Implementing SafeCare Kenya to Reduce Noncommunicable Disease Burden: Building Community Health Workers' Capacity to Support Parents with Young Children

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Project Summary/Abstract In 2021, Kenya’s Ministry of Health’s Department of Non-Communicable Diseases (NCD) issued a strategic plan to “halt and reverse” the country’s rising NCD burden. Worldwide, the most common forms of NCD among children and adolescents are mental health disorders and injuries/violence. Ample research supports the causal pathway between early childhood adversity, in particular child maltreatment, and vulnerability to a range of NCD in later life through toxic stress and biological embedding. A major risk factor for NCD in Kenya is childhood maltreatment, with up to 70% of Kenyans report experiencing maltreatment during childhood typically by their parents due to lack of appropriate parenting skills, misunderstanding of child development, not providing proper medical attention, and obstacles to providing basic needs and adequate supervision. While parenting prevention programs are evidence-based approaches to remedy risk factors for NCD, and Kenya has begun the arduous task of addressing NCD burden, a significant gap remains in public health approaches to prevention work targeting the youngest Kenyans. The purpose of this R01 proposal is to conduct a Hybrid Type 2 study to examine the implementation and effectiveness of the recently adapted evidenced-based program, SafeCare, as a primary prevention approach to address the country’s NCD burden. SafeCare Kenya (SCK) improves parenting skills, reducing the likelihood of child maltreatment and subsequent risk for NCD. This project will continue the six-year partnerships amongst Africa Mental Health Research and Training Foundation (AMHRTF; Nairobi-based partner), Pacific University, Georgia State University and its National SafeCare Training and Research Center (SafeCare developers), and key country and regional stakeholders, including families, professionals, government, and researchers to scale-up and disseminate SCK. This project leverages Kenya’s Community Health Volunteers (CHV), the well-established and primary workforce for maternal and child physical health in Kenya, to implement the intervention. Virtual and in- person delivery modes will be examined to identify the best method for sustainability. Three specific aims will be accomplished in this 5-year study: (1) Determine clinical effectiveness of SCK using a parallel group multilevel-randomized trial. (2) Determine feasibility and probable utility of SCK implementation. (3) Initiate efforts to begin scale-up and sustainment of SCK across Kenya. We will recruit 312 families paired with 24 CHV randomly assigned to deliver SCK (16 Providers; 208 families) or care as usual (8 Providers; 104 families). Our project’s long-term goals are to: (1) build sustainable research and implementation capacity in Kenya and Africa and (2) disseminate a culturally relevant, evidence-based parenting program to promote children’s wellbeing and reduce risk of NCD across the lifespan.