Effectiveness Study of a Treatment to Improve the Mental Health of Children and Adolescents

NCT ID: NCT03075475

Last Updated: 2018-07-02

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: NA
• Total Enrollment: 83 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-06-01
• Study Completion Date: 2018-01-08

Brief Summary

This randomized controlled trial evaluates the effectiveness of a psychotherapeutic intervention, the Common Elements Treatment Approach (CETA), to address the mental health needs of children and adolescents age 8-17 who have been affected by armed conflict in Kachin State, Myanmar. The 10-12 week talk-based counseling treatment, delivered by community mental health workers, will be evaluated against a wait-list control group. This project follows on a recently completed trial of CETA for adult trauma survivors from Myanmar along the Thai-Myanmar border which found that CETA was acceptable, accessible, and effective in improving mental health and functioning of adults. The investigators hypothesize that the intervention will be similarly effective for improving the mental health and functioning of children and adolescents.

Detailed Description

The Common Elements Treatment Approach (CETA) is a trans-diagnostic psychotherapeutic intervention.

Results from qualitative interviews following the randomized controlled trial (RCT) of CETA for adults (IRB # 00003601) and during the scale-up of CETA services have indicated that there is a major need for mental health services for children and adolescents in Myanmar, as currently there are no evidence-based psychotherapy services for children and adolescents in the country. Specifically, since the initial trial the research team has received requests from community-based organizations to implement CETA for children and adolescents in Kachin language-speaking communities in northern Myanmar. Local partners and the Applied Mental Health Research group (AMHR) at Johns Hopkins University (JHU) believe that CETA is amenable for use with children and adolescents and that this population would benefit in similar ways to adults. A qualitative study has since been conducted (IRB# 00006933), and the data used to develop and validate an assessment instrument with children and adolescents in Kachin state (IRB# 00006929).

The JHU research team will work with the local partner organization, Kachin Baptist Convention (KBC), to implement this project. KBC is a well-established community-based organization that currently provides emergency relief services to approximately 20,000 displaced Kachin people living in 42 camps. Their community outreach activities are non-denominational.

Participants will mostly be accessed through schools and in partnership with the local implementing partner. Their teachers, secondary caregivers and persons from the local partner organization who work with them regularly - all of whom are involved in the study as key community informants - will identify and refer the potential child/adolescent participants for screening into the study. Screening will otherwise be open to all children/adolescents, and those who are eligible will be asked to participate in the trial. Informed consent will be obtained from the parent/guardian and informed assent from the child. Participants will be randomly assigned to either receive CETA immediately or be put on a waitlist to receive treatment later.

Counselors will be current employees of the local partner organization who have participated in a 2-week initial training followed by 8-10 weeks of supervised practice. Counselors will receive weekly clinical supervision for the duration of the trial.

During the RCT, 10-12 weekly CETA sessions will be delivered individually in private spaces either at schools, homes, or in the community. In most cases, the children are living in the camps with their parents/guardians. Counselors will also follow-up with control children on a weekly basis to assess their symptoms using a client monitoring form. Both treatment and control participants will be reassessed using the same assessment instrument following the treatment period.

Conditions

Child Mental Disorder; Behavior Problem

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

CETA Treatment

For treatment group participants, they will then have weekly Common Elements Treatment Approach (CETA) counseling sessions with a counselor lasting no more than 1.5 hours per session, and a total of approximately 10-12 sessions. They will then repeat the assessment instrument after their last session, as well as 6 months after finishing treatment, and these meetings will again last no more than 1.5 hours. All total, it is expected that treatment group participants will have 13 meetings with a study team member or counselor over the course of their participation.

Group Type: EXPERIMENTAL

Common Elements Treatment Approach

Intervention Type: BEHAVIORAL

The Common Elements Treatment Approach (CETA), is a trans-diagnostic psychotherapy that is based on common evidence-based treatments for depression, anxiety, trauma and stress related disorders. This treatment can be used to treat individuals with any of these mental health problems and with any combination of these problems. CETA expands upon traditional treatment approaches that are designed to focus on one specific disorder and has been proven through multiple rigorous trials to reduce the burden of multiple common mental health problems and improve functionality among men and women living in low resource settings. CETA can be provided to people in their own communities by trained and supervised lay providers, for example community health workers.

Waitlist

Waitlist group participants be contacted by a study team member from the local partner organization regularly (weekly) while they are on the wait list. These contacts from the study team will be short and last less than 30 minutes and will be used to briefly assess symptom levels and safety. At the end of their wait period, they will be asked to complete the assessment instrument a second time and this meeting will take no more than 1.5 hours. For participants in the waitlist group, we estimate 13 meetings total during their wait period (2 meetings of no more than 1.5 hours, 10 contacts less than 30 minutes).

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Common Elements Treatment Approach

The Common Elements Treatment Approach (CETA), is a trans-diagnostic psychotherapy that is based on common evidence-based treatments for depression, anxiety, trauma and stress related disorders. This treatment can be used to treat individuals with any of these mental health problems and with any combination of these problems. CETA expands upon traditional treatment approaches that are designed to focus on one specific disorder and has been proven through multiple rigorous trials to reduce the burden of multiple common mental health problems and improve functionality among men and women living in low resource settings. CETA can be provided to people in their own communities by trained and supervised lay providers, for example community health workers.

Intervention Type: BEHAVIORAL

Other Intervention Names

CETA

Eligibility Criteria

Inclusion Criteria

• Moderately or severely affected (cutoff to be defined during validation phase) children ages 8-17 years.

Exclusion Criteria

• Active psychosis or serious developmental disorder (e.g., mental retardation, autism) that would preclude participation in cognitive-behavioral oriented skills intervention

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

United States Agency for International Development (USAID)

FED

Sponsor Role: collaborator

Johns Hopkins Bloomberg School of Public Health

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Catherine Lee, PhD

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins Bloomberg School of Public Health

Locations

Kachin Baptist Convention Jan Mai Kawng Camp

Myitkyina, Kachin State, Burma

Countries

Burma

References

Bolton P, Lee C, Haroz EE, Murray L, Dorsey S, Robinson C, Ugueto AM, Bass J. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014 Nov 11;11(11):e1001757. doi: 10.1371/journal.pmed.1001757. eCollection 2014 Nov.

Reference Type: BACKGROUND

PMID: 25386945 (View on PubMed)

Other Identifiers

00007317

Identifier Type: -

Identifier Source: org_study_id