Cognitive Behavioral Therapy for Orphans

孤儿认知行为治疗

• 批准号: 7685965
• 负责人: KATHRYN WHETTEN
• 金额: $ 30.2万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-06 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7685965
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adult; Affect; Africa; Africa South of the Sahara; Age; Agreement; Anger; Anxiety; Area; Behavioral; Bereavement; Caregivers; Caring; Cessation of life; Child; Childhood; Chronic; Climacteric; Cognitive; Collaborations; Communication; Communities; Consensus; Country; Data; Decision Making; Dimensions; Elements; Emotional; Empathy; Environment; Event; Evidence based intervention; Evidence based program; Extended Family; Family; Feasibility Studies; Feedback; Focus Groups; Frequencies; Funding; Grief reaction; HIV Seropositivity; Health; High Prevalence; Individual; Intervention; Life; Medical; Medical center; Mental Health; Modeling; Morbidity - disease rate; Nutritional; Orphan; Outcome; Parents; Prevalence; Problem behavior; Process; Provider; Psychosocial Assessment and Care; Public Health; Recruitment Activity; Research; Research Design; Research Infrastructure; Resources; Schools; Series; Services; Social Network; Societies; Stress; Stretching; Supervision; Symptoms; System; Tanzania; Testing; Training; Trauma; Youth; aged; base; behavioral health; child well being; cognitive behavior therapy; depression; design; efficacy testing; evidence base; experience; follow-up; health economics; improved; member; mortality; programs; psychosocial; response; satisfaction; skills; therapy development

DESCRIPTION (provided by applicant): Background: Children in geographical areas with high prevalence HIV/AIDS are known to have significant unmet psychosocial needs, particularly those related to grief and trauma from parent death. Living with an ill and dying parent and, then, with the life changes that accompany parent death are often manifested as emotional difficulties, behavior problems, and poor health and educational outcomes. Data from earlier studies by our team and others demonstrate the high frequency of trauma-related symptoms and child traumatic grief among affected children. Although service providers, including NGOs, CBOs, and FBOs, offer psychosocial support services, there is a need for evidence-based intervention, particularly around grief, applicable to these children in sub-Saharan Africa. Aims: Interventions using cognitive behavioral therapy (CBT) approaches for children affected by trauma, chronic and multiple, and traumatic grief are shown to be effective in wealthier nations; there are only limited data on the use of CBT approaches in resource poor areas. The models for traumatic grief have not been systematically adapted and tested in these areas of high need. This R34 proposal is designed to examine a) how an evidence-based CBT intervention for orphaned children can be adapted to an existing guardian/orphan support model being carried out in East Africa,; b) how the new grief and bereavement focused group model can be integrated into the existing community care infrastructure; c) how children and caregivers can be recruited and retained; and d) whether the intervention results include promising outcomes for the well being of children and their guardians. This feasibility study is designed to result in preliminary data to be used for an R01 application to test the efficacy of the model. Research Design: The first step for adapting the CBT model involves a community based participatory process for examining the need and applicability of specific CBT interventions for local children as well as how these intervention can be integrated into the current psychosocial support model for orphans and their guardians. The step involves focus groups for service providers, guardians, children, and our existing community advisory board. Then, a sequence of 4 treatment groups, including a minimum of 48 total single or double orphans aged 7-13 and their current guardians will be recruited for a series of four 16 week group treatment sessions. The enrollees will be recruited from villages in and around Moshi, Tanzania. Children and their guardians are assessed pre-, post- and at follow-up on dimensions of emotional and behavioral well being. Outcomes: The anticipated outcomes from this R34 project include 1) an adaptation of existing Western based treatment models for grief and bereavement, 2) preliminary findings from the integrated model, and 3) promising to use for an R01 proposal testing the intervention in resource poor areas. This study is designed to examine a) how an evidence-based CBT intervention for orphaned children can be adapted to the local environment and a local program in Tanzania; b) how it can be integrated into the existing community public health infrastructure; c) how children and caregivers can be recruited and retained; and d) whether the intervention results include promising outcomes for the health and psychosocial well being of children and their guardians.

描述（由申请人提供）： 背景：已知艾滋病毒/艾滋病高发地区的儿童有显着未得到满足的社会心理需求，特别是那些与父母死亡造成的悲伤和创伤相关的需求。与生病和垂死的父母一起生活，以及伴随父母死亡而发生的生活变化，通常表现为情绪困难、行为问题以及健康和教育成果不佳。我们团队和其他人早期研究的数据表明，受影响的儿童中创伤相关症状和儿童创伤性悲伤的发生率很高。尽管包括非政府组织、社区组织和宗教组织在内的服务提供者提供社会心理支持服务，但仍需要适用于撒哈拉以南非洲儿童的基于证据的干预措施，特别是针对悲伤的干预措施。目的：在富裕国家，使用认知行为疗法 (CBT) 方法对遭受慢性和多重创伤以及创伤性悲伤影响的儿童进行干预被证明是有效的；关于在资源贫乏地区使用 CBT 方法的数据有限。创伤性悲伤的模型尚未在这些急需的领域进行系统的调整和测试。该 R34 提案旨在审查 a) 如何将针对孤儿的基于证据的 CBT 干预措施适应东非正在实施的现有监护人/孤儿支持模式； b) 如何将新的悲伤和丧亲之痛重点群体模式整合到现有的社区护理基础设施中； c) 如何招募和保留儿童和照顾者； d) 干预结果是否包括对儿童及其监护人的福祉有希望的结果。该可行性研究旨在得出初步数据，用于 R01 应用程序以测试模型的功效。研究设计：调整 CBT 模式的第一步涉及基于社区的参与过程，以审查特定 CBT 干预措施对当地儿童的需求和适用性，以及如何将这些干预措施纳入当前针对孤儿及其监护人的心理社会支持模式。这一步骤涉及服务提供者、监护人、儿童以及我们现有的社区咨询委员会的焦点小组。然后，将招募一系列 4 个治疗组，包括至少 48 名 7-13 岁的单人或双人孤儿及其当前监护人，进行一系列 4 次为期 16 周的小组治疗。参与者将从坦桑尼亚莫希及其周边的村庄招募。对儿童及其监护人在情绪和行为健康方面进行事前、事后和后续评估。成果：R34 项目的预期成果包括 1) 对现有西方悲伤和丧亲之痛的治疗模型进行调整，2) 综合模型的初步结果，以及 3) 承诺用于测试资源贫乏地区干预措施的 R01 提案。本研究旨在探讨 a) 如何使针对孤儿的基于证据的 CBT 干预措施适应坦桑尼亚的当地环境和当地计划； b) 如何将其融入现有的社区公共卫生基础设施； c) 如何招募和保留儿童和照顾者； d) 干预结果是否包括对儿童及其监护人的健康和社会心理福祉有希望的结果。