Pragmatic RCT of a multi-level mechanistically informed community intervention to prevent the onset of behavioral health symptoms among socioeconomically disadvantaged pandemic affected children

多层次、机械化的社区干预的务实随机对照试验，以预防受大流行影响的社会经济弱势儿童出现行为健康症状

• 批准号: 10670793
• 负责人: Tara Leytham-Powell
• 金额: $ 64.09万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670793
• 关键词: Address; Affect; Alabama; Anxiety; Attenuated; Behavior; COVID-19; COVID-19 impact; COVID-19 pandemic; Caregivers; Child; Childhood; Climate; Communities; Consolidated Framework for Implementation Research; Control Groups; Coping Behavior; Coping Skills; Coupled; Diagnosis; Disasters; Distress; Education; Elements; Exposure to; Family; Future; Goals; Hurricane; Individual; Intervention; Life Cycle Stages; Link; Mediating; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Morbidity - disease rate; National Institute on Minority Health and Health Disparities; New Zealand; Oklahoma; Outcome; Parents; Poverty; Poverty Areas; Prevention; Prevention program; Professional counselor; Randomized; Randomized, Controlled Trials; Research; Resources; Risk; SARS-CoV-2 exposure; Safety; Schools; Security; Self Efficacy; Symptoms; Time; United States; Well in self; Wildfire; arm; attentional control; behavioral health; behavioral health intervention; community intervention; community organizations; coping; design; effective intervention; efficacy evaluation; eighth grade; emotional distress; ethnic minority; experience; follow up assessment; future pandemic; health disparity; healthy lifestyle; high risk; implementation barriers; improved; intervention effect; minority children; mortality; neighborhood disadvantage; pandemic disease; pandemic impact; pediatric trauma; peer; peer support; physical health service; poor communities; post intervention; preservation; prevent; preventive intervention; prospective; protective factors; public health emergency; racial minority; skills; social; social health determinants; socioeconomic disadvantage; stressor; therapy design

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic is having a profound impact on children globally, jeopardizing their sense of safety, security, and behavioral health. In addition to COVID-19, millions of children are still recovering from recent hurricanes that struck the southern the United States. Children exposed to climate-induced disasters (e.g. hurricanes) are at a significant risk for mental and behavioral health challenges. Coupled with an enduring pandemic, many of these children are disproportionately at risk for escalating mental health problems. Racial and ethnic minority children who live in socio-economically disadvantaged neighborhoods are among the most vulnerable during and after large-scale disasters. They are more likely experience high levels of social and material losses, displacement, and lack of access to mental and physical health services. Thus, there is a critical need for these children to received accessible, empirically supported preventative interventions to mitigate the onset of mental illness and behavioral health issues. Most post-disaster behavioral health interventions are designed to treat rather than prevent mental health conditions and are often inaccessible to racial and ethnic minority children living in socio-economically disadvantaged communities. The present study, therefore, seeks to examine the implementation and efficacy of the COVID-19 adaptation of a disaster focused empirically supported prevention intervention, the Journey of Hope (JoH), distributed by Save the Children, a humanitarian organization serving socio-economically disadvantaged and racial and ethnic minority children in communities dually impacted by COVID-19 and recent hurricanes that struck the Southern United States. The long-term goals of this study are to: (1) respond to the critical need of accessible behavioral health interventions designed to prevent and/or reduce COVID-19 related distress; and (2) provide an understanding on how a COVID-19 tailored prevention intervention mitigates behavioral health disparities among racial and ethnic minority children in high poverty settings who have been exposed to multiple large scale disasters. In a pragmatic randomized control trial with 800 children between 3-8th grade, we seek to: Aim 1: Evaluate the efficacy of the COVID-19 adapted JoH (JoH-C19) in preventing behavioral health and interpersonal problems among socio-economically disadvantaged and racial and ethnic minority children who have been exposed to multiple large-scale disasters relative to a healthy life-style attention control condition. Aim 2: Examine if hypothesized mechanisms of change variables (social connectedness, adaptive coping, self-efficacy) mediate intervention effects (JoH-C19 vs attention control) on child individual behavioral health and interpersonal outcomes. Aim 3: Assess the moderating impact of COVID-19 related stressors on behavioral health outcomes among children who participate in JoH-C19 versus the control condition. Aim 4: Explore implementation barriers, facilitators, and acceptability of the JoH-C19 within school and afterschool settings and delivered by community and school-based counselors.

项目概要/摘要 COVID-19 大流行正在对全球儿童产生深远影响，危及他们的安全感， 安全和行为健康。除了 COVID-19 之外，数百万儿童仍在从最近的疫情中恢复中 袭击美国南部的飓风。遭受气候引发灾害的儿童（例如， 飓风）面临着精神和行为健康挑战的重大风险。再加上经久不衰的 新冠疫情大流行期间，这些儿童中的许多人面临着心理健康问题不断升级的风险。种族 生活在社会经济弱势社区的少数民族儿童是最贫困的儿童之一 大规模灾害期间和之后的脆弱性。他们更有可能经历高水平的社交和 物质损失、流离失所以及无法获得精神和身体健康服务。因此，有一个 这些儿童迫切需要获得可获得的、经经验支持的预防性干预措施 减轻精神疾病和行为健康问题的发作。大多数灾后行为健康 干预措施的目的是治疗而不是预防心理健康问题，而且往往无法为人们所接受。 生活在社会经济弱势社区的种族和族裔少数儿童。目前的研究， 因此，旨在研究以灾难为重点的 COVID-19 适应措施的实施和效果 经验支持的预防干预措施，即“希望之旅”(JoH)，由救助儿童会 (Save the Children) 分发， 为社会经济弱势儿童以及种族和族裔少数儿童提供服务的人道主义组织 社区受到 COVID-19 和最近袭击美国南部的飓风的双重影响。这 本研究的长期目标是：(1) 满足可及的行为健康的迫切需求 旨在预防和/或减少与 COVID-19 相关的痛苦的干预措施； (2) 提供理解 关于 COVID-19 量身定制的预防干预措施如何减轻种族和群体之间的行为健康差异 遭受多次大规模灾害的高度贫困环境中的少数民族儿童。在一个 对 800 名 3-8 年级儿童进行的务实随机对照试验，我们力求： 目标 1：评估 适应 COVID-19 的 JoH (JoH-C19) 在预防行为健康和人际关系问题方面的功效 社会经济弱势儿童以及曾接触过的种族和族裔儿童 多次大规模灾害与健康生活方式注意力控制状况相关。目标 2：检查是否 假设的变化变量机制（社会联系、适应性应对、自我效能）调解 对儿童个体行为健康和人际交往的干预效果（JoH-C19 与注意力控制） 结果。目标 3：评估 COVID-19 相关压力源对行为健康的调节影响 参加 JoH-C19 的儿童与对照条件下的结果。目标 4：探索 JoH-C19 在学校和课外环境中的实施障碍、促进因素和可接受性 由社区和学校的辅导员提供。