Innovation summary

Children who experience violence are at increased risk of developing psychosocial and mental health problems; however, most children in these settings do not receive the care they need. The HealthNet TPO program delivers a multi-tiered psychosocial care package combining mental health promotion, prevention and treatment to address the needs of at-risk children and adolescents.

The program has three tiers:

Health promotion

Health promotion interventions are provided to increase awareness of the mental health needs of children and increase community resilience. These include:

  • Peer-support groups
  • Community sensitization
  • Psychoeducation

Prevention

Prevention activities target subgroups of children with psychosocial distress and include:

  • Detection using brief, context-sensitive screener in schools
  • Structured group intervention to address symptoms of distress and strengthen protective factors

Treatment

Children with severe mental health problems receive treatment as necessary, which may include:

  • Individual counseling
  • Parental support
  • Referral to a psychiatrist

Impact summary

  • The Classroom-Based Intervention (CBI) has been shown to be effective in several clinical trials in Indonesia3, Nepal4and Sri Lanka5
  • A series of non-randomized evaluation studies once the program had been rolled out across all five countries showed that it improved case detection and made effective care available to over 96,000 children in five countries6 
  • Cost of treatment between $4.60 and $11.26 USD7

"The program has resulted in improved case detection with a developed and validated screening instrument, making care accessible to over 96,000 children, and generating empirical evidence on the effectiveness of interventions."


- Jordans et al. (2013)4

Innovation details

The multi-tiered care package consists of a variety of interventions within each tier.

Health promotion

The first tier comprises mental health promotion activities, aiming to increase adaptive adjustment and community resilience. This tier’s activities include running peer groups, which are recreational activities combined with theme-centered group discussions for children without indication for care. It also includes community sensitization and psycho-education to increase awareness of the mental health needs of children, as well as of existing coping strategies and resources.

Prevention

The second tier consists of interventions that target subgroups of children with elevated psychosocial distress. Detection of children in need of psychosocial support is done by a brief context-sensitive screening tool that was developed and validated in each context. This tool, the Child Psychosocial Distress Screener, is employed within the school setting. The second tier includes a structured group intervention (CBI) aimed at decreasing symptoms of distress and strengthening protective factors.

Treatment

The third tier comprises treatment for children with severe mental health problems. This tier’s actions include providing individual counseling to reduce symptoms and improve functioning. Children requiring specialized treatment are referred to a psychiatrist by the counselors, whenever necessary and possible.

Key drivers

  • Effective infrastructure and collaboration within each of the country sites
  • Relatively freely allocated funds, which are not restricted to the achievement of rigid, pre-defined objectives
  • A unique dual focus on implementation and research, and direct translation between the two within the same program

Challenges

  • Transitioning from development of the innovation to scale-up across countries
  • Due to lack of resources, the program has stopped in all countries apart from Burundi and to some extent Nepal

Continuation

Work is continuing to improve the care package, including developing and evaluating a new family-based intervention in Burundi, Sudan and Nepal. Future plans include improving care for severe mental disorders within the package.1-2

Partners

Funders

Evaluation methods

Most of the care package components were subjected to rigorous research primarily through randomized controlled trials. After program implementation, a practice-driven evaluation of the care package was conducted based on routine monitoring and evaluation data, as well as a series of n=1 studies.

Cost of implementation

The full cost per beneficiary of the program (including project management, administrative costs, and program delivery costs etc.) varied between countries as detailed below: 7

  • Burundi $4.60 USD
  • Indonesia $11.26 USD
  • Sri Lanka $6.55 USD
  • Sudan $11.25 USD

Impact details

The program has resulted in improved case detection with a developed and validated screening instrument, making care accessible to over 96,000 children. It has generated empirical evidence on the effectiveness of interventions, and improved understanding of the working mechanisms and components of some of the interventions.

References

  1. Tol WA et al. (2008) School-based mental health intervention for political violence-affected children in Indonesia: a cluster randomized trial. JAMA, 300:655-662.
  2. Jordans MJD et al. (2010) Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. Journal of Child Psychology and Psychiatry, 51:818-826.
  3. Tol W et al. (2012) Outcomes and moderators of a preventive school-based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial. World Psychiatry, 11:114-122.
  4. Jordans MJD et al. (2013) Implementation of a mental health care package for children in areas of armed conflict: a case study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan. PLoS Med 10(1):e1001371.
  5. Jordans MJD et al. (2011) Mental health interventions for children in adversity: pilot-testing a research strategy for treatment selection in low-income settings. Social Science and Medicine, 73:456-466.
  6. Jordans MJD et al. (2013) A controlled evaluation of a brief parenting psycho-education intervention in Burundi. Social Psychiatry and Psychiatric Epidemiology, 48(11):1851-1859.
  7. Jordans MJD et al. (2011). Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of armed conflict. Community Mental Health Journal, 47: 267-277.

Research
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Country

Burundi, Sri Lanka, Sudan, Indonesia, Nepal

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