Trial of the Youth Readiness Intervention
Condition: Anxiety Disorder/Anxiety State; Depressive Disorder/Psychology; Social Problems/Psychology; Stress, Psychological; Violence, Non-accidental
MeSH terms: Depressive Disorder; Anxiety Disorders; Stress, Psychological
Study type: Interventional

Summary: 
      The research will first examine data obtained from YRI participants to investigate effects of
      the group sessions on psychosocial and functioning outcomes in youth.

      In pursuit of this aim, this research will investigate the following hypothesis:
      Participation in the Youth Readiness Intervention will reduce symptoms of internalizing,
      externalizing, trauma-related symptoms, and improve prosocial skills and functioning among
      war-affected 15-24 year olds in Sierra Leone.

      The research also intends to examine whether youth enrolled in a psychosocial "Youth
      Readiness Intervention" (YRI) and a complementary education program fare better than an
      education-only control group, a psychosocial-only control group, and a waitlist control
      group.

      In pursuit of this second aim, this research will investigate the following hypothesis: A
      combined psychosocial-education program is an effective paradigm for improving psychosocial,
      functional, educational, and economic self-sufficiency outcomes among war-affected youth.
    

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 randomized study of 416 school-intending youth age 15-24 will use a parallel design to
      examine the potential benefits of enrolling in a psychosocial intervention--the YRI--prior to
      enrolling in an educational program. Assessments will be performed pre-/post-intervention and
      at 6-month and 12-month follow-ups. These long-term evaluations will examine whether benefits
      are sustained, accrue, or depreciate over time. Data will improve understanding of how a
      psychosocial-education intervention translates to economic outcomes like employment, as
      compared to an education-only intervention.

      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. It is designed to reduce symptoms of internalizing, externalizing,
      trauma-related symptoms, and improve prosocial skills and functioning among war-affected
      15-24 year olds. 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.

      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.
    

Intervention name(s): YRI; EducAid educational programming
Intervention type(s): Behavioral; Other
Intervention description(s): The YRI brings together six empirically-supported practice elements shown to be efficacious across different mental health interventions, as well as methods intended to socialize youth and improve self-efficacy. Practice elements address the broad scope of problems evidenced in Sierra Leonean war-affected youth and enhance the YRI's pacing, which progresses through three phases traditionally used in trauma treatments (stabilization, integration, connection). The weekly intervention takes place over 10 sessions lasting approximately one hour and a half. Groups are divided by gender and age. Each group is paired with two interventionists of the same gender.; EducAid is a charitable trust that provides free year-round education to over 1,500 youth, along with food, medicine, and shelter when needed. 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.
Other intervention name(s): Youth Readiness Intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
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