Evaluation of a Community-Based Psychosocial Intervention for War-Affected Youth

对受战争影响的青少年进行基于社区的社会心理干预的评估

• 批准号: 8396963
• 负责人: Ryan K McBain
• 金额: $ 2.92万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396963
• 关键词: Adaptive Behaviors; Address; Affect; Africa; Africa South of the Sahara; Age; Anxiety; Attention; Behavior; Behavior Therapy; Bosnia-Herzegovina; Child; Cognitive Therapy; Commit; Communities; Community Relations; Comorbidity; Conflict (Psychology); Cost Effectiveness Analysis; Country; Data; Data Collection; Development; Distress; Early treatment; Economics; Education; Effectiveness of Interventions; Elements; Emotional; Employment; Enrollment; Evaluation; Exhibits; Family; Family Relationship; Feeling hopeless; Financial cost; Funding; Hostility; Human; Individual; Institutes; Intention; Intervention; Learning; Left; Life; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mental Depression; Mental Health; Occupational; Outcome; Participant; Performance; Phase; Policies; Population; Post-Traumatic Stress Disorders; Problem Solving; Problem behavior; Randomized; Readiness; Refugees; Regulation; Reporting; Research; Research Training; Risk Behaviors; Sampling; Sampling Studies; Schools; Series; Sierra Leone; Social Functioning; Soldier; Sri Lanka; Stress; Symptoms; Techniques; Time; Training; Treatment/Psychosocial Effects; Uganda; United States; Violence; Waiting Lists; War; Work; Workplace; Youth; arm; base; biological adaptation to stress; cohort; control trial; cost; cost effectiveness; design; evidence base; experience; follow-up; functional disability; functional outcomes; improved; indexing; interpersonal therapy; intervention effect; peace; post intervention; programs; prospective; psychosocial; skills; social; success

DESCRIPTION (provided by applicant): Presently, over one billion children live in countries affected by armed conflict, and in many cases these children are directly involved in the violence. In the context of Sierra Leone's 11-year civil war (1991-2002), conscription of children into armed forces was routine. As a result, children often witnessed or were forced to commit acts of extreme violence; those uprooted from their families were typically coerced to function as front- line soldiers, spies and human shields. A growing literature continues to outline the psychosocial effects of such war exposures, which includes heightened levels of anxiety, depression, and posttraumatic stress. Psychosocial interventions for war-affected youth have been implemented in a diversity of post-conflict settings. In most instances, interventions represent a package of empirically-supported behavioral treatments (ESBTs) which integrate elements of psycho-education, problem-solving skills, as well as cognitive-behavioral therapy and interpersonal therapy techniques, which have been shown to affect outcomes ranging from reductions in PTSD symptoms to improvements in adaptive behavior. However, in most studies only a limited array of mental health outcomes are investigated, often with little attention to broader functional outcomes such as family relations or educational attainment. Likewise, the longer-term effects of interventions are not typically reported, leaving unanswered whether intervention benefits accrue over time. Lastly, financial costs are rarely documented. As such, it remains unclear whether replication of interventions is financially feasible. This proposal builds off of a prospective longitudinal study in Sierra Leone, which has chronicled the development of war-affected youth over the past ten years. The sponsor of this proposal, Dr. Theresa Betancourt, will be implementing a randomized wait-listed control trial of an ESBT for youth who continue to demonstrate poor psychosocial functioning. Utilizing a series of measures which have been validated and culturally-adapted, the impacts of this intervention will be measured in terms of improvements in mental health (depression, anxiety, hostility, posttraumatic stress reactions and prosocial behavior) as well as functional outcomes including community and family relations, education and employment. The intention of this proposal is to extend this effort by helping conduct a three month follow-up with the initial treatment cohort (n=64), as well as by relating the portfolio of measured benefits to the programmatic costs of the intervention. While three month follow-up will investigate whether intervention benefits continue to accrue over time and lend further evidence regarding intervention effectiveness, collection of data on programmatic costs will provide an index of the intervention's financial feasibility and efficiency in terms of dollars per outcome. Together, these two components will provide a realistic picture of the utility of a community-based psychosocial intervention for war- affected youth. Ultimately, the evidence base generated by this effort can serve to inform policies and programs for war-affected populations globally, including refugee populations in the United States. PUBLIC HEALTH RELEVANCE: Building on a unique longitudinal study of war-affected youth in Sierra Leone, the proposed research intends to address several critical gaps in the current literature on psychosocial interventions for war-affected youth. Embedded within a randomized wait-listed control trial, this project will measure the effects of a community-based psychosocial intervention at three months follow-up in 64 youth ages 15-24, providing important information on the accumulated benefits of such efforts, and measuring benefits across an array of outcomes including mental health, community and family relations, education and employment. Furthermore, benefits for all youth participating in the trial (n=128) will be related to the programmatic costs of the intervention in order to provide a more comprehensive representation of the intervention's efficiency and financial feasibility.

目前，超过10亿儿童生活在受武装冲突影响的国家，在许多情况下，这些儿童直接参与了暴力。在塞拉利昂11年内战（1991-2002年）的背景下，征募儿童加入武装部队是司空见惯的事。因此，儿童经常目睹或被迫实施极端暴力行为;那些背井离乡的儿童通常被迫充当前线士兵、间谍和人盾。越来越多的文献继续概述这种战争暴露的心理社会影响，其中包括焦虑，抑郁和创伤后压力的加剧。在各种冲突后环境中，对受战争影响的青年采取了心理社会干预措施。在大多数情况下，干预措施代表了一系列由心理学支持的行为治疗（ESBT），其中整合了心理教育，解决问题的技能以及认知行为治疗和人际治疗技术的元素，已被证明可以影响从减少PTSD症状到改善适应行为的结果。然而，在大多数研究中，只有有限的一系列心理健康结果进行了调查，往往很少关注更广泛的功能结果，如家庭关系或教育程度。同样，干预措施的长期效果通常也没有得到报告，因此没有回答干预措施的好处是否会随着时间的推移而增加。最后，财务费用很少记录在案。因此，目前尚不清楚复制干预措施在财政上是否可行。这项建议是在塞拉利昂进行的一项前瞻性纵向研究的基础上提出的，该研究记录了过去十年来受战争影响的青年的发展情况。这项提案的发起人Theresa Betancourt博士将为继续表现出不良心理社会功能的青少年实施ESBT的随机等待对照试验。利用一系列经过验证和文化适应的措施，将从心理健康（抑郁、焦虑、敌意、创伤后应激反应和亲社会行为）的改善以及社区和家庭关系、教育和就业等功能成果方面衡量这一干预措施的影响。本提案的目的是扩大这一努力， 通过帮助对初始治疗队列（n=64）进行为期三个月的随访，以及将测量的收益组合与干预的计划成本相关联。虽然三个月的后续行动将调查干预措施的效益是否随着时间的推移继续积累，并提供有关干预措施有效性的进一步证据，但收集有关方案成本的数据将提供干预措施财务可行性和效率的指数 每项成果的成本。这两个组成部分合在一起，将提供一个现实的画面，说明基于社区的心理社会干预对受战争影响的青年的效用。最终，这一努力所产生的证据基础可以为全球受战争影响的人口，包括美国的难民人口的政策和计划提供信息。 公共卫生关系：在塞拉利昂受战争影响的青年独特的纵向研究的基础上，拟议的研究打算解决目前文献中的几个关键差距对受战争影响的青年的心理社会干预。嵌入在一个随机的等待名单对照试验中，该项目将在64名15-24岁的青少年中进行为期三个月的随访，以衡量基于社区的心理社会干预的效果，提供有关这些努力的累积效益的重要信息，并衡量包括心理健康，社区和家庭关系，教育和就业在内的一系列成果的效益。此外，参与试验的所有青年（n=128）的收益将与干预措施的方案成本相关，以便更全面地代表干预措施的效率和财务可行性。