Violence, Non-accidental Clinical Trial
Official title:
Adapting Mental Health Interventions for War-Affected Youth Through Employment Programs in Sierra Leone
The research will first examine data obtained from YRI participants to investigate effects of
the group sessions on psychosocial functioning outcomes in youth aged 15 - 24. The research
also intends to examine whether youth participating in YRI and complementary income
generating activities will fare better than an employment only control group. Finally, the
research intends to examine whether utilizing lay health workers are a is cost-effective and
scalable method for addressing mental health concerns.
The research will investigate the following hypotheses:
1. Participants who are exposed to YRI will demonstrate greater reduction in mental health
and behavioral problems than participants who are waitlisted for YRI over the same
period; emotion regulation will operate as a major mechanism of YRI improvements; high
comorbidity will be a treatment modifier;
2. Improvements in mental health and functioning due to YRI will lead to (mediate) greater
employment outcomes and superior economic self-sufficiency over time; and
3. Homelessness, orphanhood, young parenthood, and high problems in emotion regulation
co-morbid with other mental health conditions will be major moderators lessening the
effectiveness of YRI.
4. Lay and trained practitioners at agencies participating in the combined mental
health-employment program will demonstrate high fidelity to evidence-based treatment
components and that good satisfaction, social support, and professional exchange of
evidence-based practices will emerge.
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.
This exploratory randomized control study of youth aged 15-24 comparing outcomes among youth
participating in YRI proceeding enrollment in an income generating activity program (YRI +
EP) to a control group that participates only in income generating activity programs (EP).
This study is not fully powered to detect differences between groups and is instead a test of
the intervention feasibility and acceptability, with quantitative participant assessments
occurring at baseline, 3-months, 6-months, and 12-months with respect to employment related
measures, and participant and interventionists interviews to elucidate mechanisms by which
the intervention was more or less successful.
The YRI is an evidence-based group intervention developed in 2010 to address key emotional,
behavioral, and functioning difficulties identified by the PI's prior longitudinal study of
war-affected youth. The YRI has three overarching goals: (1) To improve interpersonal and
community relationships through work with youth and community members; (2) To help vulnerable
youth develop skills in emotional regulation, problem-solving, and interpersonal interactions
necessary to be successful members of their communities; (3) To promote the healthy
integration of difficult memories for youth who experience difficulties due to traumatic
exposure. 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. During this
study YRI will be delivered by trained counselors,
Income generating activity programming will be carried out by GOAL and their partner St.
George's Foundation through use of their current grant funding. GOAL focuses on supporting
people in need by providing healthcare resources, advocating and advancing child protection
practices and policies, and administering livelihood programs to empower them improve their
lives in a sustainable manner. The St. George's Foundation's addresses child welfare concerns
by actively reaching out to homeless and orphaned children. Their already existing employment
program is 4 months in length and consists of skills training, soft skills development
(primarily in numeracy and literacy), and a cash transfer of $200. The employment
intervention is carried out by social workers and counselors, who have been trained to
support delivery of the intervention.
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