TREAT INTERACT: Implementing a User Involved Education- and Health System Interactive Task-shifting Approach for Child Mental Health Promotion in Uganda
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 180
- 试验地点
- 2
- 主要终点
- Attitudes about Child Mental Health (Perceived Discrimination-Devaluation (Link et al., 1987) questionnaire
研究概览
简要总结
This study will adapt a school version (mhGAP-IGs) of the World Health Organization´s (WHO) "Mental Health Gap Action Programme Intervention Guide" (mhGAP). Both teachers and health workers will receive training in mhGAP, and systems for collaboration between the school and health sector as well as other relevant stakeholders will be developed and integrated. The project is conducted in close collaboration with key stakeholders from the Ministry, the health and education sector, the police, and religious leaders. The aim is to increase mental health literacy among school staff, facilitate a healthy school environment, and increase detection of mental health needs among primary school aged children.
详细描述
Background: Mental and neuropsychological disorders make up approximately 14 percent of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs). In these countries, more than 90% of children cannot access mental health services, therefore service strengthening is warranted. The main objective of the TREAT INTERACT study is to adapt, implement and evaluate the impact of a novel, intersectoral treatment interactive approach to prevent, identify, refer, and treat mental health problems in children and adolescents through a user centered task-shifting adaptation and implementation of the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Eastern Uganda. In this study the aims are to: 1) Adapt the mhGAP-IG to primary school settings, 2) Implement the adapted module-based school program and investigate effective implementation strategies and teacher, student, and caregiver outcomes, 3) Develop, implement and evaluate an intersectoral supervision, referral and communication model between the health and education sectors, and 4) Develop sustainable and scalable implementation advice and guidelines with policymakers.
Methods: This project is a pragmatic mixed-methods hybrid Type II Implementation-Effectiveness study utilizing a co-design approach. The main study will utilize a stepped-wedged design with phased implementation where participating schools will be randomized to intervention initiation. Those not yet randomized to the intervention will serve as "controls". There will be six starting sequences and three schools will be randomized to intervention initiation at each randomization interval. In addition, other quantitative designs including a nested prospective cohort, case control studies, cross-sectional studies in addition to qualitative research will strengthen the necessary components for successful implementation and evaluation.
Population: Teachers are the primary participants in the trial. In addition, data will be collected from health personnel, school leadership, pupils and their caregivers.
Outcomes: Implementation outcomes include detection, reach, sustainability and service delivery to children and adolescents in need of the mhGAP from the school and health sectors. Main client outcomes include teachers´ mental health literacy, stigma and violence towards the school children. Child and caregiver outcomes will include mental health status, mental health literacy, and help-seeking behavior.
Discussion: This study will provide knowledge on implementation and sustainability of mental health programs relevant for children in primary schools in line with current WHO guidelines.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 5 Years 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •A teacher/ staff member at a preselected TREAT INTERACT primary school in Mbale.
- •Child-caregiver pairs are eligible when a learner is enrolled in a selected primary school in Mbale, the child has a caregiver living with him or her and provides ascent, and the caregiver with a child in the selected school providing informed consent.
排除标准
- •Not part of preselected primary school
- •Lack of informed consent
研究组 & 干预措施
Cohort 1
An Ugandan adapted version of the mhGAP-IG child and adolescent mental health module will be used for identification, assessment, and management of common mental disorders in children and adolescents at primary schools.
干预措施: Adapted version of the mhGAP-IG (Other)
Cohort 2
Same as arm 1
干预措施: Adapted version of the mhGAP-IG (Other)
Cohort 3
Same as arms 1-2
干预措施: Adapted version of the mhGAP-IG (Other)
Cohort 4
Same as arms 1-3
干预措施: Adapted version of the mhGAP-IG (Other)
Cohort 5
Same as arms 1-4
干预措施: Adapted version of the mhGAP-IG (Other)
Cohort 6
Same as arms 1-5
干预措施: Adapted version of the mhGAP-IG (Other)
结局指标
主要结局
Attitudes about Child Mental Health (Perceived Discrimination-Devaluation (Link et al., 1987) questionnaire
时间窗: Through study completion, an average of 1.5 years
For teachers. 10 items measuring stigma and mental health literacy. Scored from 1 (strongly disagree) to 7 (strongly agree). A summed score is created (a minimum score of 0 and a maximum score of 70, where a higher score mean a better outcome)
The dimensions of discipline inventory, school (DDI; Strauss & Faucher, 2007)
时间窗: Through study completion, an average of 1.5 years
For children. 11 items measuring incidents of teacher violence. Scored from 0 (never) to 4 (at least once a year). A summed score is created (a minimum score of 0 and a maximum score of 44, where a higher score mean a worse outcome)
Service measure on access to mental health care, developed by the project group
时间窗: Through study completion, an average of 1.5 years
For teachers. 21 items measuring the following dimention of Service Utilization will be created during the mapping process: * Wait Times * Geographical Accessibility * Affordability * Equity and Disparities * Satisfaction and Perceived Access * Referral Patterns * Availability of Services Scored 0 (never) to 4 (at least once a year). A summed score is created (a minimum score of 0 and a maximum score of 105, where a higher score mean a better outcome)
The Program Sustainability tool (Finch et al., 2013)
时间窗: Through study completion, an average of 1.5 years
For teachers. 22 items measuring the following: * Financial stability * Organizational Support * Staff Retention: * Program Integration * Stakeholder Perceptions * Program Outcomes and Impact It is scored from 0 (little to no extent) to 7 (to a very great extent). A summed score is created (a minimum score of 0 and a maximum score of 154, where a higher score mean a better outcome)
Treatment at home, developed by the project group, by inspiration from our siste project "TREAT C-AUD")
时间窗: Through study completion, an average of 1.5 years
For children. 10 items measuring treatment at home. Scoring instructions will be deveoped during the mapping process.
Reach questionnaire, developed by the project group
时间窗: Through study completion, an average of 1.5 years
For teachers. Proportion of children reached by the program. Consist of one question: "Have you ever referred a child at school to the health system?" If no (scored 0), no further questions are asked. If yes (scored 1), an additional 5 questions follows (e.g., "If yes, have any of these referrals to the health system been because of a mental health problem?")
次要结局
- Organizational Readiness for Implementing Change (Shea et al., 2014)(Through study completion, an average of 1.5 years)
- Teacher concerns about child mental health, developed by the project group, after inspiration from Yifeng et al., 2022(Through study completion, an average of 1.5 years)
- Mental health knowledge (Evans-Lacko et al.,(Through study completion, an average of 1.5 years)
- AUDIT scale (WHO)(Through study completion, an average of 1.5 years)
- Child alcohol use, developed by the project group(Through study completion, an average of 1.5 years)
- Fidelity Scale, developed by the project group(Through study completion, an average of 1.5 years)
- Pediatric Symptom Checklist (PSC-17; Jellinek et al., 1998)(Through study completion, an average of 1.5 years)
- Provider Report of Sustainment Scale (PRESS) (Moullin et al., 2021) (PRESS): development and validation (PRESS; Moullin et al., 2021)(Through study completion, an average of 1.5 years)
- Perceived teacher support and its influence on adolescent career development (Metheny et al., 2008)(Through study completion, an average of 1.5 years)
- Attitudes on Gender Norms (Waszak et al., 2000) questionnaire(Through study completion, an average of 1.5 years)
- Help-seeking behaviour, developed by the project group after inspiration from Yifeng et al., 2022(Through study completion, an average of 1.5 years)
- Teacher Support Scale (TSS; Metheny, McWhirter, & O'Neil, 2008)(Through study completion, an average of 1.5 years)
- Teacher violence scale (Piskin et al, 2014)(Through study completion, an average of 1.5 years)
- The Implementation Leadership Scale (Aarons, Ehrhart, et al., 2014)(Through study completion, an average of 1.5 years)
- Child mental health - Pediatric symptoms (Jelinek et al.)(Through study completion, an average of 1.5 years)
- The Implementation Quality Questionnaire (Bogen, 2020)(Through study completion, an average of 1.5 years)
- General Health Questionnaire (GHQ; Goldberg, 1970)(Through study completion, an average of 1.5 years)
- The dimensions of discipline inventory, home (DDI; Strauss & Faucher, 2007)(Through study completion, an average of 1.5 years)
- Sexual violence, developed by the project group(Through study completion, an average of 1.5 years)
- Dimensions of discipline inventory (DDI; Straus and Fauchier, 2007)(Through study completion, an average of 1.5 years)