Pragmatic RCT of a multi-level mechanistically informed community intervention to prevent the onset of behavioral health symptoms among socioeconomically disadvantaged pandemic affected children

项目摘要/摘要 新冠肺炎疫情正对全球儿童产生深刻影响，危及他们的安全感， 安全和行为健康。除了新冠肺炎，数以百万计的儿童仍在从最近的 袭击美国南部的飓风。暴露在气候灾害中的儿童(例如 飓风)是精神和行为健康挑战的重大风险。再加上经久不衰的 在大流行期间，这些儿童中的许多人面临不断升级的心理健康问题的风险不成比例。种族 生活在社会经济贫困社区的少数民族儿童是最多的 在大规模灾难期间和之后易受伤害。他们更有可能经历高水平的社交和 物质损失、流离失所以及无法获得心理和身体健康服务。因此，有一个 这些儿童迫切需要接受可获得的、有经验支持的预防性干预 减轻精神疾病和行为健康问题的发作。大多数灾后行为健康 干预措施的目的是治疗而不是预防心理健康状况，而且往往无法获得 生活在社会经济不利社区的少数族裔儿童。本研究的目的是： 因此，力求把考察新冠肺炎灾难改编的实施效果作为一个重点 经验性支持的预防干预，希望之旅(JOH)，由救助儿童会分发，a 人道主义组织，服务于社会经济弱势群体和少数族裔儿童 受新冠肺炎和最近袭击美国南部的飓风双重影响的社区。这个 这项研究的长期目标是：(1)满足可获得行为健康的迫切需求 旨在预防和/或减少新冠肺炎相关痛苦的干预措施；以及(2)提供理解 关于新冠肺炎量身定制的预防干预如何缓解种族和 处于高度贫困环境中的少数民族儿童，他们遭受了多次大规模灾难。在一个 本研究以800名3-8年级儿童为被试，进行实用型随机对照试验，旨在：目的1：评价 新冠肺炎改编的乔赫(JOH-C19)在预防行为健康和人际问题方面的效果 在社会经济上处于不利地位的儿童以及受到 多次大范围灾害相对健康的生活方式关注控制状况。目标2：检查是否 假设的变化机制变量(社会连通性、适应性应对、自我效能)起中介作用 Joh-C19与注意控制对儿童个体行为健康和人际关系的干预效应 结果。目标3：评估新冠肺炎相关压力源对行为健康的缓和影响 参加Joh-C19的儿童与对照条件下的结果。目标4：探索 在学校和课外环境中实施Joh-C19的障碍、促进者和可接受性 并由社区和学校辅导员提供。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic is having a profound impact on children globally, jeopardizing their sense of safety, security, and behavioral health. In addition to COVID-19, millions of children are still recovering from recent hurricanes that struck the southern the United States. Children exposed to climate-induced disasters (e.g. hurricanes) are at a significant risk for mental and behavioral health challenges. Coupled with an enduring pandemic, many of these children are disproportionately at risk for escalating mental health problems. Racial and ethnic minority children who live in socio-economically disadvantaged neighborhoods are among the most vulnerable during and after large-scale disasters. They are more likely experience high levels of social and material losses, displacement, and lack of access to mental and physical health services. Thus, there is a critical need for these children to received accessible, empirically supported preventative interventions to mitigate the onset of mental illness and behavioral health issues. Most post-disaster behavioral health interventions are designed to treat rather than prevent mental health conditions and are often inaccessible to racial and ethnic minority children living in socio-economically disadvantaged communities. The present study, therefore, seeks to examine the implementation and efficacy of the COVID-19 adaptation of a disaster focused empirically supported prevention intervention, the Journey of Hope (JoH), distributed by Save the Children, a humanitarian organization serving socio-economically disadvantaged and racial and ethnic minority children in communities dually impacted by COVID-19 and recent hurricanes that struck the Southern United States. The long-term goals of this study are to: (1) respond to the critical need of accessible behavioral health interventions designed to prevent and/or reduce COVID-19 related distress; and (2) provide an understanding on how a COVID-19 tailored prevention intervention mitigates behavioral health disparities among racial and ethnic minority children in high poverty settings who have been exposed to multiple large scale disasters. In a pragmatic randomized control trial with 800 children between 3-8th grade, we seek to: Aim 1: Evaluate the efficacy of the COVID-19 adapted JoH (JoH-C19) in preventing behavioral health and interpersonal problems among socio-economically disadvantaged and racial and ethnic minority children who have been exposed to multiple large-scale disasters relative to a healthy life-style attention control condition. Aim 2: Examine if hypothesized mechanisms of change variables (social connectedness, adaptive coping, self-efficacy) mediate intervention effects (JoH-C19 vs attention control) on child individual behavioral health and interpersonal outcomes. Aim 3: Assess the moderating impact of COVID-19 related stressors on behavioral health outcomes among children who participate in JoH-C19 versus the control condition. Aim 4: Explore implementation barriers, facilitators, and acceptability of the JoH-C19 within school and afterschool settings and delivered by community and school-based counselors.