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Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial.

Huang KY, Nakigudde J, Calzada E, Boivin MJ, Ogedegbe G, Brotman LM - Trials (2014)

Bottom Line: Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs.Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions.The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Health, New York University Langone Medical Center, 227 East 30th Street, 1st Floor, New York, NY 10016, USA. Keng-Yen.Huang@nyumc.org.

ABSTRACT

Background: Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions are not available in SSA. This study will investigate the transportability of an evidence-based program from a developed country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers and consists of professional development (five days) to introduce strategies for effective behavior management and positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective practices and tailoring to meet the needs of individual students.

Methods/design: The design of this study is guided by two implementation frameworks, the Consolidated Framework for Implementation Research and the Teacher Training Implementation Model, that consider multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during a new academic year). Fidelity measures will be assessed throughout the program implementation period (during professional development and consultation sessions). Individual teacher and contextual factors will be assessed at baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions.

Discussion: The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings.

Trial registration: This trial was registered with ClinicalTrials.gov (registration number: NCT097115) on 15 May 2013.

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Implementation conceptual model. This Figure illustrates the relationship among contextual predictors, implementation fidelity and implementation and child mental health outcomes.
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Fig1: Implementation conceptual model. This Figure illustrates the relationship among contextual predictors, implementation fidelity and implementation and child mental health outcomes.

Mentions: Figure 1 shows the theory of change model for ParentCorps implementation. Our implementation framework is adapted from Reinke et al.’s Teacher Training Implementation Model (TTIM) [56] and Damschroder and Lowery’s Consolidated Framework for Implementation Research (CFIR) [36]. While TTIM focuses on multidimensional aspects of intervention fidelity as related to implementation outcomes, CFIR focuses on five domains of contextual factors that may impact implementation outcomes. As per the model, fidelity (including adherence and quality of program implementation, and trainees’ engagement and exposure to the program as defined in the TTIM [56]) may impact teacher implementation of evidence-based practices in the classroom, which in turn will impact student and school outcomes. In addition, five domains of contextual predictors, derived from the CFIR [36] (including intervention characteristics, outer setting, inner setting, individual characteristics and organization process), may impact program implementation (both on fidelity and implementation outcomes) and sustainability. This study focuses on implementation processes and outcomes in the gray shaded boxes in Figure 1. Among the contextual predictors, only the school/inner characteristics (such as school leadership and climate) and individual characteristics (such as teacher factors) will be considered because of the relevance to the school contexts. This study will not focus on contextual predictors related to intervention (ParentCorps) characteristics’ because previous work shows that ParentCorps fits well within Ugandan contexts (see above).Figure 1


Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial.

Huang KY, Nakigudde J, Calzada E, Boivin MJ, Ogedegbe G, Brotman LM - Trials (2014)

Implementation conceptual model. This Figure illustrates the relationship among contextual predictors, implementation fidelity and implementation and child mental health outcomes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289288&req=5

Fig1: Implementation conceptual model. This Figure illustrates the relationship among contextual predictors, implementation fidelity and implementation and child mental health outcomes.
Mentions: Figure 1 shows the theory of change model for ParentCorps implementation. Our implementation framework is adapted from Reinke et al.’s Teacher Training Implementation Model (TTIM) [56] and Damschroder and Lowery’s Consolidated Framework for Implementation Research (CFIR) [36]. While TTIM focuses on multidimensional aspects of intervention fidelity as related to implementation outcomes, CFIR focuses on five domains of contextual factors that may impact implementation outcomes. As per the model, fidelity (including adherence and quality of program implementation, and trainees’ engagement and exposure to the program as defined in the TTIM [56]) may impact teacher implementation of evidence-based practices in the classroom, which in turn will impact student and school outcomes. In addition, five domains of contextual predictors, derived from the CFIR [36] (including intervention characteristics, outer setting, inner setting, individual characteristics and organization process), may impact program implementation (both on fidelity and implementation outcomes) and sustainability. This study focuses on implementation processes and outcomes in the gray shaded boxes in Figure 1. Among the contextual predictors, only the school/inner characteristics (such as school leadership and climate) and individual characteristics (such as teacher factors) will be considered because of the relevance to the school contexts. This study will not focus on contextual predictors related to intervention (ParentCorps) characteristics’ because previous work shows that ParentCorps fits well within Ugandan contexts (see above).Figure 1

Bottom Line: Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs.Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions.The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Health, New York University Langone Medical Center, 227 East 30th Street, 1st Floor, New York, NY 10016, USA. Keng-Yen.Huang@nyumc.org.

ABSTRACT

Background: Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions are not available in SSA. This study will investigate the transportability of an evidence-based program from a developed country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers and consists of professional development (five days) to introduce strategies for effective behavior management and positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective practices and tailoring to meet the needs of individual students.

Methods/design: The design of this study is guided by two implementation frameworks, the Consolidated Framework for Implementation Research and the Teacher Training Implementation Model, that consider multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during a new academic year). Fidelity measures will be assessed throughout the program implementation period (during professional development and consultation sessions). Individual teacher and contextual factors will be assessed at baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions.

Discussion: The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings.

Trial registration: This trial was registered with ClinicalTrials.gov (registration number: NCT097115) on 15 May 2013.

Show MeSH