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

摘要 低收入和中等收入儿童的精神、神经和物质（MNS）障碍负担 LMICs（中低收入国家）是巨大的。虽然已经努力改善心理健康干预措施， 为幼儿提供的服务，以及在高收入国家制定的一些基于证据的干预措施（EBI）。 这些国家已经成功地运输，并证明对改善儿童的 在中低收入国家的心理健康方面，仍然存在许多重大差距。从有效性研究的角度来看， 适应低收入国家的战略尚未广泛推广，尚未审查其有效性和机制，也没有重点关注 幼儿期的预防性干预。从实施的角度来看，中低收入国家的大多数EBI依赖于 由于缺乏精神卫生专业人员，执行工作采用任务转移的方法; 然而，与任务转移有关的挑战很少得到解决。此应用程序的总体目标是 通过研究人口方法EBI促进幼儿期的有效性来应对这些差距 乌干达一个最低收入国家的心理健康，同时研究解决任务转移的策略 最大限度地提高EBI效率的挑战。本研究中考虑的EBI是ParentCorps-Professional 发展（PD），一个以学校为基础的EBI，培训和支持教师应用EBI策略，以促进 儿童心理健康。PD方法代表了精神卫生保健的任务转移模型， 从专业人员到教师都有预防责任，以促进儿童的心理健康。两项疗效研究 在乌干达和尼泊尔进行的研究表明，任务转移是可行的， 儿童、教师和学校拟议的研究建立在积极的证据和进一步的研究基础上， 有效性、成本效益和使用可扩展实现的PD的基本机制 在乌干达的多个地区采用这种方法。此外，根据先前的调查结果，近80%的乌干达人 教师（EBI策略使用者）经历职业压力，这威胁到PD的吸收，有效性， 和持续，我们建议测试教师压力管理包（T-健康）作为一种增强 去警局使用混合群集随机对照试验（cRCT），我们将随机选择36所学校， 教师和1，980对亲子对三种条件之一：PD + T-健康（PDT），PD单独（PD）， 控制具体目的是：1）评价PD和PDT的短期和长期有效性， 2）研究PD和PDT的有效性机制和变革理论; 以及3）检查有助于有效任务转移的实施情境因素和机制 以及教师在PD和PDT学校中对EBI策略的吸收。

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.