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

项目摘要/摘要 社会风险因素，或人们出生、成长、生活和年龄的不利条件，导致更大的 世界范围内2，3和更低的治疗参与度问题。4-7社会心理健康问题的流行率和影响 风险因素(SRF)在中低收入国家尤为明显，那里的个人太少- 特别是有心理健康需求的儿童得到照顾。据我们所知，在全球精神健康方面 在研究中，我们没有系统地开发和评估应对SRF和心理问题的策略 健康治疗。这项研究建立在NIMH资助的肯尼亚一项试验的基础上，该试验名为“建立和维持干预措施” 儿童(基础)：低资源环境下的任务转移心理健康护理“(R01MH112633)。这个 研究目标是在循证心理治疗的同时，制定应对和缓解自发性神经功能障碍的策略 (EBPS)使用非殖民化方法。8参与基础研究报告的非殖民化顾问和监护人 参加适应文化的EBP(以创伤为中心的认知行为治疗)的儿童9 经历了高SRF率(粮食不安全、缺乏支持系统)，强烈要求改善 10-12因此，该项目直接回应了社区的需求和 鉴于战略框架的负面影响，解决了对有效执行循证政策的书面挑战 心理健康轨迹和治疗参与度。这项研究的目的是：1)考察 在治疗中通过定性访谈解决SRF的障碍和促进者 接受基础治疗的PT辅导员和监护人。2)协作设计有影响力的 在与主管和辅导员的为期两天的研讨会期间，解决治疗中的SRF的实用策略。 3)调查两天的培训是否在制定的策略中 和培训后监督 影响 辅导员级别的结果(例如，感知的自我效能/自我控制、有效性、可行性和 战略成果框架战略的可接受性)。正如许多学者所强调的，殖民地在 当前和过去的全球研究，13，14研究小组将通过给予特权，积极反对殖民态度 在整个研究过程中，社区利益相关者在所有研究活动和决策过程中发出声音。 通过该项目制定的战略有可能提高参与和提高 EBP是基本的，理想情况下将推广到全球其他EBP。我们的最终目标是改进 低收入到中等收入国家有心理健康需求的个人的结果。

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.