Suubi(Hope)4StrongerFamilies: Addressing Child Behavioral Health by Strengthening Financial Stability and Parenting among Families in Uganda

项目摘要 撒哈拉以南非洲(SSA)的儿童背负着巨大的未得到满足的心理健康需求。最近 系统回顾估计，在SSA中，每7名儿童中就有1名与严重的精神健康问题作斗争。世界 卫生组织估计患病率可能更高(20%)。在整个SSA，贫困率很高， 艾滋病毒/艾滋病、粮食不安全、耻辱和不完善的卫生安全网系统加剧了严重的童年 行为健康(CBH)需要并阻碍有效的反应。破坏性行为障碍(DBD)是 尤其令人担忧的是，它们一直持续到青春期和成年期。DBD也与穷人高度相关 成年后的身体健康和人际关系挑战。因此，解决特定于上下文的社会 鉴于南沙地区的儿童占区域总人口的一半以上，对儿童健康的影响是至关重要的。 如果要在SSA中满足儿童的需求，那么：1)实施在SSA中设计和测试的干预措施，以及 在现有的以儿童为重点的机构内调动资源是至关重要的；2)综合干预措施 同时针对SSA对CBH的特定影响，并可与儿童/家庭合作提供- 服务社区环境是必要的；3)CBH的群体、社区和人口方法是 需要推动可扩展的解决方案。在社会行动、资产和家庭系统理论的指导下，建议 这项研究将考察EE和FS针对社会、家庭和背景的干预的机制。 具体的驱动因素影响到900名中上小学(10至14岁)乌干达儿童的心理健康。 这项研究使用了一种实验性的纵向设计，对30所随机分组的小学进行了比较 单一和联合干预方案；EE和FS对经济、知觉和功能的影响 调解人；以及针对具体情况的主持人。这三个研究条件是：1)仅EE，2)仅基于MFG的FS， 3)EE+MFG相结合的FS。干预措施将提供12个月；并将进行评估 在基线、12、24和36个月时。具体目标是：目标1：仅审查EE的影响，以制造业为基础 单纯FS，以及基于EE+MFG的联合FS对儿童DBD症状和行为功能的影响；目标2： 测试仅基于EE、仅基于MFG的FS以及基于EE+MFG的组合FS对家庭财务稳定性的影响 (例如，粮食和住房稳定性、物质资产、储蓄)、养育子女和保护家庭进程(例如，家庭 组织、照顾者/儿童互动、凝聚力、支持)和与寻求帮助相关的感知(例如， 耻辱)对CBH和功能的影响；并评估这些变化机制是否介导了对 DBD症状和行为功能，并探索特定于上下文的主持人对 干预效果；目标3：定性检查参与者对每个干预手臂的体验。这个 调查团队将利用他们在SSA的长期合作伙伴关系，最大限度地提高公共卫生影响 研究成果，缩短从新知识到制度和人口水平提高的时间差距。

PROJECT ABSTRACT Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. A recent systematic review estimated that 1 in 7 children in SSA struggle with a serious mental health issue. The World Health Organization estimates prevalence rates may be even higher (20%). Across SSA, high rates of poverty, HIV/AIDS, food insecurity, stigma and an inadequate health safety net system exacerbate serious childhood behavioral health (CBH) needs and impede an effective response. Disruptive behavioral disorders (DBDs) are particularly concerning as they persist through adolescence and adulthood. DBDs are also highly related to poor physical health and interpersonal challenges in adulthood. Hence, addressing the context-specific social influences on CBH is critical given that children in SSA comprise more than half of the total regional population. If children’s needs are to be met in SSA, then: 1) implementing interventions designed and tested in SSA, and which mobilize resources within existing child-focused institutions is critical; 2) combined interventions that simultaneously target SSA-specific influences on CBH and can be delivered in collaboration with child/family- serving community settings are necessary; and 3) group, community and population approaches to CBH are needed to drive scalable solutions. Guided by Social Action, Asset, and Family Systems theories, the proposed study will examine the mechanisms by which EE and FS interventions targeting social, familial and context- specific drivers affect the mental health of 900 Ugandan children in mid-upper primary school (10 to 14 years). The study uses an experimental, longitudinal design across 30 cluster randomized primary schools to compare single and combination intervention options; influences of EE and FS on economic, perceptual and functioning mediators; and context-specific moderators. The three study conditions are: 1) EE only, 2) MFG-based FS only, 3) combined EE+MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24 and 36 months. The specific aims are: Aim 1: Examine the impact of EE only, MFG-based FS only, and combined EE+MFG-based FS on children’s DBD symptoms and behavioral functioning; Aim 2: Test the influence of EE only, MFG-based FS only, and combined EE+MFG-based FS on family financial stability (e.g., food and housing stability, material assets, savings), parenting and protective family processes (e.g., family organization, caregiver/child interaction, cohesion, support) and perceptions related to help seeking (e.g., stigma) on CBH and functioning; and assess whether these change mechanism mediate intervention effects on DBD symptoms and behavioral functioning, and explore moderation by context-specific moderators of intervention effects; and Aim 3: Qualitatively examine participants’ experiences with each intervention arm. The investigative team will leverage their long-term partnerships in SSA to maximize the public health impact of the research findings and to shorten the time gap from new knowledge to system and population-level improvement.