Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial
Authors: Huang Keng-Yen , Nakigudde Janet , Kisakye Elizabeth Nsamba , Sentongo Hafsa , Dennis-Tiwary Tracy A. , Tozan Yesim , Park Hyung , Brotman Laurie Miller 
Published: June 2022

AbstractBackgroundChildren in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI,ParentCorps Professional Development (PD),to scale-up and sustain the EBI in Uganda to promote early childhood students’ mental health. Our previous studies in Uganda supported that culturally adaptedPDresulted in short-term benefits for classrooms, children, and families. However, our previous implementation ofPDwas relied on mental health professionals (MHPs) to providePDto teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to providePDat scale.ObjectivesThis study tests a new scalable and sustainablePDimplementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-upPD,and protocol for studying the effectiveness-implementation ofParentCorps-PDfor teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects ofPDon teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students.MethodsUsing a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions:PD + Teacher-Wellness (PDT), PDalone (PD), and Control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness.DiscussionThis research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children’s mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings.Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327;https://clinicaltrials.gov/ct2/show/NCT04383327) on May13, 2020.