Project Summary
Linked to the 20-year longitudinal study of war in Sierra Leone (project brief here), the Youth Readiness Intervention (YRI) is a promising approach for addressing mental health problems among at-risk youth in Sierra Leone. The YRI uses a structured, manual curriculum divided into 12 modules, with sequential 90-minute group sessions designed to be delivered by non-specialists. It integrates six empirically-supported practice elements shown to have trans-diagnostic efficacy across symptom dimensions of mental health disorders, ranging from major depressive disorder and anxiety to conduct problems. The YRI has three phases which are delivered in a sequential fashion: stabilization, integration, and connection. The YRI is designed to be integrated into education or livelihoods programs: it was initially delivered in educational settings, and later, integrated into youth employment programs tied to regional economic development in Sierra Leone, the Youth FORWARD project, in which the program was delivered by the German Corporation for International Development (GIZ). The prior Youth FORWARD (NIH-funded) study was a a hybrid type II implementation design that allowed us to test both effectiveness and implementation outcomes simultaneously. Currently, through philanthropic funding, we are testing the long-term effects through a four-year follow up of Youth FORWARD to contribute to the evidence base for validated, cost-effective mental health and livelihoods programs in Sierra Leone and other low-resource settings, helping address the mental health treatment gap in conflict-affected countries. In addition, through an NIMH-funded project, we are examining the diffusion and spillover of the YRI by quantifying the indirect benefits experienced by peers and caregivers through a cost-effectiveness and return on investment analysis.
Approach
We will follow up with 600 of the original 1200 Youth FORWARD participants in three rural districts of Sierra Leone: Kailahun, Kono, and Koinadugu. Our sampling approach will take into account the clusters and three study arms from Youth FORWARD. Clusters of youth (segregated by gender) were randomly assigned to one of three groups: the employment promotion program, the employment promotion program in addition to the YRI, and a control group. As in the original trial, we are using a mixed methods approach in the follow-up study.
Aims and Goals:
- We will deliver the same assessment battery as used in Youth FORWARD to each of the 600 study participants.
- In addition, 30 females will be purposively sampled based on previous mental health and socio-economic outcomes in order to help us understand the unique challenges that females face in Sierra Leone, how these challenges may impact the efficacy of the YRI, and to help us refine future interventions to be equally effective for both men and women.
Findings on diffusion of the YRI will inform the feasibility of peer-led interventions and the development of additional educational materials to amplify YRI components identified as most transferrable. Findings on spillover effects will inform the potential reach and penetration of evidence-based practices in LMICs. Lessons learned will inform the GoSL, GIZ, and development actors on investing in evidence-based mental health interventions in low-resource settings. y understanding the mechanisms of spillover and diffusion and by quantifying the indirect benefits experienced by peers and caregivers through a cost-effectiveness and return on investment analysis, this study will help advance implementation science research in LMICs and inform policy makers' decisions about investment and scale up of evidence-based mental health interventions in low-resource settings.
Measurement & Metrics
The Youth Assessment Battery, which was first delivered during Youth FORWARD, will be administered again in the follow-up study. The battery includes multiple measures of economic self-sufficiency, such as hours worked on each of several types of income-generating activities and self reports that yield detailed estimates of gross and net income. Numerous scales assess aspects of mental and physical health and functioning, including disability. Mental health measures include anxiety/depression, interpersonal functioning, emotion regulation, and PTSD.
Key Findings
When the YRI was originally implemented in secondary schools in urban Freetown ten years ago, youth who received the YRI showed improvements in mental health, pro-social attitudes, daily functioning, and educational outcomes. Teachers reported that YRI participants were more likely to persist in school (28.8% vs. 4.7%) and had better attendance and classroom behavior. The cluster-randomized trial implemented in 2018/2019 demonstrated that youth (ages 18-30) participating in the YRI and the employment promotion program reported better socio-economic and mental health outcomes than counterparts in the EPP-only and in the control group. Specifically, improvements in emotion regulation and reductions in anxiety/depression were found, in addition to increases in self-employment hours.
Publications & Documents
Project Support
This study was  previously supported by the United States Institute of Peace, the UBS Optimus Foundation, the National Institute for Mental Health, the National Institute on Aging, Harvard Catalyst, the Julie Henry Junior Faculty Development Fund, the Australian Psychological Society, the Australian National Health and Medical Research Council.
Currently, funding is from GDS, Imaginable Futures, and the National Institute of Mental Health.
Partnerships
Caritas Freetown, Innovations for Poverty Action (IPA), University of Georgia
Global Reach
The YRI is being tested and adapted in Sierra Leone, Kenya, Colombia, and South Sudan.Â
Contact:
Joshua Bogus
Associate Director for Research