SMART Africa (Strengthening Mental Health Research and Training)
Condition: Comparison Group; Multiple Family Groups by Parent Peers; Multiple Family Groups by Community Health Workers
Study type: Interventional

Summary: 
      The objective of this research study is to examine the implementation of and outcomes
      associated with an evidence-based practice (EBP), specifically Multiple Family Group (MFG)
      targeting youth disruptive behavior challenges and success, through a scale up intervention
      study in Uganda, and two pilot studies that will be conducted in Kenya and Ghana.
    

Detailed description: 
      A longitudinal experimental mixed methods effectiveness-implementation hybrid research design
      will be employed. The study will be conducted across thirty primary schools representing both
      semi-urban and rural communities. We expect to involve 3,000 youth (in primary schools grades
      2 through 7; 8 to 13 years) and their adult caregivers (3,000) in Uganda, 180 youth and their
      caregivers (180) in Ghana, and 180 youth and their caregivers (180) in Kenya.

      Schools will be randomly assigned to 3 study conditions: 1) MFG-delivered by trained family
      peers; 2) MFG-delivered by community health workers (school health education program
      coordinators in Ghana); or, 3) Comparison: mental health and school support materials (e.g.,
      books, uniforms). Data will be collected at baseline, 8 and 16 weeks, and 6 months follow-up
      (10 months from baseline).

      More specifically the objectives of this study are:

      Primary objectives

        1. To examine short- and long-term outcomes associated with the MFG. Hypothesis: Children
           in the treatment groups (MFG) will improve significantly more compared to those in the
           comparison (usual care) group.

        2. To examine how systematic variations in the delivery of an evidence-based MFG program
           impacts outcomes for children with behavioral difficulties and their caregivers in each
           country context.

           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 comparison condition. We expect that parent peers - compared to
           community health workers - will evidence significantly more success engaging families to
           attend MFG sessions, thus, children in the MFG-parent peer delivered condition will
           evidence the great improvement relative to the other two study conditions.

           Secondary objectives

        3. To compare the uptake and implementation of MFGs by trained existing family peers and
           community outreach health workers.

           Hypothesis: Given the level of training that community outreach health workers have
           received prior to the study as part of their regular professional training, they will
           evidence higher fidelity initially, yet with training and ongoing supervision, we expect
           these differences to decrease over time.

        4. To examine multi-level (state/government, NGOs, families, schools, communities)
           influences on the uptake, implementation, effectiveness and sustainability of EBPs that
           address serious child disruptive behavioral challenges.
    

Intervention name(s): MFG
Intervention type(s): Behavioral
Intervention description(s): The MFG is a series of weekly meetings guided by a protocol.Over the course of 16 weeks, groups are held weekly and are facilitated by trained and supervised group leaders (in this case either parent peers or community health outreach workers). Groups can consist of up to 20 families involving adult caregivers and all children over six years of age in the family. The protocols have been designed to provide opportunities during each session to directly apply content to the realities of family life, emergent cultural and values perspectives, as well as tailor messages to age of child. Redundancy for missed appointments and opportunities for reinforcement is built in. We aim for families to attend at least 8 meetings or more (out of 16 sessions in total), as findings suggests this dose is needed to reduce child conduct problems and the majority of families reach this goal.
Other intervention name(s): 4Rs and 2Ss; Amaka Amasanyufu (Happy Families in Luganda-Uganda); Dang-Malgu (Family Togetherness in Dagbani-Ghana)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Schools will be randomly assigned to 3 study conditions: 1) MFG-delivered by trained family peers; 2) MFG-delivered by community health workers; or, 3) Comparison: Mental health and school support materials (books).
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: child behavior; intervention; multiple family group; Sub Saharan Africa; caregivers