Expanding the Reach of Evidence-Based Mental Health Treatment: Diffusion and Spillover of Mental Health Benefits Among Peer Networks and Caregivers of Youth Facing Compounded Adversity in Sierra Leone

扩大循证心理健康治疗的范围：在塞拉利昂面临复杂逆境的青少年的同伴网络和照顾者中传播和溢出心理健康益处

• 批准号: 10093136
• 负责人: Theresa Stichick Betancourt
• 金额: $ 61.63万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-11 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10093136
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Affect; Africa South of the Sahara; Anxiety; Asia; Behavior; Behavioral; Boston; Caregivers; Child; Cognitive; Cognitive Therapy; Consent; Control Groups; Cost Effectiveness Analysis; Costs and Benefits; Country; Data; Development; Diffuse; Diffusion; Ebola; Economics; Educational Materials; Effectiveness; Elements; Evaluation; Evidence based practice; Factor Analysis; Funding; Gender; Geographic Locations; German population; Government; Guilt; Health; Health Benefit; Health Care Costs; Health Services; Health Services Research; Household; Intervention; Investments; Knowledge; Learning; Link; Measurable; Measures; Mental Depression; Mental Health; Mental Health Services; Middle East; Outcome; Outcome Study; Outcomes Research; Participant; Peer Group; Penetration; Policies; Policy Maker; Population; Process; Provider; Public Health; Readiness; Recording of previous events; Reporting; Research; Research Design; Research Personnel; Resources; Schools; Sierra Leone; Social Network; Social Work; Stress; Symptoms; System; Techniques; Time; Violence; War; Widespread Disease; Youth; aged; base; behavioral health; biological adaptation to stress; care burden; college; commune; comparison intervention; cost; cost effectiveness; daily functioning; effective intervention; emotion dysregulation; emotion regulation; emotional distress; evidence base; experience; follow-up; functional disability; implementation framework; implementation intervention; implementation research; implementation science; implementation strategy; improved; innovation; intervention cost; intervention effect; intervention participants; low and middle-income countries; member; peer; peer networks; post-traumatic stress; scale up; service gap; skills; social; success; therapy design; therapy development; violence exposure

PROJECT SUMMARY The proposed study links with and leverages an ongoing scale up study of a cognitive behavioral therapy (CBT) based intervention, the Youth Readiness Intervention (YRI), among youth facing adversity in Sierra Leone that is currently being implemented in partnership with the Government of Sierra Leone (GoSL) and the Gesellschaft für Internationale Zusammenarbeit (GIZ). The YRI has demonstrated feasibility and effectiveness for improving emotion regulation and daily functioning in youth. This study aims to harness the mechanisms of natural diffusion of CBT techniques learned among peer groups and spillover phenomenon in reduction of burden to cohabitating caregivers. Preliminary studies of the YRI in Sierra Leone indicate both mechanisms occur. Researchers from the Boston College School of Social Work will examine the potential of the YRI to reach a larger segment of the population by examining the extent to which indirect effects result in measureable incremental health benefits (symptoms and functioning) among nonparticipants. Study aims are to investigate (1) mechanism of diffusion—the untargeted and unplanned spread of new practices among social network members—of YRI components and mental health benefits experienced by nonparticipant peers who learn YRI practices from YRI participants; (2) indirect mental health benefits experienced by nonparticipants among cohabitating caregivers of YRI participants (spillover effects); and (c) incremental health costs and benefits among YRI participants' caregivers and peers through cost-effectiveness and return on investment analysis. Study design includes a control group (current YRI participants and YRI nonparticipants). YRI participants and control participants who consent to the current study will nominate 3 peers in their social networks aged 18-24 and will also identify their primary cohabitating caregiver. Following consent, peers and caregivers will be assessed at baseline and 6-month follow-up on mental health, emotion regulation, daily functioning, and sense of burden (caregivers only). Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scale-up, to enhance knowledge exchange across global research networks. Assessing implementation research outcomes, including penetration of YRI effects and cost-effectiveness of the YRI as distinct outcomes will provide key information about the success of YRI implementation, thereby supporting decisions about whether to increase scale up efforts in Sub-Saharan Africa and other LMICs. Findings on diffusion of the YRI will inform the feasibility of peer-led interventions and the development of additional educational materials to amplify YRI components identified as most transferrable. Findings on spillover effects will inform the potential reach and penetration of evidence-based practices in LMICs. Lessons learned will inform the GoSL, GIZ, and development actors on investing in evidence-based mental health interventions in low-resource settings.

项目概要 拟议的研究与正在进行的认知行为疗法的扩大研究联系起来并利用它 在塞拉利昂面临逆境的青年中开展基于 CBT 的干预措施，即青年准备干预措施 (YRI) 利昂目前正在与塞拉利昂政府 (GoSL) 和 Gesellschaft für Internationale Zusammenarbeit (GIZ)。 YRI已证明可行性和有效性 改善青少年的情绪调节和日常功能。本研究旨在利用以下机制 所学到的 CBT 技术在同侪群体中自然传播，以及减少 同居照顾者的负担。对塞拉利昂 YRI 的初步研究表明这两种机制 发生。波士顿学院社会工作学院的研究人员将研究 YRI 的潜力： 通过检查间接影响在多大程度上影响到更大范围的人口 非参与者中可衡量的增量健康益处（症状和功能）。研究目标是 调查（1）传播机制——新实践在人群中无目标、无计划的传播 社交网络成员——YRI 组成部分以及非参与者同伴所经历的心理健康益处 向 YRI 参与者学习 YRI 实践； (2) 间接的心理健康益处 YRI 参与者的同居照顾者中的非参与者（溢出效应）； (c) 增进健康 通过成本效益和回报，了解 YRI 参与者的护理人员和同伴的成本和收益 投资分析。研究设计包括一个对照组（当前 YRI 参与者和 YRI 非参与者）。 同意当前研究的 YRI 参与者和对照参与者将在其社交媒体中提名 3 位同伴 18-24 岁的网络，还将确定他们的主要同居照顾者。经同意后，同行和 护理人员将在基线和 6 个月的随访中接受心理健康、情绪调节、日常护理等方面的评估。 功能和负担感（仅限护理人员）。研究结果还纳入了通用指标 实施科学，包括项目背景、评估和扩大规模的措施，以加强 全球研究网络之间的知识交流。评估实施研究成果， 包括 YRI 效应的渗透和 YRI 的成本效益，因为不同的结果将提供关键 有关 YRI 实施成功与否的信息，从而支持有关是否增加 YRI 的决策 加大在撒哈拉以南非洲和其他中低收入国家的努力。 YRI 传播的调查结果将告知 同伴主导的干预措施和开发额外教育材料以扩大 YRI 的可行性 被确定为最可转移的组件。关于溢出效应的调查结果将告知潜在的影响范围和 循证实践在中低收入国家的渗透。汲取的经验教训将告知国家政府、德国国际合作机构和 发展行为者在资源匮乏地区投资循证心理健康干预措施。