Abstract：
BACKGROUND: Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents.
METHODS: This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780.
RESULTS: 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use.
CONCLUSIONS: The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services.
BACKGROUND: Sint Antonius Stichting Projects.
UNASSIGNED: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.
METHODS: This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780.
RESULTS: 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use.
CONCLUSIONS: The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services.
BACKGROUND: Sint Antonius Stichting Projects.
UNASSIGNED: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.
摘要：
背景：需要促进儿童寻求精神卫生保健帮助的策略，特别是在低收入和中等收入国家以及复杂的环境中。这项试验的目的是比较一个基于小插图的，社区层面,主动病例检测工具（CCDT）反对提高标准意识，以促进儿童和青少年寻求心理健康帮助。
方法：这项阶梯式楔形集群随机试验在BidiBidi，KyakaII,Kyangwali,Omugo,和乌干达的犀牛难民定居点。社区看门人接受了为期2天的培训课程，内容涉及使用CCDT主动发现有心理健康问题的儿童，并鼓励儿童（或其照顾者）使用乌干达跨文化心理社会组织提供的心理健康护理服务。在基线,组织实施了常规检测或提高心理健康意识的活动。在交叉到CCDT实施时，看门人在日常活动中使用该工具。主要结果是儿童和青少年使用精神保健服务。没有地区一级的儿童人口估计。因此,服务使用是根据总人口规模计算的。我们将CCDT实施的效果报告为发病率比率(IRR)，这是我们根据一个计算日历时间的模型制作的，曝光时间,和人的时间。估算了IRR，以分析每个方案和意向治疗人群随时间的影响。该试验已在ISRCTN注册中心注册，编号ISRCTN19056780。
结果：到10月，选择了28个行政区参加试验，2021年。在2022年1月1日至11月8日之间，四个区域的七个集群以1个月的间隔依次从常规护理过渡到CCDT实施。CCDT由177名训练有素的社区看门人实施。9个月后,2385名儿童参观了精神保健服务；其中，1118（47％）为女孩，1267（53％）为男孩（平均年龄12·18岁[SD4.03]）。1998年，儿童首次或重返服务；其中，937（47％）为女孩，1061（53％）为男孩（平均年龄12·08岁[SD4·06]）。与标准的提高认识活动相比，CCDT的实施与实施后第一个月精神卫生保健服务使用的增加相关(20·91倍变化[95%CI12·87-33·99])。尽管随着时间的推移，CCDT和CCDT前地区的服务使用量略有下降，CCDT区在精神卫生服务使用中保持了时间平均16·89倍的增长（95％CI8·15-34·99）。
结论：CCDT使社区看门人能够增加儿童和青少年对精神保健服务的使用。植根于社区的基于小插图的战略可以成为缩小儿童精神保健差距的宝贵贡献，特别是伴随着可获得的精神保健服务。
背景：圣安东尼斯·斯蒂奇丁项目。
■对于阿拉伯语，摘要的法语和西班牙语翻译见补充材料部分。
方法：这项阶梯式楔形集群随机试验在BidiBidi，KyakaII,Kyangwali,Omugo,和乌干达的犀牛难民定居点。社区看门人接受了为期2天的培训课程，内容涉及使用CCDT主动发现有心理健康问题的儿童，并鼓励儿童（或其照顾者）使用乌干达跨文化心理社会组织提供的心理健康护理服务。在基线,组织实施了常规检测或提高心理健康意识的活动。在交叉到CCDT实施时，看门人在日常活动中使用该工具。主要结果是儿童和青少年使用精神保健服务。没有地区一级的儿童人口估计。因此,服务使用是根据总人口规模计算的。我们将CCDT实施的效果报告为发病率比率(IRR)，这是我们根据一个计算日历时间的模型制作的，曝光时间,和人的时间。估算了IRR，以分析每个方案和意向治疗人群随时间的影响。该试验已在ISRCTN注册中心注册，编号ISRCTN19056780。
结果：到10月，选择了28个行政区参加试验，2021年。在2022年1月1日至11月8日之间，四个区域的七个集群以1个月的间隔依次从常规护理过渡到CCDT实施。CCDT由177名训练有素的社区看门人实施。9个月后,2385名儿童参观了精神保健服务；其中，1118（47％）为女孩，1267（53％）为男孩（平均年龄12·18岁[SD4.03]）。1998年，儿童首次或重返服务；其中，937（47％）为女孩，1061（53％）为男孩（平均年龄12·08岁[SD4·06]）。与标准的提高认识活动相比，CCDT的实施与实施后第一个月精神卫生保健服务使用的增加相关(20·91倍变化[95%CI12·87-33·99])。尽管随着时间的推移，CCDT和CCDT前地区的服务使用量略有下降，CCDT区在精神卫生服务使用中保持了时间平均16·89倍的增长（95％CI8·15-34·99）。
结论：CCDT使社区看门人能够增加儿童和青少年对精神保健服务的使用。植根于社区的基于小插图的战略可以成为缩小儿童精神保健差距的宝贵贡献，特别是伴随着可获得的精神保健服务。
背景：圣安东尼斯·斯蒂奇丁项目。
■对于阿拉伯语，摘要的法语和西班牙语翻译见补充材料部分。
