Abstract
BackgroundChildren in Sub-Saharan Africa (SSA) comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs. Although effective interventions for the treatment of disruptive behavioral disorders (DBDs) in youth have been tested in high-poverty and high-stress communities in developed countries, and are relevant for widespread dissemination in low- and middle-income countries (LMICs), most of these evidence-based practices (EBPs) have not been utilized in SSA, a region heavily impacted by poverty, diseases including HIV/AIDS, and violence. Thus, this paper presents a protocol for a scale-up longitudinal experimental study that uses a mixed-methods, hybrid type II, effectiveness implementation design to test the effectiveness of an EBP, called Multiple Family Group (MFG) aimed at improving child behavioral challenges in Uganda while concurrently examining the multi-level factors that influence uptake, implementation, sustainment, and youth outcomes.MethodsThe MFG intervention will be implemented and tested via a longitudinal experimental study conducted across 30 public primary schools located in both semi-urban and rural communities. The schools will be randomly assigned to three study conditions (n = 10 per study condition): (1) MFG delivered by trained family peers; (2) MFG delivered by community health workers; or; (3) comparison: usual care comprising mental health care support materials, bolstered with school support materials. A total of 3000 children (ages 8 to 13 years; grades 2 to 7) and their caregivers (N = 3000 dyads); 60 parent peers, and 60 community health workers will be recruited. Each study condition will comprise of 1000 child-caregiver dyads. Data will be collected at baseline, 8 and 16 weeks, and 6-month follow-up.DiscussionThis project is the first to test the effectiveness of the MFG intervention while concurrently examining multi-level factors that influence overall implementation of a family-based intervention provided in schools and aimed at reaching the large child population with mental health service needs in Uganda. Moreover, the study draws upon an EBP that has already been tested for delivery by parent peers and community facilitators, and hence will take advantage of the advancing science behind task-shifting. If successful, the project has great potential to address global child mental health needs.Trial registrationClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.
Highlights
Children in Sub-Saharan Africa (SSA) comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs
To examine short-term and longitudinal behavioral outcomes associated with the Multiple Family Group (MFG) Hypothesis Children who participate in MFG with their families will display significantly reduced conduct difficulties and increased functioning over time compared to those involved in the comparison condition
We expect that parent peers will evidence significantly more success engaging families to attend MFG sessions; children in the MFG-parent-peer-delivered condition will evidence greater improvement relative to the other two study conditions
Summary
The proposed study will be conducted across primary schools representing both semi-urban and rural communities. Adaptation of MFG manual During phase I (months 1 to 12), the study team will review the existing MFG intervention protocol, as well as the South African training and delivery methods used in the CHAMP program of research (e.g., cartoon format of information delivery and family practice activities, training protocols for lay counselors and community facilitators), and the SUUBI family economic strengthening approach These working groups will review the existing evidence related to the relationship between specific parent management practices, family organizational processes and livelihood approaches, and positive youth behavioral outcomes in order to align with perspectives and organization of families in SSA. Implementation, fidelity, and sustainment of two MFG implementation approaches
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