Youth as community mental health workers in humanitarian settings: A pilot test of the mechanisms of effect on their own well being

青年作为人道主义环境中的社区心理卫生工作者：对其自身福祉影响机制的试点测试

基本信息

批准号：
10684905
负责人：
Rima Afifi
金额：
$ 11.78万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2024-08-31
项目状态：
已结题

项目摘要

There are 1.8 billion young people in the world today. If engaged effectively, youth are resources and agents of change in their communities. Involving youth in work that impacts their communities has positive outcomes for youth wellbeing; and for their communities. But, youth are often marginalized, particularly in humanitarian settings. Youth wellbeing is linked to seven key protective factors: positive emotions, hope, relationships, meaning, accomplishments, autonomy, and engagement. Understanding protective factors as potential mechanisms for intervention-related change in wellbeing is a priority for research in humanitarian settings. If youth are to be meaningfully engaged as intervention agents, their work should focus on a community need. Humanitarian crises increase mental health disorders; and `normal' distress and psychological reactions affect a large percentage of the population. Yet, human resources for health are often insufficient to meet needs. Understanding the capacities of youth to support communities in the context of disasters has been noted as a research imperative. Globally, task-sharing interventions train non-professional lay community members to provide mental health care. As one example, Problem Management Plus (PM+) trains community mental health workers (CMHW) and is effective in humanitarian settings for common mental disorders and for mental distress and other problems that emerge in response to crises. We propose to engage youth – aged 18-24 years, as youth CMHW, to implement PM+ with at-risk adults (18+ years) in their communities. The Syrian refugee crises, one of the worst humanitarian crises in recent history, provides a relevant setting to implement this project. Lebanon hosts ~1.5 million Syrian refugees, and about 60% of Syrian refugees aged 15-24 years are not employed, and not in school. The Specific Aims are: Aim 1: Assess the effectiveness of being a Y-CMHW on their wellbeing, resilience, and stress levels; as compared to an equivalent control group (ECG) of Syrian refugee peers. Aim 2: Identify the mechanisms associated with changes in wellbeing, resilience, and stress. Our conceptual model describes links between the intervention, the mechanisms, and outcomes. Aim 3: Evaluate the feasibility, acceptability and fidelity of Syrian refugee youth as CMHW implementing PM+ with clients using RE-AIM as a framework for collecting implementation data. A community-engaged research approach will involve community members, including youth, in all aspects of the research project. Our results will (a) elucidate critical mechanisms through which engagement of youth to support their community enhances their own wellbeing; (b) inform research around humanitarian/refugee settings, mental health, and Y-CMHW interventions; and (c) provide a robust basis for a follow-up study via a larger RCT. Though we assess the impact of Y- CMHW in the Syrian refugee context, the premise of this intervention and its findings are equally relevant to natural emergency situations/disasters, such as in the USA.

当今世界上有18亿年轻人。如果有效地参与，青年是社区变革的资源和推动者。让青年参与影响其社区的工作对青年健康带来了积极的成果；以及他们的社区。但是，年轻人经常被边缘化，尤其是在人道主义环境中。青年健康与七个关键保护因素有关：积极的情绪，希望，人际关系，意义，成就，自主权和参与。将受保护因素理解为与干预相关的健康变化的潜在机制，是人道主义环境研究的优先事项。如果年轻人作为干预特工有意义地参与，他们的工作应集中在社区需求上。人道主义危机增加了心理健康障碍； “正常”的困扰和心理反应会影响很大一部分人口。但是，健康的人力资源通常不足以满足需求。在灾难背景下，了解青年人支持社区的能力已被认为是一项研究。在全球范围内，任务共享干预措施训练非专业的外行社区成员提供心理保健。作为一个例子，问题管理加上（PM+）培训社区精神卫生工作者（CMHW），并且在人道主义环境中有效的常见精神疾病以及精神痛苦和其他针对危机而出现的问题。我们建议与年轻人CMHW一起吸引青年，以在其社区中使用高危成年人（18岁以上）实施PM+。叙利亚难民危机是最近历史上最严重的人道主义危机之一，为实施该项目提供了相关的环境。黎巴嫩拥有约150万叙利亚难民，约有60％的15-24岁叙利亚难民没有被雇用，也没有在学校。具体目的是：目标1：评估成为Y-CMHW在其健康，韧性和压力水平上的有效性；与叙利亚难民同伴的等效对照组（ECG）相比。目标2：确定与福祉，韧性和压力变化相关的机制。我们的概念模型描述了干预，机制和结果之间的联系。目标3：评估叙利亚难民青年的可行性，可接受性和保真度，因为CMHW与客户使用RE-AIM作为收集实施数据的框架实施PM+。社区参与的研究方法将使包括青年在内的社区成员参与研究项目的各个方面。我们的结果将（a）阐明关键机制，通过这些机制，青年参与社区的参与可以增强自己的健康；（b）有关人道主义/难民环境，心理健康和Y-CMHW干预措施的信息研究；（c）通过较大的RCT为后续研究提供了强大的基础。尽管我们评估了Y-CMHW在叙利亚难民环境中的影响，但这种干预措施的前提及其发现与自然紧急情况/灾难（例如在美国）同样相关。