SMART Africa (Strengthening Mental Health Research and Training)

A longitudinal experimental mixed methods effectiveness-implementation hybrid research design will be employed. The study will be conducted across thirty primary schools representing both semi-urban and rural communities. We expect to involve 3,000 youth (in primary schools grades 2 through 7; 8 to 13 years) and their adult caregivers (3,000) in Uganda, 180 youth and their caregivers (180) in Ghana, and 180 youth and their caregivers (180) in Kenya.

Schools will be randomly assigned to 3 study conditions: 1) MFG-delivered by trained family peers; 2) MFG-delivered by community health workers (school health education program coordinators in Ghana); or, 3) Comparison: mental health and school support materials (e.g., books, uniforms). Data will be collected at baseline, 8 and 16 weeks, and 6 months follow-up (10 months from baseline).

More specifically the objectives of this study are:

Primary objectives

• To examine short- and long-term outcomes associated with the MFG. Hypothesis: Children in the treatment groups (MFG) will improve significantly more compared to those in the comparison (usual care) group.
• To examine how systematic variations in the delivery of an evidence-based MFG program impacts outcomes for children with behavioral difficulties and their caregivers in each country context.

Hypothesis: Children who participate in MFG with their families will display significantly reduced conduct difficulties and increased functioning over time compared to those involved in comparison condition. We expect that parent peers - compared to community health workers - will evidence significantly more success engaging families to attend MFG sessions, thus, children in the MFG-parent peer delivered condition will evidence the great improvement relative to the other two study conditions.

Secondary objectives

• To compare the uptake and implementation of MFGs by trained existing family peers and community outreach health workers.

Hypothesis: Given the level of training that community outreach health workers have received prior to the study as part of their regular professional training, they will evidence higher fidelity initially, yet with training and ongoing supervision, we expect these differences to decrease over time.

• To examine multi-level (state/government, NGOs, families, schools, communities) influences on the uptake, implementation, effectiveness and sustainability of EBPs that address serious child disruptive behavioral challenges.

Inclusion criteria

• Inclusion criteria for caregiver/child dyads:

• Adult caregiver of a child in primary school, grades two through 7, ages 8 to 13 years
• Adult caregiver willing to consent and available for research and intervention activities
• Child between the ages 8 to 13 or in primary school (grades two through seven) who is screened for ODD or CD as measured by the Disruptive Behavior Disorder Rating Scale, Impairment Scale, and Iowa Conners Scale.
• Child willing to assent.

• Inclusion criteria for parent peers:
• Caregivers of children who agree to be trained to provide support to families.

• Inclusion criteria for community health workers
• Lay paraprofessionals who work within primary care settings.

• Inclusion criteria for school directors
• Directors who oversee schools where the proposed intervention will have been tested.

Exclusion criteria

• Exclusion criteria for caregiver/child dyads:

• Lack of understanding of study and study procedures as determined by the research team
• Child or caregiver refusal to participate

• Exclusion criteria for parent peers:
• Refusal to participate

• Exclusion criteria for community health workers
• Refusal to participate

• Exclusion criteria for school directors
• Refusal to participate