A Feasibility Trial of the Youth Readiness Intervention: A Group Psychosocial Intervention for War-affected Youth in Sierra Leone

In Sierra Leone, a dangerous gap remains between long-term psychosocial needs and adequate services. As youth affected by the war begin to enter adulthood, they face new challenges including unemployment, interrupted education, the need to support families, marginalization and stigma, as well as the remaining psychological effects of exposure to war. Healthy social integration is critical to the long-term wellbeing of this generation, but the evidence base on effective interventions to improve skills and self-efficacy is severely limited. Despite the high burden of mental health problems among war-affected youth in Sub-Saharan Africa, few empirically-supported behavioral treatments (ESBTs) or evidence-based interventions have been implemented in this region. This study stands to make an important contribution to knowledge on effective and culturally-sensitive mental health services that can be implemented in settings fraught by multiple hardships, including war, poverty, low educational attainment, and other hardships.

The Research Program on Children and Global Adversity at the Harvard School of Public Health has implemented the Youth Readiness Intervention (YRI) to address some of the challenges that youth face, including lack of education and employment, stigma and marginalization, and the long-term psychological effects of exposure to war. The YRI is an evidence-based group intervention designed to improve emotion regulation/reduce anger and foster prosocial functioning among 15-24 year old war-affected youth. It is grounded in findings from Betancourt et al.'s three wave-longitudinal study carried out from 2002 to 2008, which provides insight into how the adjustment of youth in post-conflict Sierra Leone is shaped by violence exposure and post -conflict loss and life disruption including family reconfiguration.

The intervention has three main goals: (1) Develop emotion regulation skills for healthy coping; (2) Develop problem solving skills to assist with achieving goals; (3) Improve interpersonal skills to enable healthy relationships and effective communication. Primary mental health outcomes include decreased anxiety, hostility, and depression, and increased pro-social attitudes, as measured by the Oxford Refugee Studies Psychosocial Adjustment Scale and the African Youth Psychosocial Assessment.

The addition of biomarkers research will build on a rare randomized controlled trial conducted in 2012-2014, where the control group will now receive the treatment and will be randomized in a lagged design to YRI or control and then all participants treated with the YRI. Therefore, the research data collection of the biomarkers will have three overarching aims: 1) To develop feasible and acceptable methods for collecting and analyzing genetic and epigenetic biomarkers from war-exposed youth in Sierra Leone. This will include forging collaborations with expert colleagues engaged in biomarker research, development of ethical protocols for data collection/storage, and review of the literature on genetic variation and mechanisms related to psychopathology. 2) To obtain biosamples from the control study participants of the randomized controlled YRI trial (2012-2014) and investigate the possibility of using this research methodology as a component of a fourth wave of data collection among war-affected youth and their families. 3) To investigate improvements in epigenetic marks (DNA methylation) pre- and post- the Youth Readiness Intervention and its associations with the findings from participants' self-reports on emotion regulation and prosocial functioning.

EducAid is a charitable trust established in 1994. Devoted to promoting education among underprivileged and war-affected young people in Sierra Leone through holistic and academic learning, EducAid provides free year-round education to over 1,500 youth, along with food, medicine, and shelter when needed. EducAid has a keen interest in exploring how psychosocial interventions can promote academic, social, and emotional well-being in students. EducAid's education model aims to improve academic knowledge, self-efficacy, and attitudes toward school. Additionally, it aims to nurture hope for the future and a sense of normalcy through interactions with teachers, mentors, and peers. Following participation in the education component, participants' employment and economic activity will be assessed using standardized instruments for cross-cultural work, including the World Bank Living Standards Surveys.