Abstract
BackgroundEvidence-based mental health interventions have helped address health services gaps, but their reach and societal benefit can be limited in low resource settings. The current study extends an ongoing scale-up study of a cognitive behavioral therapy (CBT)-based intervention, the Youth Readiness Intervention (YRI), among high risk youth in post-conflict Sierra Leone to investigate mechanisms of diffusion and spillover effects of the YRI among peers and caregivers of youth who receive the intervention.MethodsWe will recruit and enroll YRI index participants and control index participants (ages 18–30). Index participants will complete a standardized ego-network survey to nominate three peers in their social networks and identify their primary cohabitating caregiver. Identified peers and caregivers who consent to participate will complete a quantitative assessment battery on mental health outcomes, emotion regulation, and daily functioning at baseline and 8-month follow-up. Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scaleup. Social network analysis will investigate diffusion of YRI components across peer networks. Linear growth modeling will examine mental health spillover effects among caregivers. Incremental health costs and benefits among YRI participants’ caregivers and peers will be assessed through cost-effectiveness and return on investment analysis.DiscussionAssessing implementation research outcomes, including penetration of YRI effects across social networks and cost-effectiveness of the YRI as distinct outcomes, will provide key information about the success of YRI implementation. Lessons learned could inform decisions to increase scale up efforts in Sub-Saharan Africa and other low resource settings.
Highlights
Evidence-based mental health interventions have helped address health services gaps, but their reach and societal benefit can be limited in low resource settings
Peer-led models for diffusion of cognitive behavioral therapy (CBT) skills could be a cost effective strategy to extend the reach of evidence based mental health interventions in low resource and post-conflict settings
The current study extends ongoing mental health services research in Sierra Leone on a cognitive behavioral therapy (CBT)-based intervention, the Youth Readiness Intervention (YRI)
Summary
The YRI’s demonstrated effectiveness in prior research [6,7,8] and its simple, transdiagnostic practice elements offer a highly suitable intervention for delivery in community settings by a range of lay workers in low resource settings with a basic level of education [8] In this diffusion and spillover study, we will adopt a broader perspective to consider the indirect effects of the YRI on participants’ peer networks and cohabitating caregivers by examining (a) the extent to which indirect effects (i.e., diffusion and spillover) result in measurable incremental health outcomes in nonparticipants; (b) whether these indirect effects can be amplified in intervention design and implementation strategies; and (c) how to factor indirect effects into cost-effectiveness analysis to more accurately determine economic valuation and public health impact. Adopting a broader perspective may demonstrate the potential for the YRI and similar evidence-based mental health interventions in low resource settings to reach a larger population and result in both incremental mental health benefits and other societal benefits
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