Designing a digital, parent-led cognitive behavioural therapy-based intervention for young people with mental health problems in low-income settings

对于中低收入国家(LMIC)的年轻人来说，由于缺乏治疗师、耻辱和文化上适当的干预措施，获得治疗焦虑升高、情绪低落和情绪困扰等一般心理健康问题的护理极其困难。由年轻人完成的数字治疗干预是一种可能的解决方案，但它们也面临着重大挑战：流失率很高，长时间使用屏幕可能会对发育产生负面影响，而且LMIC中的年轻人可能无法单独接触智能手机或电脑。父母主导的治疗干预是一种有效的替代方案，父母具备以各种方式支持子女心理健康的技能，包括提供认知行为疗法(CBT)。最近，高收入国家已经开始开发数字家长主导的干预措施，以改善儿童心理健康。虽然这些干预措施显示出希望，但由于资金和交付基础设施的巨大差异，在低收入国家部署新的独立方案往往是不切实际的。经过严格设计的心理干预措施如果能够作为现有方案的一部分，并补充内容和重点，例如积极的育儿方案(Triple P，为终身健康育儿，不可思议的岁月)，就可以在LMIC中获得更大的影响，而LMIC中的数百万父母已经能够获得这些方案。教育父母管理孩子的心理健康是帮助儿童应对与低收入家庭和人道主义环境相关的心理痛苦的重要一步。我的研究将调查这在低收入环境下的可行性，确定可以整合到现有育儿计划中的数字、家长主导的CBT干预的重要内容和交付考虑。我们将与项目利益攸关方和参与者合作，共同设计一种数字干预措施，可以与现有的育儿计划整合，也可以作为一种简短的独立干预措施。然后，将测试数字育儿计划ParentText的现有实施方案中嵌入的可行性和可接受性。这项研究的潜在影响是双重的。首先，目前在LMIC中还没有可扩展的、由家长领导的针对儿童心理健康的治疗干预措施。通过参与性研究，这项工作将产生一种干预措施，可以在世界各地的LMIC中进行测试。其次，这种方法是新颖的，因为到目前为止还没有关于利用现有育儿方案的基础设施来提供针对儿童心理健康的数字、父母主导的治疗干预的研究。如果有效，这种方法可以极大地降低向数百万儿童提供初级精神卫生保健的复杂性。

For young people in low- and middle-income countries (LMICs), accessing care for general mental health problems such as elevated anxiety, depressed mood, and emotional distress is extremely difficult due to a lack of therapists, stigma, and culturally appropriate interventions. Digital therapeutic interventions that are completed by young people are one possible solution, but they also have significant challenges: attrition rates are high, long bouts of screen time can negatively impact development, and young people in LMICs may not have individual access to a smartphone or computer. Parent-led therapeutic interventions are an effective alternative, where parents are equipped with skills to support their child's mental health in a variety of ways, including by delivering cognitive-behavioural therapy (CBT). Recently, high-income countries have begun developing digital parent-led interventions for improving child mental health. While these interventions show promise, deploying new, standalone programmes in LMICs is oftenimpractical due to significant variations in funding and delivery infrastructure. Rigorously designed psychological interventions can have greater reach in LMICs if they can be delivered as part of existing programs with complimentary content and focus, such as positive parenting programmes (Triple P, Parenting for Lifelong Health, Incredible Years), which millions of parents in LMICs have already have access to. Teaching parents to manage their child's mental health is an important step in helping children cope with psychological distress associated with LMICs and humanitarian settings. My research will investigate the feasibility of this in a low-income setting, identifying the important content and delivery considerations for a digital, parent-led CBT intervention that can be integrated into existing parenting programmes. In collaboration with programme stakeholders and participants, we will co-design a digital intervention that can be integrated with existing parenting programmes or as a brief, standalone intervention. This will then be tested for feasibility and acceptability embedded in an existing implementation of a digital parenting programme, ParentText. The potential implications for this research are twofold. First, there are currently no scalable, digital parent-led therapeutic interventions for child mental health in LMICs. Through participatory research, this work will produce an intervention that can be tested in LMICs around the world. Second, this approach is novel, as there is no research to date on utilising an existing parenting programme's infrastructure to deliver a digital, parent-led therapeutic intervention for child mental health. If effective, this approach could greatly reduce the complexity of delivering primary mental health care to millions of children.