Evaluation of a Classroom-Based Psychosocial Intervention in Conflict-Affected Nepal
A cluster randomized controlled trial
In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal. The Classroom-Based Intervention (CBI) is a 5-week, 15-session (approximately 60-minute sessions) protocolized group intervention. CBI is an eclectic intervention based on concepts from creative-expressive and experiential therapy, cooperative play and cognitive behavioral therapy. A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, post-traumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11–14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group. Of the 325 participants in the study, 167 (51.4%) were boys and 158 (48.6%) were girls. Levels of education ranged from grades 2 to 8, with the majority in grades 6 to 8 (68%).
This study demonstrated efficacy of the Classroom-Based Intervention (CBI) for improving social-behavioral and positive aspects of wellbeing indicators among subgroups of children exposed to armed conflict in a low-income country.
- CBI produced moderate reductions of general psychological difficulties and aggression for boys and increased prosocial behavior for girls. Hope increased for older children.
- CBI did not demonstrate increased reduction of psychiatric symptoms compared with control conditions.
- CBI should be introduced in the context of a stepped-care system as a secondary prevention intervention for at-risk children in conjunction with other interventions for symptomatic children.