Effectiveness and Implementation of an Early Childhood School-Based Mental Health Intervention in Low-Resource Communities

摘要 中低收入儿童精神、神经和物质(MNS)障碍的负担 国家(LMIC)数量巨大。尽管已经努力改善心理健康干预措施和 为幼儿提供的服务，以及在高收入人群中开展的一些循证干预措施 国家已经被成功地运送，并被证明对改善儿童的 在低收入中等收入国家的心理健康方面，仍然存在许多严重差距。从有效性研究的角度来看，大多数EBI 适应LMIC的情况尚未得到广泛推广、审查有效性和机制或将重点放在 儿童早期的预防性干预。从实现的角度来看，LMIC中的大多数EBI依赖于 因精神卫生专业人员(MHPS)短缺而采取的任务转移实施方法； 然而，与任务转移相关的挑战很少得到解决。此应用程序的总体目标是 通过研究人口-EBI方法促进儿童早期发展的有效性来应对这些差距 一个LMIC-乌干达的精神健康，以及同时研究应对任务转移的策略 最大限度地提高EBI有效性的挑战。这项研究中考虑的EBI是ParentCorps-Professional 发展(PD)，一个以学校为基础的EBI，培训和支持教师应用EBI战略来促进 儿童心理健康。PD方法代表了一种通过转换来实现心理保健的任务转换模式 从专业人员到教师的预防责任，以促进儿童的心理健康。两项功效研究 在乌干达和尼泊尔进行的工作证明了任务转移的可行性，并对 儿童、教师和学校拟议的研究建立在积极证据和进一步研究的基础上 使用可扩展实施的PD的有效性、成本效益和基本机制 在乌干达的多个地区采用了这一方法。此外，根据此前的调查结果，近80%的乌干达人 教师(EBI策略使用者)经历职业压力，这威胁到PD的吸收、有效性、 和支持，我们建议测试教师压力管理包(T-Wellness)作为增强 致警局。使用混合整群随机对照试验(CRCT)，我们将随机抽取36所学校和540所学校 教师和1,980对亲子对以下三种情况之一：PD+T-Wellness(PDT)、单独PD(PD)和 控制力。具体目标是：1)评估PD和PDT的短期和长期疗效， 2)检验PD和PDT的有效性机制和变化理论； 以及3)审查有助于有效转移任务的执行背景因素和机制 以及教师在PD和PDT学校中采用EBI策略的情况。

ABSTRACT The burden of pediatric mental, neurological, and substance (MNS) disorders in low-and middle-income countries (LMICs) is tremendous. Although efforts have been made to improve mental health interventions and services for young children, and a number of evidence-based interventions (EBIs) developed in high-income countries have been successfully transported and demonstrated to be efficacious for improving children’s mental health in LMICs, many critical gaps remain. From the effectiveness research perspective, most EBIs adapted to LMICs have not been scaled widely, examined effectiveness and mechanisms, or focused on preventive interventions in early childhood. From the implementation perspective, most EBIs in LMICs rely on task-shifting approach of implementation because of shortage of mental health professionals (MHPs); however, challenges related to task-shifting have rarely been addressed. The overall goal of this application is to respond to these gaps by studying effectiveness of a population-approach EBI to promote early childhood mental health in one LMIC-Uganda, as well as simultaneously studying strategies that address task-shifting challenges to maximize EBI effectiveness. The EBI considered in this study is ParentCorps-Professional Development (PD), a school-based EBI that trains and support teachers to apply EBI strategies to promote child mental health. The PD approach represents a task-shifting model of mental healthcare by shifting preventive duties from professionals to teachers to promote children’s mental health. Two efficacy studies conducted in Uganda and Nepal have demonstrated feasibility of task-shifting, and positive impacts on children, teachers and schools The proposed study builds on the positive evidence and further study effectiveness, cost-effectiveness, and underlying mechanisms of PD using a scalable implementation approach in multiple regions in Uganda. In addition, based on previous findings that nearly 80% of Ugandan teachers (the EBI strategy users) experience occupational stress which threatens PD uptake, effectiveness, and sustainment, we propose to test a teacher stress management package (T-Wellness) as an enhancement to PD. Using a hybrid cluster randomized controlled trial (cRCT), we will randomize 36 schools with 540 teachers and 1,980 parent-child pairs to one of three conditions: PD + T-Wellness (PDT), PD alone (PD), and control. The Specific Aims are: 1) to evaluate the short- and longer-term effectiveness of PD and PDT, relative to control; 2) to examine effectiveness mechanisms and theory of change underlying the PD and PDT; and 3) to examine implementation contextual factors and mechanisms that contribute to effective task-shifting and teachers’ uptake of EBI strategies within PD and PDT schools.