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GLOBVAC-Global helse- og vaksin.forskn

Implementing a user involved education- and health system interactive task-shifting approach for child mental health promotion in Uganda

Alternative title: Implementering av en oppgavefordelingsmodell mellom utdannings- og helsesektoren for å fremme barns psykiske helse i Uganda?

Awarded: NOK 12.0 mill.

How can more children get help with mental health problems in a country with 20 million children and only 7 child psychologists? Despite economic growth in Uganda, 42% still live below the poverty line. Children growing up in poverty are more likely to experience violence and trauma. In addition to violence in the home, more than half of children in Uganda experience physical violence from teachers. How can we prevent violence and help children with mental health challenges when the need is so great and the resources so scarce? In this research project, teachers will receive training in mental health and basic preventive measures through the World Health Organization`s (WHO) «Mental Health Gap Action Programme Intervention Guide» (mhGAP-IG). By developing and integrating systems for cooperation between the school and health sector, children with severe problems will be referred to the first- or second-line services. The aim is to prevent school violence and reduce mental health stigma. The aim of the project is fourfold: 1. Develop a school version of the mhGAP with user involvement. 2. Implement the adapted mhGAP-IG and investigate effective implementation strategies and client outcomes. 3. Develop, implement and evaluate an intersectoral supervision, referral and communication model between the health and education sector. 4. Develop implementation advice to guide policy-makers in how to implement and sustain large-scale evidence-informed interventions for youth. By identifying effective implementation strategies, this study will produce knowledge about how mental health programs can be implemented and sustained in resource-constrained contexts where the need is great and the resources are scarce. The study is conducted by the Norwegian Center for Violence and Traumatic Stress Studies, the University of Bergen, Norway, and the Norwegian University of Science and Technology, and the University of Makerere in Uganda.

Uganda is recognizing mental problems among children as a major public health challenge. However, mental health services are facing lack of resources, stigmatizing attitudes, and a lack of help-seeking and systems for referrals. A task-shifting approach is highlighted as necessary to archive universal health coverage. The primary school attendance in Uganda is close to 100% for the first grades in primary school and constitute as such a unique opportunity for detection. The aim of the TREAT INTERACT project is to develop, implement and evaluate the impact of a novel, inter-sectorial TREATment INTERACTive program to identify, prevent and treat mental health problems in children and adolescents in Uganda through a user involved task-shifting adaptation and implementation of the WHO´s mhGAP-IG (Mental Health Gap Action Programme, Intervention Guide) among primary school staff. The overall goal is to generate knowledge on task-shifting implementation strategies to strengthen the inter-sectorial collaboration enhancing communication and referral strategies between the child’s school, community, and the health system. The TREAT INTERACT project group from the Norwegian Center for Violence and Traumatic Stress Studies, the University of Bergen and Norwegian University of Science and Technology in Norway, and the University of Makerere in Uganda, have designed a work programme consisting of 4 scientific work-packages (WP). In WP1 we will use intervention and implementation mapping and user-involvement in the adaptation of mhGAP’s child and adolescent mental health module for the primary school focusing on child development, behavioural- and emotional mental health. WP2 will test out the implementation and intersectoral communication strategies using a stepped-wedge design. WP3 will implement the mhGAP-IG school module together with a referral and supervision system and school communication platform. In WP4 we will assess sustainability and integration perspectives.

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GLOBVAC-Global helse- og vaksin.forskn