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

项目摘要 拟议的研究与正在进行的认知行为疗法研究相联系，并利用了该研究 (CBT)在塞拉利昂面临逆境的青年中， 目前正在与塞拉利昂政府和联合国开发计划署（开发署） Gesellschaft für Internationale Zusammenarbeit（GIZ）. YRI已经证明了可行性和有效性 改善青少年的情绪调节和日常功能。本研究旨在利用 同伴群体中学习到的CBT技术的自然扩散和减少 对同居照顾者的负担。对塞拉利昂YRI的初步研究表明， 发生.波士顿大学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 非参与者中可测量的增量健康益处（症状和功能）。研究目的是 研究（1）扩散机制-新做法在不同群体中的无针对性和无计划的传播 YRI成员的社会网络成员和非参与者同伴经历的心理健康益处 从YRI参与者那里学习YRI实践的人;（2） YRI参与者的同居照顾者中的非参与者（溢出效应）;以及（c）健康增量 YRI参与者的照顾者和同伴之间的成本和收益， 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）。 同意参与本研究的YRI参与者和对照参与者将在他们的社交网络中提名3名同伴。 网络，并将确定他们的主要同居照顾者。同意后，同行和 将在基线和6个月随访时评估护理人员的心理健康、情绪调节、每日 功能和负担感（仅照顾者）。研究成果还纳入了以下方面的共同指标： 实施科学，包括项目背景、评价和扩大规模的措施，以加强 通过全球研究网络进行知识交流。评估执行情况研究成果， 包括YRI效应的渗透和YRI的成本效益作为不同的结果将提供关键的 有关YRI实施成功的信息，从而支持是否增加 扩大在撒哈拉以南非洲和其他低收入国家的努力。YRI传播的结果将告知 同侪主导干预措施的可行性，以及编制更多的教育材料，以扩大青年倡议 被确定为最可转移的组件。关于溢出效应的调查结果将为潜在的影响范围提供信息， 在中低收入国家普及循证做法。吸取的经验教训将为斯里兰卡政府、德国国际合作署和 发展行为体在资源匮乏环境中投资于循证心理健康干预措施。

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.