This study involves efforts to advance the science of prevention in early childhood mental health in low-resource communities. Investigators will assess the effectiveness, practical implementation strategies, and underlying mechanisms of the evidence-based intervention, ParentCorps-Professional Development, in urban and rural Uganda. Two implementation approaches, with and without the teacher stress management package, T-Wellness, will be compared for efficacy.
Promoting child mental health in low-resource or low-income country settings faces numerous challenges in global health research. Although efforts have been made to improve mental health interventions and services for young children, evidence-based interventions (EBIs) for children in low-and middle-income countries (LMICs) are limited. Most mental health EBIs in LMICs have not been scaled widely, and do not focus on early childhood. Mechanisms of action and effectiveness are not well understood. Additionally, most EBIs in LMICs rely on community health workers (CHWs) or a task-shifting approach of implementation because of resource barriers and shortage of mental health professionals (MHPs). However, challenges related to task-shifting (e.g., CHW stress and job burnout) have rarely been studied. For task-shifting to be successful, strategies to overcome challenges faced by CHWs and understanding mechanisms to conduct effective task-shifting are paramount. The overall goal of this study is to address these EBI effectiveness and implementation knowledge gaps by providing a preventive EBI (mWEL-Professional Development (PD), adapted from the US ParentCorps-Professional Development) that utilizes a task-shifting and a scalable implementation model to promote early childhood students' mental health in a LMIC-Uganda. PD is a school-based EBI and preventive mental health service provision model that supports teachers and school personnel to apply EBI strategies to promote young children's mental health. The PD approach represents a task-shifting model of mental healthcare by shifting mental health preventive duties from professionals to teachers to optimize school children's mental health. Therefore, teachers are considered as CHWs. This study examines impacts and cost-effectiveness of the EBI/PD on teachers and students, as well as examines underlying mechanisms (or theories of change) that contribute to intervention effect. In addition, considering most Ugandan teachers (or CHWs) experience occupational stress that threatens PD uptake, effectiveness, and sustainment, this study will also test a teacher stress management package (T-Wellness, adapted from EBIs) as an enhancement to PD. This study will investigate whether PD + T-Wellness (PDT) is more effective for CHWs/teachers than PD alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
2,444
Multi-component school-based intervention that promotes early childhood mental health and development. Teachers (pre-primary to 4th grade) will participate in a 3-day ParentCorps-PD training during the school term. They will also receive 8 sessions (8 hours) of face-to-face group-based coaching during after the training. Coaching sessions are to help teachers apply EBI strategies in their classrooms, engage families, and develop competencies.
A brief teacher stress management psychoeducation package, adapted from EBIs including one-day workshop for common stress management and stress management, and three follow-up group support sessions (3 additional monthly 1-hr wellness sessions for teachers as a group that were integrated into the 3 of the 8 PD coaching sessions. A total 3 hours of coaching were included.
Hoima School
Hoima, Uganda
Kampala School
Kampala, Uganda
Teacher Knowledge of Evidence-Based Practice (Knowledge Score)
Teachers will complete a 10-item quiz assessing EBI knowledge. The total score is the number of correct responses and ranges from 0-100; higher scores indicate greater knowledge.
Time frame: Baseline
Teacher Knowledge of Evidence-Based Practice (Knowledge Score)
Teachers will complete a 10-item quiz assessing EBI knowledge. The total score is the number of correct responses and ranges from 0-100; higher scores indicate greater knowledge.
Time frame: Month 6
Teacher EBI Practice Score
Use of Evidence-Based Practices was assessed with six measures: (i) Practice of evidence-based strategies (applied a range of evidence-based behavioral management strategies such as praise and proactive strategies) (9 items, 1-5 point scale); (ii) Non-harsh discipline (4 items, 1-5 point scale); (iii) Mindfulness (awareness of own actions and consideration of student's situations when interacting or disciplining students) (10 items, 1-4 point scale); (iv) Emotion socialization-supporting negative emotion (practice used to support students in managing negative emotions) (6 items, 1-5 point scale); (v) Family engagement (frequency in interacting with families) (2 items, 1-5 point scale); and (vi) Teacher-Student Interaction (5 items, 1-5 point scale). The final score is a mean composite of these six measures and ranges from 1-5; where higher scores indicate greater use of EBI practices.
Time frame: Baseline
Teacher EBI Practice Score
Use of Evidence-Based Practices was assessed with six measures: (i) Practice of evidence-based strategies (applied a range of evidence-based behavioral management strategies such as praise and proactive strategies) (9 items, 1-5 point scale); (ii) Non-harsh discipline (4 items, 1-5 point scale); (iii) Mindfulness (awareness of own actions and consideration of student's situations when interacting or disciplining students) (10 items, 1-4 point scale); (iv) Emotion socialization-supporting negative emotion (practice used to support students in managing negative emotions) (6 items, 1-5 point scale); (v) Family engagement (frequency in interacting with families) (2 items, 1-5 point scale); and (vi) Teacher-Student Interaction (5 items, 1-5 point scale). The final score is a mean composite of these six measures and ranges from 1-5; where higher scores indicate greater use of EBI practices.
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Time frame: Month 6
Teacher EBI Practice Score
Use of Evidence-Based Practices was assessed with six measures: (i) Practice of evidence-based strategies (applied a range of evidence-based behavioral management strategies such as praise and proactive strategies) (9 items, 1-5 point scale); (ii) Non-harsh discipline (4 items, 1-5 point scale); (iii) Mindfulness (awareness of own actions and consideration of student's situations when interacting or disciplining students) (10 items, 1-4 point scale); (iv) Emotion socialization-supporting negative emotion (practice used to support students in managing negative emotions) (6 items, 1-5 point scale); (v) Family engagement (frequency in interacting with families) (2 items, 1-5 point scale); and (vi) Teacher-Student Interaction (5 items, 1-5 point scale). The final score is a mean composite of these six measures and ranges from 1-5; where higher scores indicate greater use of EBI practices.
Time frame: Month 18
Teacher Stress Score
Teacher Stress was assessed using four measures: (i) Work Burnout (level of emotional and physical exhaustion from work) (9 items, 1-7 point scale), (ii) Family Stress (relationship stress) (5 items, 1-4 point scale); (iii) Kessler Psychological Distress Scale (K10) (anxiety and depressive symptoms) (10 items, 1-5 point scale); and (iv) Organization/ School Staff Stress (teachers' perception of level of stress in school) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate higher stress levels.
Time frame: Baseline
Teacher Stress Score
Teacher Stress was assessed using four measures: (i) Work Burnout (level of emotional and physical exhaustion from work) (9 items, 1-7 point scale), (ii) Family Stress (relationship stress) (5 items, 1-4 point scale); (iii) Kessler Psychological Distress Scale (K10) (anxiety and depressive symptoms) (10 items, 1-5 point scale); and (iv) Organization/ School Staff Stress (teachers' perception of level of stress in school) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate higher stress levels.
Time frame: Month 6
Teacher Stress Score
Teacher Stress was assessed using four measures: (i) Work Burnout (level of emotional and physical exhaustion from work) (9 items, 1-7 point scale), (ii) Family Stress (relationship stress) (5 items, 1-4 point scale); (iii) Kessler Psychological Distress Scale (K10) (anxiety and depressive symptoms) (10 items, 1-5 point scale); and (iv) Organization/ School Staff Stress (teachers' perception of level of stress in school) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate higher stress levels.
Time frame: Month 18
Teacher Stress Management
Teacher Stress Management was assessed using four measures: (i) Cognitive regulation (ability to redirect negative thinking to positive thinking when distressed) (3 items, 1-5 point scale); (ii) Emotion Expression (ability to express emotion) (4 items, 1-5 point scale); (iii) Emotion Acceptance (ability to accept negative emotion) (3 items, 1-5 point scale); and (iv) Support from Work (getting support from school staff) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate greater management of stress.
Time frame: Baseline
Teacher Stress Management
Teacher Stress Management was assessed using four measures: (i) Cognitive regulation (ability to redirect negative thinking to positive thinking when distressed) (3 items, 1-5 point scale); (ii) Emotion Expression (ability to express emotion) (4 items, 1-5 point scale); (iii) Emotion Acceptance (ability to accept negative emotion) (3 items, 1-5 point scale); and (iv) Support from Work (getting support from school staff) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate greater management of stress.
Time frame: Month 6
Teacher Stress Management
Teacher Stress Management was assessed using four measures: (i) Cognitive regulation (ability to redirect negative thinking to positive thinking when distressed) (3 items, 1-5 point scale); (ii) Emotion Expression (ability to express emotion) (4 items, 1-5 point scale); (iii) Emotion Acceptance (ability to accept negative emotion) (3 items, 1-5 point scale); and (iv) Support from Work (getting support from school staff) (5 items, 1-5 point scale). The total score is a mean composite of these four measures and ranges from 1-5; higher scores indicate greater management of stress.
Time frame: Month 18
Child's Emotion Regulation Score
Parents answer 6 questions about their child's emotion regulation behavior over the past 7 days. Each item is rated on a Likert scale from 0 (not at all) to 4 (very well). The total score ranges from 0 to 4; higher scores indicate greater emotion regulation.
Time frame: Baseline
Child's Emotion Regulation Score
Parents answer 6 questions about their child's emotion regulation behavior over the past 7 days. Each item is rated on a Likert scale from 0 (not at all) to 4 (very well). The total score ranges from 0 to 4; higher scores indicate greater emotion regulation.
Time frame: Month 6
Child's Emotion Regulation Score
Parents answer 6 questions about their child's emotion regulation behavior over the past 7 days. Each item is rated on a Likert scale from 0 (not at all) to 4 (very well). The total score ranges from 0 to 4; higher scores indicate greater emotion regulation.
Time frame: Month 18
Child Mental Health- Conduct Problem
Conduct problem items (5 items) from the Strengths and Difficulties Questionnaire (SDQ) are rated by parents, which assesses child's conduct and non-compliant behaviors over the last six months. Each item is rated on a Likert scale from 0 (not true) to 2 (certainly true). The total score is the sum of responses and ranges from 0-10; higher scores indicate greater difficulties.
Time frame: Baseline
Child Mental Health- Conduct Problem
Conduct problem items (5 items) from the Strengths and Difficulties Questionnaire (SDQ) are rated by parents, which assesses child's conduct and non-compliant behaviors over the last six months. Each item is rated on a Likert scale from 0 (not true) to 2 (certainly true). The total score is the sum of responses and ranges from 0-10; higher scores indicate greater difficulties.
Time frame: Month 6
Child Mental Health- Conduct Problem
Conduct problem items (5 items) from the Strengths and Difficulties Questionnaire (SDQ) are rated by parents, which assesses child's conduct and non-compliant behaviors over the last six months. Each item is rated on a Likert scale from 0 (not true) to 2 (certainly true). The total score is the sum of responses and ranges from 0-10; higher scores indicate greater difficulties.
Time frame: Month 18