Expanding the Reach of Evidence-Based Mental Health Treatment: Diffusion and Spillover of Mental Health Benefits Among Peer Networks and Caregivers of Youth Facing Compounded Adversity in Sierra Leone

项目总结 这项拟议的研究与正在进行的认知行为疗法的扩大研究相联系并发挥了作用。 在塞拉利昂面临逆境的青年中，基于CBT的干预措施--青年准备干预(YRI) 目前正在与塞拉利昂政府和 Zusammenarbeit(GIZ)。YRI已经证明了其可行性和有效性 用于改善青少年的情绪调节和日常功能。本研究的目的是利用这一机制 CBT技术在同龄人群体中的自然传播和减少的溢出现象 同居照顾者的负担。对塞拉利昂YRI的初步研究表明，这两种机制都 发生。来自波士顿学院社会工作学院的研究人员将研究YRI的潜力 通过检查间接影响在多大程度上导致 非参与者中可衡量的增量健康益处(症状和功能)。研究的目标是 调查(1)扩散机制--新做法的无目标和计划外传播 YRI组件的社交网络成员和非参与者同龄人体验的心理健康益处 谁从YRI参与者那里学习YRI实践；(2)通过以下方式获得的间接心理健康益处 YRI参与者的同居照顾者中的非参与者(溢出效应)；和(C)增量健康 通过成本效益和回报在YRI参与者的照顾者和同龄人中的成本和收益 投资分析。研究设计包括一个对照组(当前YRI参与者和YRI非参与者)。 同意当前研究的YRI参与者和对照参与者将在其社交网络中提名3个同龄人 18-24岁的网络，并将确定他们的主要同居照顾者。在征得同意后，同行和 照顾者将在基线上进行评估，并对精神健康、情绪调节、每日6个月的随访进行评估 功能和负担感(仅限照顾者)。研究结果还包括以下方面的共同指标 实施科学，包括项目背景、评估和扩大的措施，以加强 跨全球研究网络的知识交流。评估执行情况研究成果， 包括“长三角倡议”的渗透效应和“长三角倡议”的成本效益，作为不同的成果，将提供关键 关于成功实施YRI的信息，从而支持关于是否增加 加大在撒哈拉以南非洲和其他小岛屿发展中国家的努力。有关“青年政策研究所”推广工作的研究结果将告知 同行带头干预的可行性和开发额外的教育材料以扩大YRI 被确定为最具可转移性的组件。关于溢出效应的发现将为潜在的覆盖范围和 以证据为基础的做法在低收入国家的渗透率。吸取的经验教训将为全球服务体系、GIZ和 发展行为者在低资源环境下投资于基于证据的心理健康干预措施。

PROJECT SUMMARY The proposed study links with and leverages an ongoing scale up study of a cognitive behavioral therapy (CBT) based intervention, the Youth Readiness Intervention (YRI), among youth facing adversity in Sierra Leone that is currently being implemented in partnership with the Government of Sierra Leone (GoSL) and the Gesellschaft für Internationale Zusammenarbeit (GIZ). The YRI has demonstrated feasibility and effectiveness for improving emotion regulation and daily functioning in youth. This study aims to harness the mechanisms of natural diffusion of CBT techniques learned among peer groups and spillover phenomenon in reduction of burden to cohabitating caregivers. Preliminary studies of the YRI in Sierra Leone indicate both mechanisms occur. Researchers from the Boston College School of Social Work will examine the potential of the YRI to reach a larger segment of the population by examining the extent to which indirect effects result in measureable incremental health benefits (symptoms and functioning) among nonparticipants. Study aims are to investigate (1) mechanism of diffusion—the untargeted and unplanned spread of new practices among social network members—of YRI components and mental health benefits experienced by nonparticipant peers who learn YRI practices from YRI participants; (2) indirect mental health benefits experienced by nonparticipants among cohabitating caregivers of YRI participants (spillover effects); and (c) incremental health costs and benefits among YRI participants' caregivers and peers through cost-effectiveness and return on investment analysis. Study design includes a control group (current YRI participants and YRI nonparticipants). YRI participants and control participants who consent to the current study will nominate 3 peers in their social networks aged 18-24 and will also identify their primary cohabitating caregiver. Following consent, peers and caregivers will be assessed at baseline and 6-month follow-up on mental health, emotion regulation, daily functioning, and sense of burden (caregivers only). Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scale-up, to enhance knowledge exchange across global research networks. Assessing implementation research outcomes, including penetration of YRI effects and cost-effectiveness of the YRI as distinct outcomes will provide key information about the success of YRI implementation, thereby supporting decisions about whether to increase scale up efforts in Sub-Saharan Africa and other LMICs. Findings on diffusion of the YRI will inform the feasibility of peer-led interventions and the development of additional educational materials to amplify YRI components identified as most transferrable. Findings on spillover effects will inform the potential reach and penetration of evidence-based practices in LMICs. Lessons learned will inform the GoSL, GIZ, and development actors on investing in evidence-based mental health interventions in low-resource settings.