Attending to the “whole” child in mental health care: Utilizing a partnership approach to address social risk factors alongside an evidence-based psychotherapy

项目总结/摘要 社会风险因素，或人们出生、成长、生活和年龄增长的不利条件， 心理健康问题2，3和世界范围内较低的治疗参与。 风险因素（SRF）在中低收入国家尤其明显，在这些国家， 特别是儿童-有心理健康需要的人得到照顾。据我们所知，在全球精神卫生领域， 研究，我们还没有系统地开发和评估战略，以解决SRF与心理 健康治疗。这项研究建立在NIMH资助的肯尼亚试验的基础上， 儿童（基础）：在低资源环境中转移任务的精神卫生保健”（R 01 MH 112633）。的 研究目标是制定策略，在循证心理治疗的同时，解决和减轻SRF 8参与BASIC研究报告的非专业顾问和监护人 儿童参加了适应文化的EBP（以创伤为中心的认知行为疗法）9 经历了高比率的SRF（粮食不安全，缺乏支持系统），强烈呼吁改善 10 -12因此，该项目直接响应社区的需求， 鉴于战略成果框架的负面影响， 心理健康轨迹和治疗参与。本研究的目的是：（1）研究 SRFs以及通过定性访谈解决SRFs的障碍和促进因素， 接受BASIC治疗的PT顾问和监护人。2)协同设计有影响力的 在为期2天的研讨会期间，与主管和辅导员一起讨论治疗中的SRF的实用策略。 3)调查2天的培训是否符合制定的战略 和培训后监督 影响 辅导员层面的成果（例如，自我效能感/自我控制，有效性，可行性，和 战略成果框架战略的可接受性）。正如许多学者强调殖民主义的问题影响， 目前和过去的全球研究，13，14研究小组将积极反对殖民态度， 在整个研究过程中，在所有研究活动和决策过程中听取社区利益攸关方的意见。 通过这一项目制定的战略有可能提高参与和有效性， EBP在BASIC中，理想情况下将推广到全球其他EBP。我们的最终目标是提高 为中低收入国家有心理健康需求的个人提供的结果。

PROJECT SUMMARY/ABSTRACT Social risk factors, or adverse conditions in which people are born, grow, live, and age1, contribute to greater mental health problems2,3 and lower treatment engagement worldwide.4–7 The prevalence and impact of social risk factors (SRFs) are particularly pronounced in low-to-middle income countries, where too few individuals— and particularly children—with mental health needs receive care. To our knowledge, in global mental health research, we have not systematically developed and evaluated strategies to address SRFs alongside mental health treatments. This study builds on an NIMH-funded trial in Kenya, “Building and Sustaining Interventions for Children (BASIC): Task-Shifting Mental Health Care in Low-Resource Settings” (R01MH112633). The study goal is to develop strategies to address and mitigate SRFs alongside evidence-based psychotherapies (EBPs) using decolonizing methodologies.8 Lay counselors and guardians involved in the BASIC study report that children enrolled in the culturally-adapted EBP (Trauma-focused Cognitive Behavioral Therapy)9 experienced high rates of SRFs (food insecurity, lack of support system), with strong calls for improving outcomes by addressing SRFs in therapy.10–12 Thus, this project responds directly to community needs and addresses a documented challenge to the effective implementation of EBPs given the negative effect of SRFs on mental health trajectory and treatment engagement. The study aims to: 1) Examine the experience of SRFs and the barriers and facilitators to addressing SRFs in therapy through qualitative interviews with PT counselors and guardians who received therapy in BASIC. 2) Collaboratively design impactful and practical strategies to address SRFs in therapy during a 2-day workshop with supervisors and counselors. 3) Investigate whether a 2-day training in the developed strategies and post-training supervision impact counselor-level outcomes (e.g., perceived self-efficacy/self-control, effectiveness, feasibility, and acceptability of the SRF strategies). As many scholars have highlighted problematic influences of coloniality in current and past global research,13,14 the study team will actively work against colonial attitudes by privileging the voice of community stakeholders during all research activities and decision-making throughout the study. Strategies developed through this project have the potential to improve engagement in and effectiveness of the EBP in BASIC and ideally will be generalizable to other EBPs globally. Our ultimate goal is to improve outcomes for individuals with mental health needs in low-to-middle income countries.