Evaluation of a Community-Based Psychosocial Intervention for War-Affected Youth

描述(申请人提供)：目前，有10多亿儿童生活在受武装冲突影响的国家，在许多情况下，这些儿童直接卷入暴力。在塞拉利昂长达11年的内战(1991-2002年)背景下，征募儿童加入武装部队是例行公事。因此，儿童经常目睹或被迫实施极端暴力行为；那些背井离乡的儿童通常被迫充当前线士兵、间谍和人体盾牌。越来越多的文献继续概述这种战争暴露的心理社会影响，其中包括高度焦虑、抑郁和创伤后应激。在各种冲突后环境中对受战争影响的青年进行了心理社会干预。在大多数情况下，干预措施代表了一整套经验支持的行为治疗(ESBT)，其中整合了心理教育、解决问题的技能以及认知行为治疗和人际治疗技术的元素，事实证明，这些治疗方法可以影响从减少创伤后应激障碍症状到改善适应行为的各种结果。然而，在大多数研究中，只调查了有限的一系列心理健康结果，往往很少关注更广泛的功能结果，如家庭关系或教育程度。同样，干预的长期影响通常不会被报告，没有回答干预的好处是否会随着时间的推移而增加。最后，财务成本很少被记录在案。因此，目前尚不清楚复制干预在财务上是否可行。这项建议建立在塞拉利昂一项前瞻性纵向研究的基础上，该研究记录了过去十年受战争影响的青年的发展。这项提议的发起人Theresa Betancourt博士将实施一项随机的等待名单对照试验，对继续表现出心理社会功能较差的青少年进行ESBT。利用一系列经过验证和文化适应的措施，将从心理健康(抑郁、焦虑、敌意、创伤后应激反应和亲社会行为)的改善以及包括社区和家庭关系、教育和就业在内的功能结果来衡量这一干预措施的影响。这项提议的目的是扩大这一努力。 通过帮助对初始治疗队列(n=)进行三个月的随访，以及将衡量的收益组合与干预的方案成本联系起来。虽然三个月的跟踪调查将调查干预效益是否随着时间的推移继续积累，并提供关于干预有效性的进一步证据，但收集有关方案成本的数据将提供干预的财务可行性和效率的指数 以每个结果的美元计算。这两个组成部分结合在一起，将为受战争影响的青年提供一幅以社区为基础的心理社会干预的实际效用的图景。最终，这一努力产生的证据基础可以为全球受战争影响人口的政策和计划提供信息，包括美国的难民人口。 与公共卫生的相关性：拟议的研究以对塞拉利昂受战争影响的青年的独特纵向研究为基础，旨在解决目前关于对受战争影响的青年进行心理社会干预的文献中的几个重大空白。该项目嵌入了一项随机的等待名单对照试验，将在三个月后对15-24岁的青少年进行社区心理社会干预，提供有关此类努力累积好处的重要信息，并衡量包括心理健康、社区和家庭关系、教育和就业在内的一系列结果的好处。此外，参加试验的所有青年(n=128)的福利将与干预措施的方案费用有关，以便更全面地反映干预措施的效率和财务可行性。

DESCRIPTION (provided by applicant): Presently, over one billion children live in countries affected by armed conflict, and in many cases these children are directly involved in the violence. In the context of Sierra Leone's 11-year civil war (1991-2002), conscription of children into armed forces was routine. As a result, children often witnessed or were forced to commit acts of extreme violence; those uprooted from their families were typically coerced to function as front- line soldiers, spies and human shields. A growing literature continues to outline the psychosocial effects of such war exposures, which includes heightened levels of anxiety, depression, and posttraumatic stress. Psychosocial interventions for war-affected youth have been implemented in a diversity of post-conflict settings. In most instances, interventions represent a package of empirically-supported behavioral treatments (ESBTs) which integrate elements of psycho-education, problem-solving skills, as well as cognitive-behavioral therapy and interpersonal therapy techniques, which have been shown to affect outcomes ranging from reductions in PTSD symptoms to improvements in adaptive behavior. However, in most studies only a limited array of mental health outcomes are investigated, often with little attention to broader functional outcomes such as family relations or educational attainment. Likewise, the longer-term effects of interventions are not typically reported, leaving unanswered whether intervention benefits accrue over time. Lastly, financial costs are rarely documented. As such, it remains unclear whether replication of interventions is financially feasible. This proposal builds off of a prospective longitudinal study in Sierra Leone, which has chronicled the development of war-affected youth over the past ten years. The sponsor of this proposal, Dr. Theresa Betancourt, will be implementing a randomized wait-listed control trial of an ESBT for youth who continue to demonstrate poor psychosocial functioning. Utilizing a series of measures which have been validated and culturally-adapted, the impacts of this intervention will be measured in terms of improvements in mental health (depression, anxiety, hostility, posttraumatic stress reactions and prosocial behavior) as well as functional outcomes including community and family relations, education and employment. The intention of this proposal is to extend this effort by helping conduct a three month follow-up with the initial treatment cohort (n=64), as well as by relating the portfolio of measured benefits to the programmatic costs of the intervention. While three month follow-up will investigate whether intervention benefits continue to accrue over time and lend further evidence regarding intervention effectiveness, collection of data on programmatic costs will provide an index of the intervention's financial feasibility and efficiency in terms of dollars per outcome. Together, these two components will provide a realistic picture of the utility of a community-based psychosocial intervention for war- affected youth. Ultimately, the evidence base generated by this effort can serve to inform policies and programs for war-affected populations globally, including refugee populations in the United States. PUBLIC HEALTH RELEVANCE: Building on a unique longitudinal study of war-affected youth in Sierra Leone, the proposed research intends to address several critical gaps in the current literature on psychosocial interventions for war-affected youth. Embedded within a randomized wait-listed control trial, this project will measure the effects of a community-based psychosocial intervention at three months follow-up in 64 youth ages 15-24, providing important information on the accumulated benefits of such efforts, and measuring benefits across an array of outcomes including mental health, community and family relations, education and employment. Furthermore, benefits for all youth participating in the trial (n=128) will be related to the programmatic costs of the intervention in order to provide a more comprehensive representation of the intervention's efficiency and financial feasibility.