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

• 批准号: 10390337
• 负责人: Keng-Yen Huang
• 金额: $ 64.24万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 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/10390337
• 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 Policy; Health Professional; Human Resources; Hybrids; Income; Intervention; Kenya; Knowledge; Mediation; Mediator of activation protein; Mental Health; Mental Health Services; 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; Resource-limited setting; Resources; Rural; Schools; Service provision; Services; Strategic Planning; Stress; Students; Sustainable Development; Teacher Professional Development; Testing; Theory of Change; Training Support; Uganda; United Nations; Work; base; burden of illness; 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; scale up; social; stress management; sustainability framework; teacher; uptake

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 低收入和中等收入儿童精神、神经和物质 (MNS) 疾病的负担 尽管各国（中低收入国家）已做出巨大努力来改善心理健康干预措施和 为幼儿提供服务，以及在高收入地区制定的一些循证干预措施（EBI） 国家已成功运输并证明对改善儿童的健康状况有效 从有效性研究的角度来看，大多数 EBI 仍然存在许多关键差距。 适应中低收入国家的方案尚未广泛推广，未检验其有效性和机制，也未重点关注 从实施的角度来看，中低收入国家的大多数 EBI 依赖于儿童早期的预防性干预。 由于缺乏心理健康专业人员（MHP）而采取任务转移的实施方法； 然而，与任务转移相关的挑战很少得到解决。 通过研究人口方法 EBI 促进幼儿教育的有效性来应对这些差距 乌干达一个中低收入国家的心理健康，同时研究解决任务转移的策略 最大化 EBI 有效性的挑战 本研究中考虑的 EBI 是 ParentCorps-Professional。 发展（PD），一种基于学校的 EBI，培训和支持教师应用 EBI 策略来促进 PD 方法代表了一种通过转移来进行心理保健的任务转移模式。 专业人员对教师的预防职责，以促进儿童的心理健康 两项功效研究。 在乌干达和尼泊尔进行的研究证明了任务转移的可行性以及对 儿童、教师和学校拟议的研究建立在积极证据和进一步研究的基础上 使用可扩展实施的 PD 的有效性、成本效益和底层机制 此外，根据之前的调查结果，乌干达近 80% 的地区都采取了这种做法。 教师（EBI 策略使用者）所承受的职业压力会威胁到 PD 的吸收、有效性、 和维持，我们建议测试教师压力管理包（T-Wellness）作为增强功能 通过混合整群随机对照试验 (cRCT)，我们将随机抽取 36 所学校的 540 名学生。 教师和 1,980 名亲子对满足以下三种条件之一：PD + T-Wellness (PDT)、单独 PD (PD) 和 具体目标是： 1) 评估 PD 和 PDT 的短期和长期有效性， 相对于控制；2) 检查 PD 和 PDT 的有效性机制和变革理论； 3) 检查有助于有效任务转移的背景实施因素和机制 以及教师在 PD 和 PDT 学校中采用 EBI 策略的情况。