BACKGROUND Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents. METHODS This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780. FINDINGS 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use. INTERPRETATION The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services. FUNDING Sint Antonius Stichting Projects. TRANSLATIONS For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

中文翻译：

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一种社区病例检测工具，旨在促进乌干达难民安置点儿童和青少年寻求心理健康护理帮助：一项阶梯式楔形集群随机试验。


背景 需要制定促进儿童寻求精神卫生保健帮助的战略，特别是在低收入和中等收入国家以及复杂的环境中。本试验的目的是将基于小插曲的社区级主动病例检测工具 (CCDT) 与标准意识提高工具进行比较，以促进儿童和青少年心理健康寻求帮助。方法 这项阶梯式楔形整群随机试验在乌干达的 Bidi Bidi、Kyaka II、Kyangwali、Omugo 和 Rhino 难民安置点进行。社区看门人接受了为期 2 天的培训课程，内容涉及使用 CCDT 主动检测有心理健康问题的儿童，并鼓励儿童（或其照顾者）使用乌干达跨文化心理社会组织运营的心理保健服务。在基线时，组织实施了常规检测或心理健康意识提高活动。在与 CCDT 实施交叉时，看门人在日常活动中使用该工具。主要结果是儿童和青少年对精神卫生保健服务的使用情况。无法获得地区一级儿童人口规模的估计。因此，服务使用是根据总人口规模计算的。我们将 CCDT 实施的效果报告为发病率比 (IRR)，这是我们根据考虑了日历时间、暴露时间和人员时间的模型生成的。估计 IRR 是为了分析按方案和意向治疗人群随时间推移的效果。该试验已在 ISRCTN 注册中心注册，注册号为 ISRCTN19056780。结果 到 2021 年 10 月，选定 28 个行政区进行试点。 2022 年 1 月 1 日至 11 月 8 日期间，四个区域的七个集群以 1 个月的间隔依次从常规护理过渡到 CCDT 实施。 CCDT 由 177 名经过培训的社区看门人实施。 9 个月内，2385 名儿童接受了心理保健服务；其中，1118 名 (47%) 为女孩，1267 名 (53%) 为男孩（平均年龄 12·18 岁 [SD 4.03]）。 1998 名儿童首次或再次参加服务；其中，937 名 (47%) 为女孩，1061 名 (53%) 为男孩（平均年龄 12·08 岁 [SD 4·06]）。与标准的意识提高活动相比，CCDT 的实施与实施后第一个月精神卫生保健服务使用量的增加相关（20·91 倍变化 [95% CI 12·87-33·99]）。尽管 CCDT 和 CCDT 前区域的服务使用量随着时间的推移略有下降，但 CCDT 区域的精神卫生服务使用量保持了时间平均 16·89 倍的增长 (95% CI 8·15-34·99)。解释 CCDT 使社区看门人能够增加儿童和青少年对精神卫生保健服务的使用。植根于社区的基于小插曲的策略可以为缩小儿童之间的心理健康保健差距做出宝贵贡献，特别是在伴随着可获得的心理健康保健服务的情况下。资助圣安东尼斯·斯蒂廷项目。翻译 有关摘要的阿拉伯语、法语和西班牙语翻译，请参阅补充材料部分。