BACKGROUND Evidence-based mental health interventions have helped address health services gaps, but their reach and societal benefit can be limited in low resource settings. The current study extends an ongoing scale-up study of a cognitive behavioral therapy (CBT)-based intervention, the Youth Readiness Intervention (YRI), among high risk youth in post-conflict Sierra Leone to investigate mechanisms of diffusion and spillover effects of the YRI among peers and caregivers of youth who receive the intervention. METHODS We will recruit and enroll YRI index participants and control index participants (ages 18-30). Index participants will complete a standardized ego-network survey to nominate three peers in their social networks and identify their primary cohabitating caregiver. Identified peers and caregivers who consent to participate will complete a quantitative assessment battery on mental health outcomes, emotion regulation, and daily functioning at baseline and 8-month follow-up. Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scaleup. Social network analysis will investigate diffusion of YRI components across peer networks. Linear growth modeling will examine mental health spillover effects among caregivers. Incremental health costs and benefits among YRI participants' caregivers and peers will be assessed through cost-effectiveness and return on investment analysis. DISCUSSION Assessing implementation research outcomes, including penetration of YRI effects across social networks and cost-effectiveness of the YRI as distinct outcomes, will provide key information about the success of YRI implementation. Lessons learned could inform decisions to increase scale up efforts in Sub-Saharan Africa and other low resource settings.

中文翻译：

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塞拉利昂高危青年同龄人和看护者中循证心理健康干预的扩散和溢出效应：研究方案。

背景技术基于证据的精神卫生干预措施已经帮助解决了卫生服务方面的差距，但是在资源匮乏的情况下，其覆盖范围和社会效益可能受到限制。当前的研究扩展了正在进行的按认知行为疗法（CBT）为基础的干预措施的扩大研究，即在冲突后塞拉利昂的高危青年中进行的青年准备干预（YRI），以调查该疾病的扩散和溢出效应的机制。接受干预的青年同龄人和看护人中的青少年康复研究所。方法我们将招募和注册YRI指数参与者和对照指数参与者（18至30岁）。索引参与者将完成标准化的自我网络调查，以提名其社交网络中的三个同伴并确定其主要的同居照料者。确定的同意参加的同龄人和照顾者将完成有关心理健康结局，情绪调节以及基线和8个月随访中的日常功能的定量评估。研究成果还包含实施科学的通用指标，包括项目背景，评估和规模扩大的度量。社交网络分析将调查YRI组件在对等网络中的传播。线性增长模型将检查照顾者之间的心理健康外溢效应。YRI参与者的照护者和同伴之间增加的健康成本和收益将通过成本效益和投资回报分析进行评估。讨论评估实施研究结果，包括跨社交网络的YRI效果渗透以及YRI作为不同结果的成本效益，将提供有关YRI实施成功的关键信息。所汲取的经验教训可以为增加在撒哈拉以南非洲和其他资源匮乏地区的扩大努力的决策提供依据。