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Youth as community mental health workers in humanitarian settings: A pilot test of the mechanisms of effect on their own well being

青年作为人道主义环境中的社区心理卫生工作者：对其自身福祉影响机制的试点测试

基本信息

批准号：
10684905
负责人：
Rima Afifi
金额：
$ 11.78万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2024-08-31
项目状态：
已结题

项目摘要

There are 1.8 billion young people in the world today. If engaged effectively, youth are resources and agents of change in their communities. Involving youth in work that impacts their communities has positive outcomes for youth wellbeing; and for their communities. But, youth are often marginalized, particularly in humanitarian settings. Youth wellbeing is linked to seven key protective factors: positive emotions, hope, relationships, meaning, accomplishments, autonomy, and engagement. Understanding protective factors as potential mechanisms for intervention-related change in wellbeing is a priority for research in humanitarian settings. If youth are to be meaningfully engaged as intervention agents, their work should focus on a community need. Humanitarian crises increase mental health disorders; and `normal' distress and psychological reactions affect a large percentage of the population. Yet, human resources for health are often insufficient to meet needs. Understanding the capacities of youth to support communities in the context of disasters has been noted as a research imperative. Globally, task-sharing interventions train non-professional lay community members to provide mental health care. As one example, Problem Management Plus (PM+) trains community mental health workers (CMHW) and is effective in humanitarian settings for common mental disorders and for mental distress and other problems that emerge in response to crises. We propose to engage youth – aged 18-24 years, as youth CMHW, to implement PM+ with at-risk adults (18+ years) in their communities. The Syrian refugee crises, one of the worst humanitarian crises in recent history, provides a relevant setting to implement this project. Lebanon hosts ~1.5 million Syrian refugees, and about 60% of Syrian refugees aged 15-24 years are not employed, and not in school. The Specific Aims are: Aim 1: Assess the effectiveness of being a Y-CMHW on their wellbeing, resilience, and stress levels; as compared to an equivalent control group (ECG) of Syrian refugee peers. Aim 2: Identify the mechanisms associated with changes in wellbeing, resilience, and stress. Our conceptual model describes links between the intervention, the mechanisms, and outcomes. Aim 3: Evaluate the feasibility, acceptability and fidelity of Syrian refugee youth as CMHW implementing PM+ with clients using RE-AIM as a framework for collecting implementation data. A community-engaged research approach will involve community members, including youth, in all aspects of the research project. Our results will (a) elucidate critical mechanisms through which engagement of youth to support their community enhances their own wellbeing; (b) inform research around humanitarian/refugee settings, mental health, and Y-CMHW interventions; and (c) provide a robust basis for a follow-up study via a larger RCT. Though we assess the impact of Y- CMHW in the Syrian refugee context, the premise of this intervention and its findings are equally relevant to natural emergency situations/disasters, such as in the USA.

当今世界上有18亿年轻人。如果青年有效参与，他们将成为社区变革的资源和推动者。让青年参与影响其社区的工作对青年的福祉有积极的影响；对他们的社区也是如此。但是，青年往往被边缘化，特别是在人道主义环境中。青少年的幸福与七个关键的保护因素有关：积极情绪、希望、人际关系、意义、成就、自主和参与。理解保护因素作为干预相关的福祉变化的潜在机制是人道主义研究的优先事项。如果要使青年有意义地作为干预人员参与，他们的工作应侧重于社区需要。人道主义危机加剧了精神健康障碍；“正常”的痛苦和心理反应影响了很大一部分人。然而，保健方面的人力资源往往不足以满足需要。了解青年在灾害情况下支持社区的能力已被认为是一项研究的当务之急。在全球范围内，任务分担干预措施培训非专业的非专业社区成员提供精神卫生保健。例如，“问题管理+”培训社区精神卫生工作者，并在人道主义环境中对常见精神障碍、精神痛苦和应对危机时出现的其他问题有效。我们建议让18-24岁的青年作为青年CMHW，在他们的社区中对有风险的成年人（18岁以上）实施PM+。叙利亚难民危机是近代史上最严重的人道主义危机之一，为实施这一项目提供了相关环境。黎巴嫩收容了约150万叙利亚难民，年龄在15-24岁之间的叙利亚难民中约有60%没有工作，也没有上学。具体目标是：目标1：评估Y-CMHW对他们的幸福感、适应力和压力水平的影响；与同等对照组（ECG）的叙利亚难民同龄人相比。目标2：确定与幸福感、适应力和压力变化相关的机制。我们的概念模型描述了干预、机制和结果之间的联系。目标3：使用RE-AIM作为收集实施数据的框架，评估叙利亚难民青年作为CMHW与客户实施PM+的可行性、可接受性和保真度。社区参与的研究方法将使社区成员，包括青年，参与研究项目的各个方面。我们的研究结果将(a)阐明青年参与支持社区的关键机制，从而提高他们自己的福祉；(b)为围绕人道主义/难民环境、心理健康和Y-CMHW干预措施的研究提供信息；(c)通过更大规模的随机对照试验为后续研究提供可靠的基础。虽然我们评估了Y- CMHW在叙利亚难民背景下的影响，但这种干预的前提及其结果同样与自然紧急情况/灾害相关，例如在美国。