A Single Piece of Paper Offers Hope for Mental Health of Conflict-Exposed Children

Uganda study

The research conducted in Uganda evaluated the effectiveness of ReachNow, a tool developed by War Child to detect mental health problems among children and promote help-seeking. In communities working with ReachNow, almost 17 times as many children accessed mental health services during the nine-month study period compared to routine activities.

“Globally, an estimated 22% of conflict-affected people live with a mental health disorder. Children in this group are particularly at risk, as their needs may remain undetected and under-prioritised. It’s critical to accurately identify children in need of mental health care and encourage the use of mental health services, which is why War Child created ReachNow. This study tells us that the tool is working,” says Myrthe van den Broek, War Child Lead Researcher.

Early detection of symptoms and access to care are crucial but often delayed. Strategies to encourage children to seek mental health care are critically needed, particularly in low- and middle-income countries and in challenging environments.

Community gatekeepers

ReachNow directly addresses this by equipping key community members such as teachers, sports coaches, community health workers and youth leaders to detect mental health problems among children living in conflict settings. These community members are trained to use ReachNow's detection tool: a single sheet of paper with case studies, illustrations and a simple decision chart. This allows the user to identify children displaying signs of distress. Once children are identified as in need of care, we promote “help-seeking” and work with local partners to guide children to available services.

“The study found an association between ReachNow’s single-sheet-of-paper detection tool roll-out and increased service use by children and adolescents, as well as high detection accuracy of children in need. Put simply, the majority of children that community facilitators detected were confirmed to need mental health care services. That means we can be more confident that where this tool is being implemented, children are more likely to get the mental health care they need and deserve,” adds Myrthe.

Low-cost, evidence-based

From 1 January to 8 November 2022, 177 community members were trained to use the tool. They also learnt how to guide children to available services, taking into consideration the cultural sensitivities around seeking help for mental illness. Participating communities were in 28 zones across five refugee settlements in Uganda.

This study, A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements, adds to a growing body of evidence that shows the tool is working. Given its simplicity and ease of use, the ReachNow detection tool could become a low-cost contributor to closing the mental health care gap and strengthening mental health on a population level.

The full study can be viewed here.