian refugees in a high-income setting","volume":"33","author":"Graaff","year":"2024","journal-title":"Epidemiol Psychiatr Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-023-09491-8","article-title":"Scaling-up problem management plus for refugees in Switzerland - a qualitative study","volume":"23","author":"Spaaij","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref25","volume-title":"Health of Boston 2024: The Mental Health Report","year":"2024"},{"key":"ref26","volume-title":"Survey Details Behavioral Health Workforce Crisis in Mass","year":"2022"},{"key":"ref27","year":"2026"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.1097\/QAI.0b013e3181605df1","article-title":"The ADAPT-ITT model a novel method of adapting evidence-based HIV","volume":"47","author":"Wingood","year":"2008","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/tbm\/ibx067","article-title":"A scoping study of frameworks for adapting public health evidence-based interventions","volume":"9","author":"Escoffery","year":"2019","journal-title":"Transl Behav Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13033-018-0236-9","article-title":"Problem management plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial","volume":"12","author":"Sijbrandij","year":"2018","journal-title":"Int J Ment Health Syst"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"100109","DOI":"10.1016\/j.ssmmh.2022.100109","article-title":"A brief psychological intervention for improving the mental health of Venezuelan migrants and refugees: a mixed-methods study","volume":"2","author":"Perera","year":"2022","journal-title":"SSM Mental Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1080\/20008198.2017.1388102","article-title":"Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries","volume":"8","author":"Sijbrandij","year":"2017","journal-title":"Eur J Psychotraumatol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Admin Pol Ment Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1146\/annurev-clinpsy-032816-045217","article-title":"Psychological treatments for the world: lessons from low- and middle-income countries","volume":"13","author":"Singla","year":"2017","journal-title":"Annu Rev Clin Psychol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s10488-017-0815-0","article-title":"Mobilizing community health workers to address mental health disparities for underserved populations: a systematic review","volume":"45","author":"Barnett","year":"2018","journal-title":"Adm Policy Ment Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1007\/s10597-016-0076-5","article-title":"Reduction of burnout in mental health care providers using the provider resilience mobile application","volume":"53","author":"Wood","year":"2017","journal-title":"Community Ment Health J"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1177\/1468017310392418","article-title":"Burnout among mental health care providers","volume":"12","author":"Wood","year":"2012","journal-title":"J Soc Work"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1800509\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:48:04Z","timestamp":1781848084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1800509\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":37,"alternative-id":["10.3389\/fpubh.2026.1800509"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1800509","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"article-number":"1800509"}}