Cognitive Behavioral Therapy for Orphans

说明(申请人提供)：背景：众所周知，艾滋病毒/艾滋病高流行地区的儿童有大量未得到满足的心理社会需求，特别是与父母死亡造成的悲痛和创伤有关的需求。与生病和垂死的父母生活在一起，然后伴随着父母死亡带来的生活变化，通常表现为情感困难、行为问题以及糟糕的健康和教育结果。我们团队和其他人早期研究的数据表明，在受影响的儿童中，与创伤相关的症状和儿童创伤性悲伤的频率很高。尽管包括非政府组织、社区组织和儿童福利组织在内的服务提供者提供心理社会支持服务，但仍需要循证干预，特别是关于悲伤的干预，适用于撒哈拉以南非洲的这些儿童。目的：使用认知行为疗法(CBT)方法对受创伤、慢性和多发性创伤以及创伤性悲痛影响的儿童进行干预被证明在较富裕的国家是有效的；关于CBT方法在资源贫乏地区使用的数据有限。创伤性悲伤的模型还没有在这些急需的领域得到系统的调整和测试。这项R34建议旨在审查a)如何使针对孤儿的循证CBT干预措施适应东非正在实施的现有监护人/孤儿支助模式；b)如何将新的以悲伤和丧亲为重点的群体模式纳入现有的社区照料基础设施；c)如何招募和留住儿童和照顾者；以及d)干预结果是否包括有利于儿童及其监护人福祉的结果。这项可行性研究的目的是产生初步数据，用于R01应用，以测试模型的有效性。研究设计：采用CBT模式的第一步是以社区为基础的参与性过程，以检查针对当地儿童的特定CBT干预措施的需求和适用性，以及如何将这些干预措施整合到当前针对孤儿及其监护人的心理社会支持模式中。这一步骤涉及服务提供者、监护人、儿童和我们现有的社区咨询委员会的焦点小组。然后，将招募4个治疗组，包括总共至少48名7-13岁的单身或双亲孤儿及其目前的监护人，进行为期4个16周的小组治疗。报名人员将从坦桑尼亚莫希及其周围的村庄招募。对儿童和他们的监护人进行情绪和行为健康方面的评估，包括治疗前、治疗后和随访时。结果：R34项目的预期结果包括：1)调整现有的基于西方的悲痛和丧亲治疗模式，2)综合模型的初步发现，以及3)承诺用于R01提案，以测试对资源贫乏地区的干预。这项研究旨在研究a)针对孤儿的循证CBT干预如何适应当地环境和坦桑尼亚的当地计划；b)如何将其整合到现有的社区公共卫生基础设施中；c)如何招募和留住儿童和照顾者；以及d)干预结果是否包括对儿童及其监护人的健康和心理社会福祉的良好结果。

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.