Tuesday, September 16, 2025 9/16/2025

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

Award Number: R01MH127060
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2027

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MISC-CBO: A cluster randomized control trial to improve the mental health of OVC in South Africa - 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 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 context 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 formative work to now fully test the real-world effectiveness, mechanisms of action, cost-effectiveness and implementation readiness of MISC-CBO during the critical developmental window of at-risk children aging into adolescence, consistent with NIMH’s strategic objectives.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $336,917 )
2025	2025	UNIVERSITY OF HOUSTON SYSTEM	4300 MARTIN LUTHER KING BLVD	HOUSTON	TX	77204	HARRIS	USA	Mental Health Research Grants	001	4	9/4/2025	SUPPLEMENT FOR EXPANSION	$108,000
2025	2025	UNIVERSITY OF HOUSTON SYSTEM	4300 MARTIN LUTHER KING BLVD	HOUSTON	TX	77204	HARRIS	USA	Mental Health Research Grants	000	4	9/2/2025	NON-COMPETING CONTINUATION	$228,917
														Subtotal = $336,917

Issue Date FY: 2024 ( Subtotal = $336,880 )
2024	2024	UNIVERSITY OF HOUSTON SYSTEM	4300 MARTIN LUTHER KING BLVD	HOUSTON	TX	77204	HARRIS	USA	Mental Health Research Grants	000	3	7/31/2024	NON-COMPETING CONTINUATION	$336,880
														Subtotal = $336,880

Issue Date FY: 2023 ( Subtotal = $336,808 )
2023	2023	UNIVERSITY OF HOUSTON SYSTEM	4300 MARTIN LUTHER KING BLVD	HOUSTON	TX	77204	HARRIS	USA	Mental Health Research Grants	001	2	6/27/2023	NON-COMPETING CONTINUATION	$336,808
2023	2022	UNIVERSITY OF HOUSTON SYSTEM	4300 MARTIN LUTHER KING BLVD	HOUSTON	TX	77204	HARRIS	USA	Mental Health Research Grants	000	1	4/26/2023	NEW	$0
														Subtotal = $336,808

Issue Date FY: 2022 ( Subtotal = $364,477 )
2022	2022	UNIVERSITY OF HOUSTON SYSTEM	4800 W CALHOUN ST STE 316	HOUSTON	TX	77004	HARRIS	USA	Mental Health Research Grants	000	1	9/1/2022	NEW	$364,477
														Subtotal = $364,477

Grand Total All Awards = $1,375,082

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

Award Number: R01MH127060

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2027

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