Advancing mHealth-supported Adoption and Sustainment of an Evidence-based Mental Health Intervention for Youth in a School-based Delivery Setting in Sierra Leone

项目总结 这项研究将探讨青年准备干预(YRI)的新实施战略，以及 循证心理健康干预。该战略将(A)利用交付环境(学校)和 在低收入和中等收入国家有效利用劳动力(教师)；和(B)利用技术进行创新 和mHealth工具，以提高精神卫生服务的提供质量。YRI将作为一项 塞拉利昂的课外复原力培养课外活动。老师们将发表YRI并接受 无论是手机支持的监督还是标准的面对面监督。基于移动的监管将 将在整个非洲广泛使用的免费跨平台消息和语音服务WhatsApp与 新的mHealth应用程序。MHealth应用程序最近被设计为支持对塞拉利昂人的保真度监控 开展循证家庭强化干预工作人员(R21MH124071)。MHealth应用程序 将通过关键功能支持监管，包括语音激活的内容、可填写的表单(即YRI保真度 核对表)、监控保真度的可视仪表板以及支持校本YRI教学的培训视频。 探索、准备、实施、可持续(EPIS)框架，广泛的多层次背景-- 灵敏的执行科学模型，将指导研究。混合类型3实施-有效性 设计将允许评估以移动电话为基础的监督作为新的实施战略，以及 YRI对青少年心理和行为健康的临床效果是次要结果。 目标1(探索和准备)将调查YRI成功的障碍和促进者 在塞拉利昂的中学，在移动工具的帮助下实施。一种混合方法评价 与教师、校长和政府部门官员将共同开发一项实施 在YRI交付之前的蓝图。将采用以用户为中心的设计方法来适应mHealth监管 应用程序和整合WhatsApp，创建基于手机监管的集成用户模式。目标2 (实施)将检查教师提供的YRI的可行性、可接受性、成本和保真度 接受移动监管与通过混合方式接受标准监管的比较 接近。目标3(交付方法对YRI有效性的影响)将比较YRI的有效性 在改善青少年(14-24岁)的心理健康、情绪调节和日常功能方面 接受流动监督的教师(N=480名青年)或接受监督的教师的学校环境 标准督导(N=480名青年)。目标4(可持续性)将(A)调查收养机制和 通过与教师、青年和教师进行混合方法评估，支持教师提供的YRI (B)进行成本效益和投资回报分析，以评估相对成本与 从广泛的社会角度，包括教育成果，对“青年倡议”的益处。

PROJECT SUMMARY This study will examine a new implementation strategy for the Youth Readiness Intervention (YRI), an evidence-based mental health intervention. The strategy will (a) leverage a delivery setting (schools) and workforce (teachers) used effectively in low- and middle- income countries; and (b) innovate with technology and mHealth tools to enhance mental health service delivery quality. The YRI will be implemented as an extracurricular resilience-building afterschool activity in Sierra Leone. Teachers will deliver the YRI and receive either mobile phone-supported supervision or standard in-person supervision. Mobile-based supervision will integrate WhatsApp, a free cross-platform messaging and voice service used widely throughout Africa, with a new mHealth app. The mHealth app was recently designed to support fidelity monitoring of Sierra Leonean lay workers delivering the evidence-based Family Strengthening Intervention (R21MH124071). The mHealth app will support supervision through key features, including voice activated content, fillable forms (i.e., YRI fidelity checklist), visual dashboards to monitor fidelity, and training videos to support school-based YRI delivery. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework, a broad multilevel, context- sensitive implementation science model, will guide the study. A hybrid type 3 implementation-effectiveness design will allow for evaluation of both mobile phone-based supervision as a new implementation strategy, and clinical effectiveness of the YRI on youth mental and behavioral health as secondary outcomes. Aim 1 (Exploration and Preparation) will investigate barriers and facilitators to successful YRI implementation aided by mobile-based tools in Sierra Leone’s secondary schools. A mixed methods evaluation with teachers, principals, and government ministry officials will inform co-development of an implementation blueprint prior to YRI delivery. User-centered design methods will be used to adapt the mHealth supervision app and incorporate WhatsApp to create an integrated user model of mobile phone-based supervision. Aim 2 (Implementation) will examine the feasibility, acceptability, cost, and fidelity to the YRI delivered by teachers receiving mobile-based supervision compared with those receiving standard supervision via a mixed methods approach. Aim 3 (Impact of Delivery Approach on YRI Effectiveness) will compare the effectiveness of the YRI in improving mental health, emotion regulation and daily functioning in youth (aged 14-24) when delivered in school settings by teachers who receive either mobile-based supervision (N=480 youth) or those who receive standard supervision (N=480 youth). Aim 4 (Sustainment) will (a) investigate mechanisms of adoption and sustainment of the YRI delivered by teachers through a mixed methods evaluation with teachers, youth, and principals; and (b) conduct a cost-effectiveness and return on investment analysis to evaluate relative costs vs. benefits of the YRI from a broad societal perspective, including educational outcomes.