Effectiveness and Implementation of an Early Childhood School-Based Mental Health Intervention in Low-Resource Communities

资源匮乏社区中以学校为基础的幼儿心理健康干预措施的有效性和实施

基本信息

批准号：
10161844
负责人：
Keng-Yen Huang
金额：
$ 64.8万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-08 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10161844
关键词：
Address Africa Behavioral Child Child Mental Health Childhood Communities Community Health Aides Country Development Disease Effectiveness Effectiveness of Interventions Emotional Evidence based intervention Foundations Funding Ghana Goals Health Professional Healthcare Human Resources Hybrids Income Intervention Kenya Knowledge Mediation Mediator of activation protein Mental Health Modeling National Institute of Mental Health Nepal Neurologic Occupations Outcome Parents Policy Research Population Poverty Areas Preventive Preventive service Psyche structure Randomized Randomized Controlled Trials Research Resources Rural Schools Service provision Services Stress Students Sustainable Development Teacher Professional Development Testing Theory of Change Training Support Uganda United Nations Work base burnout contextual factors cost effective cost effectiveness cost-effectiveness ratio early childhood effectiveness outcome effectiveness research effectiveness study efficacy study evidence base experience implementation outcomes implementation research improved low and middle-income countries occupational stress preventive intervention social stress management teacher uptake

项目摘要

ABSTRACT The burden of pediatric mental, neurological, and substance (MNS) disorders in low-and middle-income countries (LMICs) is tremendous. Although efforts have been made to improve mental health interventions and services for young children, and a number of evidence-based interventions (EBIs) developed in high-income countries have been successfully transported and demonstrated to be efficacious for improving children’s mental health in LMICs, many critical gaps remain. From the effectiveness research perspective, most EBIs adapted to LMICs have not been scaled widely, examined effectiveness and mechanisms, or focused on preventive interventions in early childhood. From the implementation perspective, most EBIs in LMICs rely on task-shifting approach of implementation because of shortage of mental health professionals (MHPs); however, challenges related to task-shifting have rarely been addressed. The overall goal of this application is to respond to these gaps by studying effectiveness of a population-approach EBI to promote early childhood mental health in one LMIC-Uganda, as well as simultaneously studying strategies that address task-shifting challenges to maximize EBI effectiveness. The EBI considered in this study is ParentCorps-Professional Development (PD), a school-based EBI that trains and support teachers to apply EBI strategies to promote child mental health. The PD approach represents a task-shifting model of mental healthcare by shifting preventive duties from professionals to teachers to promote children’s mental health. Two efficacy studies conducted in Uganda and Nepal have demonstrated feasibility of task-shifting, and positive impacts on children, teachers and schools The proposed study builds on the positive evidence and further study effectiveness, cost-effectiveness, and underlying mechanisms of PD using a scalable implementation approach in multiple regions in Uganda. In addition, based on previous findings that nearly 80% of Ugandan teachers (the EBI strategy users) experience occupational stress which threatens PD uptake, effectiveness, and sustainment, we propose to test a teacher stress management package (T-Wellness) as an enhancement to PD. Using a hybrid cluster randomized controlled trial (cRCT), we will randomize 36 schools with 540 teachers and 1,980 parent-child pairs to one of three conditions: PD + T-Wellness (PDT), PD alone (PD), and control. The Specific Aims are: 1) to evaluate the short- and longer-term effectiveness of PD and PDT, relative to control; 2) to examine effectiveness mechanisms and theory of change underlying the PD and PDT; and 3) to examine implementation contextual factors and mechanisms that contribute to effective task-shifting and teachers’ uptake of EBI strategies within PD and PDT schools.

抽象的小儿心理，神经和物质（MNS）疾病的伯恩（Burnen）低收入国家（LMIC）是巨大的。尽管已努力改善心理健康干预措施，并为幼儿提供服务，以及在高收入中开发的许多基于证据的干预措施（EBIS）国家已成功运输和证明是有效地改善儿童的 LMIC的心理健康，仍然存在许多关键差距。从有效性研究的角度来看，大多数EBI 适应LMIC的尚未广泛缩放，检查有效性和机制，或者专注于早期的预防干预措施。从实施的角度来看，LMIC中的大多数EBI都依靠由于精神卫生专业人员的短缺（MHP），任务转移的实施方法；但是，很少解决与任务转移有关的挑战。该应用程序的总体目标是通过研究人群的有效性来应对这些差距，以促进幼儿期一个LMIC-uganda中的心理健康，以及简单的研究策略，以解决任务转移提高EBI有效性的挑战。在这项研究中考虑的EBI是ParentCorps专业开发（PD），这是一家基于学校的EBI，培训和支持教师采用EBI策略来促进儿童心理健康。 PD方法通过转移来代表心理保健的任务转换模型专业人士对教师的预防职责促进儿童的心理健康。两项效率研究在乌干达和尼泊尔进行的表明，任务转移的可行性，以及对儿童，老师和学校提出的研究以积极的证据为基础，并进一步研究使用可扩展实施的PD的有效性，成本效益和基本机制乌干达多个地区的接近。此外，根据先前的发现，乌干达近80％教师（EBI策略用户）会遇到职业压力，威胁着PD吸收，有效性，和维持，我们建议测试教师压力管理计划（T-Wellness）作为增强到PD。使用混合群集随机对照试验（CRCT），我们将将36所学校随机，540学校老师和1,980个亲子对以下三个条件之一：PD + T-Wellness（PDT），PD单独（PD）和控制。具体目的是：1）评估PD和PDT的短期和长期有效性，相对于对照； 2）检查PD和PDT的有效机制和变化理论； 3）检查实施上下文因素和机制，这些因素和机制有助于有效的任务转移以及教师对PD和PDT学校中EBI策略的吸收。