The Effectiveness of Evidence-Informed Interventions Using Community-Based Participatory Research with Vulnerable Populations in the US and Abroad

Background:  The past two decades have seen significant advancements in the development of evidence-informed interventions to support the emotional wellbeing of children and families exposed to serious negative health and mental health threats.  Community-Based Participatory Research (CBPR) is a strategy based on relationships with communities and stakeholders that can support the applicability and implementation of effective and practical service models within poverty-impacted communities.  This paper will present two theoretically driven, empirically based local and global experimental CBPR interventions designed to be sustainable in real world settings that improve child prosocial behaviors.  The 4 R’s and 2 S’s for Strengthening Families (R01 MH072649) is a collaboratively developed practice model that integrates common elements of evidence-informed treatments for behavioral difficulties into a coordinated set of practices, with a focus on strengthening families, reducing parenting stress and building social support. The Collaborative HIV Prevention Adolescent Mental Health Program in South Africa (CHAMPSA; R01 MH55701) is a family-based, developmentally timed HIV prevention intervention to reduce risk behaviors among uninfected youth. 

Methods:  Secondary bivariate analyses of baseline and post-test data of 320 families from The 4 R’s and 2 S’s and 579 children from CHAMPSA were conducted.  Consumers, community members, providers, and research staff played an integral role in developing the curriculum of both CBPR interventions.  Both interventions are randomized controlled trials with an experimental and control group.  All measurements were psychometrically validated for each population. 

Results:  From baseline to post-test, children in the 4 R’s and 2 S’s experienced significant reductions in disruptive behavior disorders (Oppositional Defiant Disorder subscale of the Iowa Connors Rating Scale; t(157) =4.636, p=.000) as compared to children in the treatment as usual group t(72) = -.178, p=.859).  An independent-samples t-test was conducted to compare depression (Child Depression Inventory) scores among children in the CHAMPSA experimental and control conditions.  At post-test, there was a significant difference in depression scores for the experimental group (M= 13.67, SD= 2.83) and control group (M= 14.25, SD= 3.08), conditions; t(551)= -2.29, p= .022.  Additionally a paired-samples t-test indicated that depression scores from the experimental condition were significantly lower in post-test (M=13.68, SD=2.84) than at baseline (M=15.17, SD= 3.19), t(258)= 7.49, p=. 000). When it comes to HIV knowledge (HIV/AIDS Transmission Knowledge Scale) at post-test there was a significant difference in scores for the experimental group (M=2.40, SD=1.47) and control group (M= 1.37, SD= 1.37), conditions; t(555)= 8.59, p=.000.

Implications:  The 4 R’s and 2 S’s have been found to improve child mental health outcomes, specifically yielding reductions in child disruptive behavior disorders. Additionally, CHAMPSA has been shown to improve child prosocial behavior and knowledge of HIV transmission.  Both CBPR interventions are characterized by equitably involving community members, organizations, and researchers in all aspects of the research process.  CBPR has changed the sustainability of the programs and helped address challenges with how they are embedded in community experiences and contexts. Involving community members in the research process that speaks to their lived experiences can better inform interventions, thereby improving outcomes for youth and their families.