Designing a digital, parent-led cognitive behavioural therapy-based intervention for young people with mental health problems in low-income settings

For young people in low- and middle-income countries (LMICs), accessing care for general mental health problems such as elevated anxiety, depressed mood, and emotional distress is extremely difficult due to a lack of therapists, stigma, and culturally appropriate interventions. Digital therapeutic interventions that are completed by young people are one possible solution, but they also have significant challenges: attrition rates are high, long bouts of screen time can negatively impact development, and young people in LMICs may not have individual access to a smartphone or computer. Parent-led therapeutic interventions are an effective alternative, where parents are equipped with skills to support their child's mental health in a variety of ways, including by delivering cognitive-behavioural therapy (CBT). Recently, high-income countries have begun developing digital parent-led interventions for improving child mental health. While these interventions show promise, deploying new, standalone programmes in LMICs is often
impractical due to significant variations in funding and delivery infrastructure. Rigorously designed psychological interventions can have greater reach in LMICs if they can be delivered as part of existing programs with complimentary content and focus, such as positive parenting programmes (Triple P, Parenting for Lifelong Health, Incredible Years), which millions of parents in LMICs have already have access to. Teaching parents to manage their child's mental health is an important step in helping children cope with psychological distress associated with LMICs and humanitarian settings. My research will investigate the feasibility of this in a low-income setting, identifying the important content and delivery considerations for a digital, parent-led CBT intervention that can be integrated into existing parenting programmes. In collaboration with programme stakeholders and participants, we will co-design a digital intervention that can be integrated with existing parenting programmes or as a brief, standalone intervention. This will then be tested for feasibility and acceptability embedded in an existing implementation of a digital parenting programme, ParentText. The potential implications for this research are twofold. First, there are currently no scalable, digital parent-led therapeutic interventions for child mental health in LMICs. Through participatory research, this work will produce an intervention that can be tested in LMICs around the world. Second, this approach is novel, as there is no research to date on utilising an existing parenting programme's infrastructure to deliver a digital, parent-led therapeutic intervention for child mental health. If effective, this approach could greatly reduce the complexity of delivering primary mental health care to millions of children.