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Child and Adolescent Psychiatry and Mental Health
Published in: Child and Adolescent Psychiatry and Mental Health 1/2018

Open Access 01-12-2018 | Research article

Feasibility study of a family- and school-based intervention for child behavior problems in Nepal

Authors: Ramesh P. Adhikari, Nawaraj Upadhaya, Emily N. Satinsky, Matthew D. Burkey, Brandon A. Kohrt, Mark J. D. Jordans

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2018

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Abstract

Background

This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.

Methods

Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6–15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale—Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders’ perceptions of the intervention.

Results

The study found that children’s behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children’s ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children’s daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom.

Conclusions

Significant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.
Appendix
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Literature
1.
Klasen H, Crombag A. What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Soc Psychiatry Psychiatr Epidemiol. 2013;48:595–611.CrossRefPubMed
2.
Fergusson DM, Horwood LJ, Ridder EM. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry. 2005;46(8):837–49.CrossRefPubMed
3.
Matos M, Bauermeister JJ, Bernal G. Parent-Child Interaction Therapy for Puerto Rican preschool children with ADHD and behaviour problems: a pilot efficacy study. Parent Process. 2009;48(2):232–52.
4.
Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–64.CrossRefPubMedPubMedCentral
5.
6.
Loeber R, Dishion T. Early predictors of male delinquency: a review. Psychol Bull. 1983;94(1):68–99.CrossRefPubMed
7.
Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(5):593–602.CrossRefPubMed
8.
Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45(2):192–202.CrossRefPubMed
9.
Rey JM, Morris-Yates A, Singh M, Andrews G, Gavin W. Continuities between psychiatric disorders in adolescents and personality disorders in young adults. Am J Psychiatry. 1995;152(6):895–900.CrossRefPubMed
10.
Canino G, Polanczyk G, Bauermeister JJ, Rohde LA, Frick PJ. Does the prevalence of CD and ODD vary across cultures? Soc Psychiatry Psychiatr Epidemiol. 2010;45(7):695–704.CrossRefPubMedPubMedCentral
11.
Bywater T, Hutchings J, Daley D, Whitaker C, Yeo ST, Jones K, et al. Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder. Br J Psychiatry. 2009;195:318–24.CrossRefPubMed
12.
Sheldrick CE. Delinquency: risk factors and treatment interventions. Curr Opin Psychiatry. 1995;8(6):362–5.CrossRef
13.
Wallen J, Rubin RH. The role of the family in mediating the effects of community violence on children. Aggress Violent Behav. 1997;2(1):33–41.CrossRef
14.
IFRC. World disasters report. Geneva: International Federation of Red Cross and Red Crescent Societies; 2016. p. 2016.
15.
Luitel NP, Jordans MJD, Sapkota RP, Tol WA, Kohrt BA, Thapa SB, et al. Conflict and mental health: a cross-sectional epidemiological study in Nepal. Soc Psychiatry Psychiatr Epidemiol. 2013;48(2):183–93.CrossRefPubMed
16.
Adhikari RP, Upadhaya N, Gurung D, Luitel NP, Burkey MD, Kohrt BA, et al. Perceived behavioural problems of school aged children in rural Nepal: a qualitative study. Child Adolesc Psychiatry Ment Health. 2015;9(25):1–9.
17.
Burkey MD, Ghimire L, Adhikari RP, Wissow LS, Jordans MJ, Kohrt BA. The ecocultural context and child behavior problems: a qualitative analysis in rural Nepal. Soc Sci Med. 2016;159:73–82.CrossRefPubMedPubMedCentral
18.
Ojha SP, Khalid A, Nepal MK, Koirala NR, Regmi SK, Gurung CK. An exploratory study of emotional and behavioural problems in physically disabled children and adolescents. J Inst Med. 2000;22(3&4):212–20.
19.
Luitel NP, Jordans MJ, Adhikari A, Upadhaya N, Hanlon C, Lund C, et al. Mental health care in Nepal: current situation and challenges for development of a district mental health care plan. Confl Health. 2015;9:3.CrossRefPubMedPubMedCentral
20.
Woolfenden S, Williams KJ, Peat J. Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10–17. Cochrane Database Syst Rev. 2001;2:1–37.
21.
Scott S, Sylva K, Doolan M, Price J, Jacobs B, Crook C, et al. Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: the SPOKES project. J Child Psychol Psychiatry. 2010;51:48–57.CrossRefPubMed
22.
Klasen H, Crombag AC. What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Soc Psychiatry Psychiatr Epidemiol. 2013;48(4):595–611.CrossRefPubMed
23.
Gardner FEM. Parents anticipating misbehaviour: observational study of strategies parents use to prevent conflict with behaviour problem children. J Child Psychol Psychiatry. 1999;40(8):1185–96.CrossRefPubMed
24.
Baker-Henningham H, Scott S, Jones K, Walker S. Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial. Br J Psychiatry. 2012;201:101–8.CrossRefPubMedPubMedCentral
25.
Araya R, Fritsch R, Spears M, et al. School intervention to improve mental health of students in Santiago, Chile: a randomized clinical trial. JAMA Pediatr. 2013;167(11):1004–10.CrossRefPubMed
26.
Jordans MJD, Kamproe I, Tol W, Kohrt B, Luitel N, Macy R, et al. Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. J Child Psychol Psychiatry. 2010;51(7):818–26.CrossRefPubMed
27.
Jordans MJD, Tol WA, Komproe IH, Susanty D, Vallipuram A, Ntamatumba P, et al. Development of a multi-layered psychosocial care system for children in areas of political violence. Int J Ment Health Syst. 2010;4(15):1–12.
28.
Adhikari RP, Upadhaya N, Gurung D, Luitel NP, Burkey MD, Kohrt BA, et al. Perceived behavioral problems of school aged children in rural Nepal: a qualitative study. Child Adolesc Psychiatry Ment Health. 2015;9:25.CrossRefPubMedPubMedCentral
29.
Jordans MJD, Tol WA, Komproe IH. Mental health interventions for children in adversity: pilot-testing a research strategy for treatment selection in low-income settings. Soc Sci Med. 2011;73(3):456–66.CrossRefPubMed
30.
Burkey MD, Ghimire L, Adhikari RP, Kohrt BA, Jordans MJD, Haroz EE, et al. Development process of an assessment tool for disruptive behavior problems in cross-cultural settings: the Disruptive Behavior International Scale—Nepal version (DBIS-N). Int J Cult Ment Health. 2016;9(4):387–98.CrossRefPubMedPubMedCentral
31.
Burkey MD, Adhikari RP, Ghimire L, Kohrt BA, Wissow LS, Luitel N, et al. Validity and psychometric properties of the Disruptive Behavior International Scale—Nepal Version: a scale developed using local stakeholder participation (Draft submitted).
32.
Tol WA, Barbui C, Galappatti A, Silove D, Betancourt TS, Souza R, et al. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet. 2011;378(9802):1581–91.CrossRefPubMedPubMedCentral
33.
Eyberg SM, Ross AW. Assessment of child behavior problems: the validation of a new inventory. J Clin Child Psychol. 1978;7(2):113–6.CrossRef
34.
Van Ginneken N, Maheedharia MS, Ghani S, Ramakrishna J, Raja A, Patel V. Human resources and models of mental healthcare integration into primary and community care in India: case studies of 72 programmes. PLoS ONE. 2017;12(6):e0178954.CrossRefPubMedPubMedCentral
35.
Patel VH, Kirkwood BR, Pednekar S, Araya R, King M, Chisholm D, et al. Improving the outcomes of primary care attenders with common mental disorders in developing countries: a cluster randomized controlled trial of a collaborative stepped care intervention in Goa, India. Trials. 2008;9:4.CrossRefPubMedPubMedCentral
36.
Gardner F, Hutchings J, Bywater T, Whitaker C. Who benefits and how does it work? Moderators and mediators of outcomes in an effectiveness trial of a parenting intervention. J Clin Child Adolesc Psychol. 2010;39:568–80.CrossRefPubMed
37.
Haggerty KP, McGlynn-Wright A, Klima T. Promising parenting programmes for reducing adolescent problem behaviours. J Child Serv. 2013;8(4):229–43.CrossRef
38.
Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Behavioural and cognitive-behavioural group based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev. 2012;2:CD008225.
39.
Scott S, Knapp M, Henderson J, Maughan B. Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ. 2001;323(7306):191.CrossRefPubMedPubMedCentral
40.
O’Donnell J, Hawkins JD, Catalano RF, Abbott RD, Day LE. Preventing school failure, drug use, and delinquency among low-income children: long-term intervention in elementary schools. Am J Orthopsychiatry. 1995;65(1):87–100.CrossRefPubMed
41.
Cutler D. Behavioral health interventions: what works and why? In: Bulatao R, Anderson N, editors. Understanding racial and ethnic differences in health in late life: a research agenda. Washington, DC: National Academies Press; 2004.
42.
43.
WHO. Social determinants of mental health. Geneva: World Health Organization and Calouste Gulbenkian Foundation; 2014.
44.
Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52(3):263–76.PubMedPubMedCentral
45.
Metadata
Title
Feasibility study of a family- and school-based intervention for child behavior problems in Nepal
Authors
Ramesh P. Adhikari
Nawaraj Upadhaya
Emily N. Satinsky
Matthew D. Burkey
Brandon A. Kohrt
Mark J. D. Jordans
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Child and Adolescent Psychiatry and Mental Health / Issue 1/2018
Electronic ISSN: 1753-2000
DOI
https://doi.org/10.1186/s13034-018-0226-3

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