Adapting Mental Health Interventions for War-Affected Youth Through Employment Programs
Condition: Anxiety Disorder/Anxiety State; Depressive Disorder/Psychology; Social Problems/Psychology; Violence, Non-accidental
MeSH terms: Depressive Disorder; Anxiety Disorders
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): YRI; Income generating activity program
Intervention type(s): Behavioral; Other
Intervention description(s): Youth Readiness Intervention (YRI) is an innovative, evidence-based mental health intervention to address co-morbid difficulties with externalizing problems (anger/emotion dysregulation) and internalizing problems (hopelessness/anxiety) among violence-affected youth. YRI methodology draws on evidence-based treatment elements commonly used in both cognitive-behavioral intervention and group interpersonal therapy. YRI has cross-cutting efficacy across a range of mental health conditions common in violence-affected youth. YRI will be delivered in 12 sessions over the course of 3 months.; Income generating activity programming will be carried out by GOAL in partnership with St. George's foundation through use of their current 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. The 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.
Other intervention name(s): Youth Readiness Intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Depression/therapy; Developing Countries; Interpersonal Relations; Life Change Events; Psychotherapy, group; Resilience, Psychological; Sierra Leone; Survivors/psychology; Social Adjustment; Social Behavior; War