Abstract
Background: There are numerous challenges to promoting child mental health in low-and-middle income countries (LMICs). Most evidence-based interventions (EBIs) adapted to LMICs have not been scaled widely or evaluated for effectiveness and underlying mechanisms. Most mental health EBIs in LMICs rely on a task-shifting approach of implementation because of the shortage of mental health professionals; however, challenges related to task-shifting are understudied. Most EBIs have not been implemented using a scalable and sustainable model that leverages and strengthens existing structures. Through a cross-sector collaboration, we are carrying out a second generation investigation of implementation and effectiveness of a school-based mental health EBI for early childhood students that uses task-shifting and builds on existing educational structures. The ultimate shared goal of this collaboration is to scale and sustain the EBI country wide. The systems-level approach to promoting child mental health builds on ParentCorps, an EBI implemented in schools that has been shown in multiple trials to yield long-term benefits on mental health and school performance. Previous studies in Uganda found that ParentCorps Professional Development (PD) for teachers resulted in short-term benefits for classrooms, children and families. Objectives: This paper describes the rationale and protocol for an effectiveness-implementation study of ParentCorps-PD for teachers in urban and rural Ugandan schools. The study considers the added value (i.e. impact and costs) of a brief wellness intervention for teachers in their task-shifting role and explores mechanisms and outcomes. Methods: Using 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 2,000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness. Discussion: This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers who are task-shifting as a potentially cost-effective strategy for promoting child mental health. Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327) on May13, 2020.
Comprehensive approaches to addressing mental health needs and enhancing school security: a hybrid type II cluster randomized trial