# MISC-CBO: A cluster randomized control trial to improve the mental health of OVC in South Africa

> **NIH NIH R01** · UNIVERSITY OF HOUSTON · 2024 · $336,880

## Abstract

ABSTRACT
Globally, there are over 16 million orphans and vulnerable children (OVC), with estimates of between 1.9-3.7
million for South Africa (SA). Despite high mental health needs of OVC, there is a crisis in scarcity of mental
health workers in SA. Community-based organizations (CBOs) offer a strategic point of intervention. In a prior
NIH-funded quasi-experimental feasibility trial we showed that the Mediational Intervention for Sensitizing
Caregivers (MISC) for CBO careworkers, thereafter named MISC-CBO, significantly reduced mental health
problems in Sesotho-speaking OVC. MISC-CBO is a year-long semi-structured, manualized video-feedback
intervention designed to enhance the caregiving capacity of CBO careworkers to improve child outcomes, by
targeting the RDoC systems for social processes (affiliation and attachment). Building on this work, we now
propose a repeated measures cluster randomized trial to fully establish the effectiveness and trans-diagnostic
mechanisms of action of MISC-CBO in 7-11 year olds – a developmental stage critical for building mental health
resilience against the adolescent onset of psychiatric problems. In addition, we will use Consolidated Framework
for Implementation Research (CFIR) constructs and input from a Community Advisory Board (CAB) to leverage
the RCT to evaluate implementation costs, climate and readiness that would better position the RCT results for
future uptake, scale up, and sustainability. In Aim 1, we will evaluate the direct effects of MISC-CBO on video-
coded CBO careworker caregiving quality (affiliation and attachment) and children’s mental health outcomes
over a 24 month period. 24 CBOs (360 children and 72 careworkers) will be recruited using our existing NGO
partner (Childline) in the Mangaung and Xhariep districts in the Free State, SA. CBOs will be randomly assigned
to receive either one year of bi-weekly MISC-CBO or TAU. We hypothesize that MISC-CBO will be associated
with comparative increases in careworker caregiving quality and reductions in mental health problems in OVC.
In Aim 2a, we will test the hypothesis that caregiving quality at end-of-intervention (12 months) accounts for
intervention effects on child mental health at 18 and 24 months. Aim 2b will evaluate the moderating effects of
orphan status and the quality of the home environment, expecting that OVC who are maternal and double
orphans, and from impoverished home environments will show reduced response to intervention compared to
children without these risk factors. Aim 3a will use World Health Organization metrics to test the hypothesis that
MISC-CBO is cost-effective in terms of disability-adjusted life years (DALYs) averted. Aim 3b will use qualitative
methodology to test the hypothesis that community stakeholders deem the climate favorable and ready for the
implementation of MISC-CBO, and that additional barriers and facilitators for scale-up and implementation will
be identified. Our proposed work extends our format...

## Key facts

- **NIH application ID:** 10876355
- **Project number:** 5R01MH127060-03
- **Recipient organization:** UNIVERSITY OF HOUSTON
- **Principal Investigator:** CARLA SHARP
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $336,880
- **Award type:** 5
- **Project period:** 2022-09-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10876355

## Citation

> US National Institutes of Health, RePORTER application 10876355, MISC-CBO: A cluster randomized control trial to improve the mental health of OVC in South Africa (5R01MH127060-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10876355. Licensed CC0.

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