Suubi(Hope)4StrongerFamilies: Addressing Child Behavioral Health by Strengthening Financial Stability and Parenting among Families in Uganda

项目摘要 撒哈拉以南非洲（SSA）的儿童因严重未满足的心理健康需求而负担沉重。最近的一 系统回顾估计，撒哈拉以南非洲地区每7名儿童中就有1名患有严重心理健康问题。世界 卫生组织估计患病率可能更高（20%）。在整个撒南非洲，贫困率很高， 艾滋病毒/艾滋病、粮食不安全、耻辱和不适当的保健安全网系统加剧了严重的儿童问题， 行为健康（CBH）需要和阻碍有效的反应。破坏性行为障碍（DBD） 特别是当他们在青春期和成年期持续存在时。DBD也与穷人密切相关。 成年期的身体健康和人际关系挑战。因此，解决特定背景下的社会问题 考虑到撒哈拉以南非洲地区的儿童占该地区总人口的一半以上，对CBH的影响至关重要。 如果要在撒南非洲满足儿童的需求，那么：1）实施在撒南非洲设计和测试的干预措施， 在现有的以儿童为重点的机构内调动资源至关重要; 2）综合干预措施， 同时针对SSA对CBH的特定影响，并可与儿童/家庭合作提供- 服务社区的设置是必要的;和3）小组，社区和人口的方法CBH是 推动可扩展的解决方案。在社会行动、资产和家庭系统理论的指导下， 这项研究将探讨EE和FS干预措施针对社会，家庭和背景的机制， 具体的驱动因素影响了900名乌干达小学中高年级儿童（10至14岁）的心理健康。 这项研究采用了一个实验性的纵向设计，在30所随机分组的小学进行比较， 单一和组合干预方案; EE和FS对经济、感知和功能的影响 调解人;和具体情况的主持人。三种研究条件是：1）仅EE，2）仅基于MFG的FS， 3)基于EE+ MFG的组合FS。干预措施将提供12个月，并将进行评估。 在基线、12、24和36个月时。具体目标是：目标1：仅审查环境工程的影响，以制造业为基础 仅FS，以及基于EE+ MFG的FS组合对儿童DBD症状和行为功能的影响;目的2： 测试仅EE、仅基于MFG的FS以及EE+基于MFG的FS组合对家庭财务稳定性的影响 (e.g.,食物和住房稳定性、物质资产、储蓄）、养育子女和保护性家庭过程（例如，家庭 组织、照顾者/儿童互动、凝聚力、支持）和与寻求帮助有关的看法（例如， 污名）对CBH和功能的影响;并评估这些变化机制是否介导了干预效应， DBD症状和行为功能，并探索由特定背景的主持人适度 干预效果;目标3：Qualitative检查参与者对每个干预组的体验。 调查小组将利用他们在SSA的长期合作伙伴关系，最大限度地提高公共卫生的影响， 研究成果，并缩短从新知识到系统和人口一级改进的时间差距。

PROJECT ABSTRACT Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. A recent systematic review estimated that 1 in 7 children in SSA struggle with a serious mental health issue. The World Health Organization estimates prevalence rates may be even higher (20%). Across SSA, high rates of poverty, HIV/AIDS, food insecurity, stigma and an inadequate health safety net system exacerbate serious childhood behavioral health (CBH) needs and impede an effective response. Disruptive behavioral disorders (DBDs) are particularly concerning as they persist through adolescence and adulthood. DBDs are also highly related to poor physical health and interpersonal challenges in adulthood. Hence, addressing the context-specific social influences on CBH is critical given that children in SSA comprise more than half of the total regional population. If children’s needs are to be met in SSA, then: 1) implementing interventions designed and tested in SSA, and which mobilize resources within existing child-focused institutions is critical; 2) combined interventions that simultaneously target SSA-specific influences on CBH and can be delivered in collaboration with child/family- serving community settings are necessary; and 3) group, community and population approaches to CBH are needed to drive scalable solutions. Guided by Social Action, Asset, and Family Systems theories, the proposed study will examine the mechanisms by which EE and FS interventions targeting social, familial and context- specific drivers affect the mental health of 900 Ugandan children in mid-upper primary school (10 to 14 years). The study uses an experimental, longitudinal design across 30 cluster randomized primary schools to compare single and combination intervention options; influences of EE and FS on economic, perceptual and functioning mediators; and context-specific moderators. The three study conditions are: 1) EE only, 2) MFG-based FS only, 3) combined EE+MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24 and 36 months. The specific aims are: Aim 1: Examine the impact of EE only, MFG-based FS only, and combined EE+MFG-based FS on children’s DBD symptoms and behavioral functioning; Aim 2: Test the influence of EE only, MFG-based FS only, and combined EE+MFG-based FS on family financial stability (e.g., food and housing stability, material assets, savings), parenting and protective family processes (e.g., family organization, caregiver/child interaction, cohesion, support) and perceptions related to help seeking (e.g., stigma) on CBH and functioning; and assess whether these change mechanism mediate intervention effects on DBD symptoms and behavioral functioning, and explore moderation by context-specific moderators of intervention effects; and Aim 3: Qualitatively examine participants’ experiences with each intervention arm. The investigative team will leverage their long-term partnerships in SSA to maximize the public health impact of the research findings and to shorten the time gap from new knowledge to system and population-level improvement.