Alternate delivery platforms and implementation models for bringing evidence-based behavioral interventions to scale for youth facing adversity: a case study in West Africa

Laura Bond, Jordan Farrar, Ryan C Borg, Katrina Keegan, Katharine Journeay, Nathan Hansen, Emmanuel Mac-Boima, Alimamy Rassin, Theresa S Betancourt, Laura Bond, Jordan Farrar, Ryan C Borg, Katrina Keegan, Katharine Journeay, Nathan Hansen, Emmanuel Mac-Boima, Alimamy Rassin, Theresa S Betancourt

Abstract

Background: Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone.

Methods: A case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth entrepreneurship programs (ENTR) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, 8 weeks of supervision notes, 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery platform. Quantitative dissemination and implementation interviews administered to youth, facilitators, and agency leaders were analyzed using descriptive statistics and mixed linear models. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform.

Results: Extant data indicate the strong feasibility and acceptability of integrating the YRI into the ENTR program. Facilitators of integration of the YRI into the ENTR include mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions, and challenges in flexibility between donors and implementation partners operating in a fragile/post-conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI.

Conclusions: Youth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions to youth in fragile and post-conflict settings. Quality improvement and sustainment of evidence-based interventions are novel concepts in such settings. The CTA strategy institutionalizes the integration of an evidence-based intervention into youth entrepreneurship programs.

Trial registration: NCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).

Keywords: Alternate delivery platforms; Collaborative team approach; Conflict-affected regions; Employment/entrepreneurship programs; Evidence-based intervention; Low-resource setting; Mental health; Scaling out; Sierra Leone; Youth.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
EPIS framework
Fig. 2
Fig. 2
Youth FORWARD leadership structure

References

    1. Charlson F, Ommeren M v, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394(10194):240–248. doi: 10.1016/S0140-6736(19)30934-1.
    1. Betancourt TS, Brennan RT, Rubin-Smith J, et al. Sierra Leone's former child soldiers: a longitudinal study of risk, protective factors, and mental health. J Am Acad Child Adolesc Psychiatry. 2010;49(6):606–615.
    1. Betancourt TS, McBain R, Newnham EA, Brennan RT. Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and post conflict factors. Child Dev. 2013;84(2):455–470. doi: 10.1111/j.1467-8624.2012.01861.x.
    1. Betancourt TS, Borisova II, de la Soudière M, Williamson J. Sierra Leone's child soldiers: war exposures and mental health problems by gender. J Adolesc Health. 2011;49(1):21–28. doi: 10.1016/j.jadohealth.2010.09.021.
    1. Sharma M, Fine SL, Brennan RT, Betancourt TS. Coping and mental health outcomes among Sierra Leonean war-affected youth: results from a longitudinal study. Dev Psychopathol. 2016;(1):1–13.
    1. JRI Research and Training Institute, Inc. Strengthening access to mental health services in Sierra Leone. Accessed 19 Dec 2020.
    1. International Monetary Fund. Sierra Leone Economic Development Documents: National Development Plan 2019-23. . Accessed 22 Dec 2020.
    1. World Bank Group Launches New Country Partnership Framework for Sierra Leone. . Accessed 22 Dec 2020.
    1. GIZ. Employment promotion programme – needs oriented qualification for youth. Factsheet. Accessed 19 Dec 2020.
    1. GIZ. Employment Promotion Programme (EPP III) Youth Development. . Accessed 19 Dec 2020.
    1. Betancourt T, Newnham E, Hann K, et al. Addressing the consequences of violence and adversity: the development of a group mental health intervention for war-affected youth in Sierra Leone. In: Raynaud J, Gau S, Hodes M, et al., editors. From Research to Practice in Child and Adolescent Mental Health. Maryland: Rowman & Littlefield; 2014. pp. 157–178.
    1. Newnham EA, McBain RK, Hann K, Akinsulure-Smith AM, Weisz J, Lilienthal GM, et al. The Youth Readiness Intervention for war-affected youth. J Adolesc Health. 2015;56(6):606–611. doi: 10.1016/j.jadohealth.2015.01.020.
    1. Betancourt TS, McBain R, Newnham EA, et al. A behavioral intervention for war-affected youth in Sierra Leone: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2014;53(12):1288–1297. doi: 10.1016/j.jaac.2014.09.011.
    1. Ogrinc G, Davies L, Goodman D, Batalden PB, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Qual Safety. 2016;25:986–992. doi: 10.1136/bmjqs-2015-004411.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical care. 2012;50(3):217–226. doi: 10.1097/MLR.0b013e3182408812.
    1. Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Sci. 2019;14(1):1. doi: 10.1186/s13012-018-0842-6.
    1. Stadnick NA, Brookman-Frazee L, Mandell DS, Kuelbs CL, Coleman KJ, Sahms T, et al. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasibility Study. 2019;5(1):51. doi: 10.1186/s40814-019-0434-5.
    1. Institute for Healthcare Improvement . Quality improvement essentials toolkit. Boston: Institute for Healthcare Improvement; 2017.
    1. Franzen SRP, Chandler C, Lang T. Health research capacity development in low and middle income countries: reality or rhetoric? A systematic meta-narrative review of the qualitative literature. BMJ Open. 2017;7(1):e012332. doi: 10.1136/bmjopen-2016-012332.
    1. Aarons G, Fettes D, Hurlburt M, et al. Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. J Clin Child Adolesc Psychol. 2014;43(6):915–928. doi: 10.1080/15374416.2013.876642.
    1. Hurlburt M, Aarons GA, Fettes D, Willging C, Gunderson L, Chaffin MJ. Interagency Collaborative Team model for capacity building to scale-up evidence-based practice. Children Youth Services Rev. 2014;39:160–168. doi: 10.1016/j.childyouth.2013.10.005.
    1. ÜstÜn TB. World Health Organization. Measuring health and disability: manual for WHO Disability Assessment Schedule WHODAS 2.0. Geneva: World Health Organization; 2010.
    1. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess. 2004;26:41–54. doi: 10.1023/B:JOBA.0000007455.08539.94.
    1. Chin WW, WmD S, Pearson AW, Stollak MJ. Perceived cohesion in small groups: adapting and testing the perceived cohesion scale in a small-group setting. Small Group Res. 1999;30(6):751–766. doi: 10.1177/104649649903000605.
    1. Seed Team Assessment Questionnaire. Content last reviewed. Agency for Healthcare Research and Quality. Rockville; 2012.
    1. Mâsse LC, Moser RP, Stokols D, Taylor BK, Marcus SE, Morgan GD, et al. Measuring collaboration and transdisciplinary integration in team science. Am J Prev Med. 2008;35(2 Suppl):S151–S160. doi: 10.1016/j.amepre.2008.05.020.
    1. Frey BB, Lohmeier JH, Lee SW, Tollefson N. Measuring collaboration among grant partners. Am J Eval. 2006;27(3):383–392. doi: 10.1177/1098214006290356.
    1. Ward AM, Regan J, Chorpita BF, Starace N, Rodriguez A, Okamura K, Daleiden EL, Bearman SK, Weisz JR. Research Network On Youth Mental Health. Tracking evidence based practice with youth: validity of the MATCH and standard manual consultation records. J Clin Child Adolesc Psychol. 2013;42(1):44–55. doi: 10.1080/15374416.2012.700505.
    1. Haroz EE, Bolton P, Nguyen AJ, Lee C, Bogdanov S, Bass J, Singh NS, Doty SB, Murray L. Measuring implementation in global mental health: validation of a pragmatic implementation science measure in eastern Ukraine using an experimental vignette design. BMC health services research. 2019;19(1):1–1. doi: 10.1186/s12913-019-4097-y.
    1. Software VERBI. MAXQDA 2018 [computer software] Berlin: VERBI Software; 2017.
    1. Betancourt TS, Hansen N, Farrar J, Borg RC, Callands T, Desrosiers A, et al. Youth functioning and organizational success for West African Regional Development (Youth FORWARD): Study Protocol. PS. 2020.
    1. Ministry of Youth Affairs. A blueprint for youth development Sierra Leone’s National Youth Programme. 2014-2018. 2014. . Accessed 1 Feb 2022.
    1. Lengnick-Hall R, Willging C, Hurlburt M, Fenwick K, Aarons GA. Contracting as a bridging factor linking outer and inner contexts during EBP implementation and sustainment: a prospective study across multiple U.S. public sector service systems. Implementation Sci. 2020;15(1):43. doi: 10.1186/s13012-020-00999-9.
    1. Government of Sierra Leone Ministry of Health and Sanitation. National Health Sector Strategic Plan. 2010-2015. November 2009. . Accessed 19 Dec 2020.
    1. National Youth Commission, Ministry of Youth Employment and Sports. Youth Development: Sierra Leone Youth Report. 2012. . Accessed 19 Dec 2020.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi