Harvard Catalyst Profiles

The Research Program on Children and Global Adversity that I direct at the FXB Center for Health and Human Rights focuses on forms of adversity that are exceptions to recent improvements in child health globally: regions affected by armed conflict and regions affected by HIV/AIDS (http://www.harvardfxbcenter.org/programs-rpcga.php).

My research is intended to help build the evidence base on mental health and preventive interventions for vulnerable children and families. I have been involved in the adaptation and testing of evidence-based interventions for mental health problems among war-affected youth, including serving as PI of an NIMH-funded Family Strengthening Intervention (FSI) in Rwanda, and as PI of a USIP-funded Youth Readiness Intervention (YRI) for war-affected youth in Sierra Leone. Both projects are positioned to contribute to our understanding of how effective evidence-based mental health interventions are in low-resource settings in Africa compared to care as usual.

In our Family-Strengthening Intervention in Rwanda (http://projectreporter.nih.gov/project_info_description.cfm?aid=8071892&icde=0) we are using a randomized controlled design to conduct a feasibility pilot, drawing study families (40 FSI, 40 controls) from social work referrals. Protective factors characterizing the family as well as mental health problems in children and caregivers will be assessed pre- and post-intervention using a culturally-validated assessment battery. We will examine feasibility and acceptability of an adapted family-based psychosocial intervention focused on building communication and resilience in families affected by HIV compared to usual care. Our findings will provide refined tools and evaluation materials for use in a future RCT. Our Specific Aims are to: 1) Adapt a US-developed, family-focused, and strengths-based prevention program to the context of HIV/AIDS in post-genocide Rwanda; 2) pilot test the intervention protocol within a small set of families to assess acceptability, feasibility and further refine an intervention manual; and 3) conduct a pilot feasibility study among 80 families to examine whether the intervention a) improves caregiver-child relationships using measures of family connectedness, good parenting and social support, and b) is associated with reduced mental health symptoms, HIV risk behaviors and increased functioning in children.

The Youth Readiness Intervention (YRI) for war-affected youth in Sierra Leone was developed as a Stage 1 trauma intervention with a focus on addressing the interpersonal skills, emotion regulation, and daily functional impairments that are typical among youth exposed to complex trauma such as war exposure in childhood. The YRI integrates common elements of evidence-based interventions for survivors of complex trauma that have demonstrated effectiveness in treatment of inpatient adolescents and survivors of childhood sexual abuse. In preliminary intervention development work, the YRI was culturally-adapted using focus groups and key informant interviews. Findings from our multi-wave longitudinal study of male and female child soldiers have informed the intervention development. The YRI itself is comprised of six empirically-supported treatment components that have demonstrated effectiveness in interventions for troubled youth in other diverse settings. Evaluations of intervention feasibility and acceptability, as well as preliminary evidence on treatment effectiveness as compared to usual care will contribute to gaps in our knowledge about interventions for youth in post-conflict settings. We are also in the process of refining the design to compare the effects of the YRI alone to the effects of secondary school access compared to combined YRI intervention and secondary school access.

In future research, we intend to move our intervention research towards the examination services delivered by well trained and supervised community health workers (task-shifting) to help address the extreme human resource constraints that characterize many low resource settings in sub-Saharan Africa. Once scientifically evaluated, such interventions are well positioned to go to scale given strong partnerships in the regions in which we work with national and international NGOs, UN Agencies, service agencies, and local government.