Analysis of the Classroom Based Intervention for children affected by violent conflict in Nepal: A secondary assessment of the reproducibility and sustainability of its treatment effect

Abstract

Children affected by violent conflict require Mental Health and Psychosocial Support (MHPSS). Jordans and colleagues (2010b) implemented and evaluated the effect of treatment with the Classroom Based Intervention (CBI) for children affected by violent conflict in Nepal. They found that treatment with the CBI did not result in psychiatric symptom reduction. However, it did reduce psychological difficulties and physical aggression (PA) for boys, increased prosocial behaviour (PSB) for girls and increased hope for older children. This research aimed to analyse the results of the one-year follow-up for PA and PSB. The first aim of this research was to investigate if there is a consistent treatment (reproducibility) effect of the CBI. The second aim of this research was to investigate if there is a sustained difference for gender. The results of the cluster randomised trial conducted by Jordans and colleagues were used to assess the level of change on PA and PSB. Children (N=325) between the age of 11 and 14 with elevated levels of psychosocial distress were allocated to an experimental- or a waitlist (intent tot treat) group. Outcomes were measured at three time-points: before treatment (T1), after treatment (T2), where after the waitlist group received treatment as well, and one year follow -up (T3). Comparing the differences in mean scores between T1 and T3 for the experimental group and T2 and T3 for the treated waitlist group show a significantly different treatment effect for PA (p=0.005) and PSB (p=0.004). This difference may be explained by different scores at baseline for participants in the experimental group as compared to participants in the waitlist group. Comparison over time shows a sustainable follow-up effect for the experimental group. The effect for gender on treatment outcomes did not sustain at one-year follow-up. A significant difference was found for gender between treatment groups on PA (p=0.000), indicating that the effect of treatment was different for boys and girls in the experimental group compared to the (treated) waitlist group. These results indicate that the CBI had a consistent sustainable treatment effect for the increase of PSB, treatment appears to be most beneficial for boys. The treatment effects for PA are not consistent and sustainable. Initial differences in mean scores on PA and PSB offer a possible explanation for the differences in effect of treatment.