Evaluation of a Community-Based Psychosocial Intervention for War-Affected Youth

对受战争影响的青少年进行基于社区的社会心理干预的评估

• 批准号: 8396963
• 负责人: Ryan K McBain
• 金额: $ 2.92万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396963
• 关键词: Adaptive Behaviors; Address; Affect; Africa; Africa South of the Sahara; Age; Anxiety; Attention; Behavior; Behavior Therapy; Bosnia-Herzegovina; Child; Cognitive Therapy; Commit; Communities; Community Relations; Comorbidity; Conflict (Psychology); Cost Effectiveness Analysis; Country; Data; Data Collection; Development; Distress; Early treatment; Economics; Education; Effectiveness of Interventions; Elements; Emotional; Employment; Enrollment; Evaluation; Exhibits; Family; Family Relationship; Feeling hopeless; Financial cost; Funding; Hostility; Human; Individual; Institutes; Intention; Intervention; Learning; Left; Life; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mental Depression; Mental Health; Occupational; Outcome; Participant; Performance; Phase; Policies; Population; Post-Traumatic Stress Disorders; Problem Solving; Problem behavior; Randomized; Readiness; Refugees; Regulation; Reporting; Research; Research Training; Risk Behaviors; Sampling; Sampling Studies; Schools; Series; Sierra Leone; Social Functioning; Soldier; Sri Lanka; Stress; Symptoms; Techniques; Time; Training; Treatment/Psychosocial Effects; Uganda; United States; Violence; Waiting Lists; War; Work; Workplace; Youth; arm; base; biological adaptation to stress; cohort; control trial; cost; cost effectiveness; design; evidence base; experience; follow-up; functional disability; functional outcomes; improved; indexing; interpersonal therapy; intervention effect; peace; post intervention; programs; prospective; psychosocial; skills; social; success

DESCRIPTION (provided by applicant): Presently, over one billion children live in countries affected by armed conflict, and in many cases these children are directly involved in the violence. In the context of Sierra Leone's 11-year civil war (1991-2002), conscription of children into armed forces was routine. As a result, children often witnessed or were forced to commit acts of extreme violence; those uprooted from their families were typically coerced to function as front- line soldiers, spies and human shields. A growing literature continues to outline the psychosocial effects of such war exposures, which includes heightened levels of anxiety, depression, and posttraumatic stress. Psychosocial interventions for war-affected youth have been implemented in a diversity of post-conflict settings. In most instances, interventions represent a package of empirically-supported behavioral treatments (ESBTs) which integrate elements of psycho-education, problem-solving skills, as well as cognitive-behavioral therapy and interpersonal therapy techniques, which have been shown to affect outcomes ranging from reductions in PTSD symptoms to improvements in adaptive behavior. However, in most studies only a limited array of mental health outcomes are investigated, often with little attention to broader functional outcomes such as family relations or educational attainment. Likewise, the longer-term effects of interventions are not typically reported, leaving unanswered whether intervention benefits accrue over time. Lastly, financial costs are rarely documented. As such, it remains unclear whether replication of interventions is financially feasible. This proposal builds off of a prospective longitudinal study in Sierra Leone, which has chronicled the development of war-affected youth over the past ten years. The sponsor of this proposal, Dr. Theresa Betancourt, will be implementing a randomized wait-listed control trial of an ESBT for youth who continue to demonstrate poor psychosocial functioning. Utilizing a series of measures which have been validated and culturally-adapted, the impacts of this intervention will be measured in terms of improvements in mental health (depression, anxiety, hostility, posttraumatic stress reactions and prosocial behavior) as well as functional outcomes including community and family relations, education and employment. The intention of this proposal is to extend this effort by helping conduct a three month follow-up with the initial treatment cohort (n=64), as well as by relating the portfolio of measured benefits to the programmatic costs of the intervention. While three month follow-up will investigate whether intervention benefits continue to accrue over time and lend further evidence regarding intervention effectiveness, collection of data on programmatic costs will provide an index of the intervention's financial feasibility and efficiency in terms of dollars per outcome. Together, these two components will provide a realistic picture of the utility of a community-based psychosocial intervention for war- affected youth. Ultimately, the evidence base generated by this effort can serve to inform policies and programs for war-affected populations globally, including refugee populations in the United States. PUBLIC HEALTH RELEVANCE: Building on a unique longitudinal study of war-affected youth in Sierra Leone, the proposed research intends to address several critical gaps in the current literature on psychosocial interventions for war-affected youth. Embedded within a randomized wait-listed control trial, this project will measure the effects of a community-based psychosocial intervention at three months follow-up in 64 youth ages 15-24, providing important information on the accumulated benefits of such efforts, and measuring benefits across an array of outcomes including mental health, community and family relations, education and employment. Furthermore, benefits for all youth participating in the trial (n=128) will be related to the programmatic costs of the intervention in order to provide a more comprehensive representation of the intervention's efficiency and financial feasibility.

描述（由申请人提供）：目前，超过 10 亿儿童生活在受武装冲突影响的国家，并且在许多情况下，这些儿童直接参与暴力。在塞拉利昂长达11年的内战（1991-2002）背景下，征募儿童加入武装部队已成为常态。因此，儿童经常目睹或被迫实施极端暴力行为；那些背井离乡的人通常被迫充当前线士兵、间谍和人体盾牌。越来越多的文献继续概述此类战争经历的心理社会影响，其中包括焦虑、抑郁和创伤后应激水平的升高。对受战争影响的青年的心理社会干预已在多种冲突后环境中实施。在大多数情况下，干预措施代表了一整套经验支持的行为治疗（ESBT），其中整合了心理教育、解决问题的技能以及认知行为治疗和人际治疗技术的要素，这些治疗已被证明可以影响以下范围的结果：从减少 PTSD 症状到改善适应行为。然而，在大多数研究中，只调查了有限的心理健康结果，往往很少关注更广泛的功能结果，例如家庭关系或教育程度。同样，干预措施的长期影响通常不会被报告，因此干预措施的益处是否会随着时间的推移而产生也没有答案。最后，财务成本很少被记录。因此，尚不清楚重复干预措施在经济上是否可行。该提案建立在塞拉利昂一项前瞻性纵向研究的基础上，该研究记录了过去十年受战争影响的青年的发展情况。该提案的发起人 Theresa Betancourt 博士将为持续表现出不良心理社会功能的青少年实施一项 ESBT 随机等待对照试验。利用一系列经过验证且适应文化的措施，该干预措施的影响将通过心理健康（抑郁、焦虑、敌意、创伤后应激反应和亲社会行为）的改善以及包括社区在内的功能结果来衡量以及家庭关系、教育和就业。该提案的目的是扩大这一努力 通过帮助对初始治疗队列（n=64）进行三个月的随访，以及将衡量的收益组合与干预的计划成本联系起来。虽然三个月的后续行动将调查干预措施的效益是否会随着时间的推移而继续累积，并提供有关干预措施有效性的进一步证据，但计划成本数据的收集将提供干预措施的财务可行性和效率的指数 就每个结果的美元而言。这两个组成部分将共同为受战争影响的青少年提供基于社区的社会心理干预的效用的现实图景。最终，这一努力产生的证据基础可以为全球受战争影响的人口（包括美国的难民）提供政策和计划。 公共卫生相关性：基于对塞拉利昂受战争影响的青年进行的独特纵向研究，拟议的研究旨在解决当前有关受战争影响青年心理社会干预的文献中的几个关键空白。该项目嵌入一项随机等待对照试验中，将测量 64 名 15-24 岁青少年在三个月随访中基于社区的心理社会干预的效果，提供有关此类努力的累积效益的重要信息，并衡量受益于一系列成果，包括心理健康、社区和家庭关系、教育和就业。此外，参与试验的所有青少年（n=128）的收益将与干预措施的计划成本相关，以便更全面地体现干预措施的效率和财务可行性。