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

描述（由申请人提供）：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，这些儿童直接参与暴力。在塞拉利昂长达11年的内战（1991-2002）期间，征召儿童入伍是家常便饭。因此，儿童经常目睹或被迫犯下极端暴力行为；那些背井离乡的人通常被迫充当前线士兵、间谍和人肉盾牌。越来越多的文献继续概述了这种战争暴露的心理社会影响，包括焦虑、抑郁和创伤后压力的加剧。在各种冲突后环境中为受战争影响的青年实施了心理社会干预。在大多数情况下，干预措施代表了一揽子经验支持的行为治疗（esbt），它整合了心理教育，解决问题的技能，以及认知行为治疗和人际治疗技术的要素，这些已被证明可以影响从减轻创伤后应激障碍症状到改善适应行为的结果。然而，在大多数研究中，只调查了有限的心理健康结果，往往很少关注更广泛的功能结果，如家庭关系或教育成就。同样，干预措施的长期效果通常也没有报道，这使得干预措施的益处是否会随着时间的推移而增加没有答案。最后，财务成本很少记录在案。因此，目前尚不清楚复制干预措施在经济上是否可行。这项建议建立在塞拉利昂一项前瞻性纵向研究的基础上，该研究记录了过去十年受战争影响的青年的发展情况。这项提案的发起人，特蕾莎·贝当古博士，将对那些持续表现出不良心理社会功能的青少年实施一项随机等待名单的ESBT对照试验。利用一系列经过验证和适应文化的措施，将根据心理健康（抑郁、焦虑、敌意、创伤后应激反应和亲社会行为）的改善以及功能结果（包括社区和家庭关系、教育和就业）来衡量这一干预措施的影响。这项建议的目的是扩大这一努力

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.