Optimizing prevention approaches for children reintegrating from orphanages in Azerbaijan

摘要 据联合国估计，全球有200万至800万儿童生活在孤儿院和孤儿院国家。 在前苏联和东欧，接受机构照料的儿童人数最多 全世界--多达130万儿童。由于苏联解体后的经济危机， 阿塞拜疆收容了大量的“社会孤儿”，即贫困父母留在国营学校的儿童。 机构职能体系多年的贫困，与父母分离，以及在孤儿院的虐待严重加剧了 被收容儿童出现心理健康问题的风险。然而，目前的非机构化和 家庭团聚倡议提供基本的个案管理服务，但不解决精神健康问题。 机构儿童的问题，不注意与贫困有关的因素， 制度化首先。预防6-12岁儿童的心理健康问题 与他们在阿塞拜疆的生物或大家庭团聚，拟议的研究将完善和测试三个 循证干预方法（a）加强家庭干预; B）心理健康筛查; 转诊治疗; c）以儿童储蓄账户的形式增强经济权能。基于 研究小组与当地社区合作委员会合作进行的形成性研究， 对干预部分进行了调整，以最大限度地适应阿塞拜疆的文化背景。在 在一项拟议的研究中，将对400名儿童-照顾者二人组进行测试， 多阶段优化战略（MOST），比较不同的干预措施， 最优组合该研究将测试每个干预成分对儿童心理健康的影响 结果（抑郁、焦虑症状;破坏性行为;创伤后症状;和干扰 附件）。如果有效的话，研究结果可以改变大规模的去机构化举措 儿童基金会或其他组织在阿塞拜疆和前苏联地区执行的项目。该研究报告指出， NIMH全球心理健康目标B的重大挑战（高级预防和 实施早期干预）：1）制定适合当地的战略，消除虐待儿童现象 2）制定干预措施，减少儿童社会经济地位低下的长期负面影响 心理健康的问题此外，R 01申请的目标是加强当地的研究专长， 对预防儿童心理健康的个人、家庭和结构性干预措施进行测试和调整 问题通过培训和合作研究，该项目将提高知识和技能：1） 儿童预防性心理健康干预措施的核心组成部分和变化机制 创伤、虐待和剥夺的历史; 2）采用多层次循证干预措施， 3）方法和统计 评估具有多个组成部分的复杂干预措施的技术。

ABSTRACT The UN estimates that globally between 2 to 8 million children live in orphanages and the countries of the former Soviet Union (fSU) and Eastern Europe have the highest number of children in institutional care worldwide--up to 1.3 million children. Due to the economic crisis following the collapse of the Soviet Union, Azerbaijan hosts a large population of “social orphans,” children left by destitute parents in state-run institutions. Years of deprivation, separation from parents, and maltreatment in orphanages severely heighten the risk of mental health problems among institutionalized children. However, current deinstitutionalization and family reunification initiatives provide basic case management services, but do not address the mental health problems of institutionalized children and do not attend to the poverty-related factors that led to institutionalization in the first place. To prevent mental health problems among 6-12 children from orphanages reunited with their biological or extended families in Azerbaijan, the proposed study will refine and test three evidence-based intervention approaches (a) family strengthening intervention; b) mental health screening and referral for treatment; and c) economic empowerment in the form of Child Savings Accounts). Based on the formative research conducted by the study team in collaboration with a local Community Collaborative Board, the intervention components have been adapted to maximize fit to the cultural context of Azerbaijan. In the proposed study, the adapted interventions will be tested with 400 child-caregiver dyads in a trial using the Multiphase Optimization Strategy (MOST) to compare different intervention components and identify the most optimal combination. The study will test effects of each intervention component on children's mental health outcomes (symptoms of depression, anxiety; disruptive behaviors; post-traumatic symptoms; and disturbances of attachment). If efficacious, the study results study could transform large-scale deinstitutionalization initiatives implemented by UNICEF or other organizations in Azerbaijan and in the fSU region. The study addresses top two challenges within the NIMH Grand Challenges in Global Mental Health Goal B (Advance prevention and implementation of early interventions): 1) to develop locally appropriate strategies to eliminate childhood abuse and 2) to develop interventions to reduce the long-term negative impact of low childhood socioeconomic status on mental health. Additionally, the goal of this R01 application is to strengthen the local research expertise in testing and adaptation of individual, family, and structural interventions for preventing child mental health problems. Through training and collaborative research, the project will enhance knowledge and skills in: 1) core components and mechanisms of change in preventive mental health interventions for children with a history of trauma, abuse and deprivation; 2) adaptation of multilevel evidence-based interventions and measurement tools to a new socio-cultural context of a fSU country; 3) methodological and statistical techniques for evaluating complex interventions with multiple components.