Reviewing the Community Case Detection Tool
For our NGO project, we will be developing an intervention that addresses help-seeking barriers for children in Uganda. The first article I will review evaluates what is necessary for supporting children, like the population we will be working with, affected by war. Living in conflict areas leads to high rates of PTSD symptoms, behavioral and emotional symptoms, and disorders, sleep problems, disturbed play, and psychosomatic symptoms (Jordans et al., 2018). War can lead to these symptoms directly or indirectly, as children do not exist independently from the world around them. Specifically, we know that the caregiver-child relationship can provide great emotional support and buffer against certain hardships. However, in these contexts, many parents may experience their own form of psychopathology that impedes them from giving sensitive and responsive caregiving. Impacts of war stretch out even further than the child’s immediate family into schools, peers, local community, and overall political climate of the country. Because of this, the authors acknowledge that new research needs to be developed that looks at the child’s social ecology so that we can develop multi-level interventions (Jordans et al., 2018).
To do this, we need to start by addressing the population’s basic needs before narrowing in on the individual child that needs help. These interventions also need to be multi-sectoral in that they involve different organizations. These interventions need to be scientifically rigorous, starting from the research going into adapting them, all the way to the research that tests the efficacy. These interventions must address any stigmatization and discrimination that takes place around the concept of mental health. They must take into account local perspectives throughout the entire adaptation process so they can be culturally relevant. And lastly, these interventions should be replicable and sustainable. A way to address this need is to implement these programs into schools. That way, they can reach a large number of children (Jordans et al., 2018).
War Child Holland uses these suggestions to create multi-level, multi-sectoral interventions from a socio-ecological perspective.
One of their techniques is known as the Community Case Detection Tool (CCDT), which we will be working with for our project. The CCDT was tested for efficacy as a proactive detection tool for internalizing and externalizing problems among children and adolescents (6–18) in military-occupied Palestine (van den Broek et al., 2021). Seeking mental health is a multi-step process involving awareness of mental health needs, obtaining information about various services, wanting help, and actually getting these services. The CCDT was adapted to address the barriers of time, human resources, and money barriers by making the tool affordable, easy to understand, and easy to train. Researchers used literature, clinical and field experience in the area, focus groups, and feasibility of detecting the symptoms in every life when deciding what symptoms their tool would test for and then used a psychologist translator to develop the tool. The CCDT consists of a vignette that describes and shows pictures of examples of children displaying psychological symptoms of externalizing and internalizing and asks ‘do you know a child displaying these symptoms?’ Researchers trained local teachers and community members for a day on how to use the tool. After a child was flagged based on the vignette, research assistants asked the caregiver if trained psychologists could screen them. They compared the results of the CCDT to The Strengths and Difficulties Questionnaire (looks for emotional symptoms, conduct problems, inattention-hyperactivity, peer problems, and prosocial behavior) and The Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Ten Questions Screen for Childhood Disability. The CCDT accurately flagged 77% of the cases as needing psychological treatment, meaning that the tool is encouragingly accurate.
A significant limitation of the study was that 1/3 of the children were excluded because their caregivers said no or could not be reached. This is where our project comes in. We will look at what encourages some caregivers and their children to comply and seek help and use that information to encourage others to do the same.
Jordans, M. J., van den Broek, M., Brown, F., Coetzee, A., Ellermeijer, R., Hartog, K., Steen, F., & Miller, K. E. (2018). Supporting children affected by war: Towards an evidence-based care system. In Mental health of refugee and conflict-affected populations (pp. 261–281).
van den Broek, M., Hegazi, L., Ghazal, N., Hamayel, L., Barrett, A., Kohrt, B. A., & Jordans, M. J. (2021). Accuracy of a proactive case detection tool for internalizing and externalizing problems among children and adolescents. Journal of Adolescent Health.
