Implementation Science for Global Child Health
Dr. Cara Maria Antonaccio
Applying implementation science frameworks and methodologies to improve health outcomes and reduce disparities for children and youth, globally, and particularly those affected by catastrophic illness, conflict, and other forms of complex childhood adversity. Deeply committed to bridging the gap between evidence and real-world practice, ensuring that effective health solutions reach the children who need them most.
CV
Implementation Science
My research centers on the co-design, implementation, and evaluation of evidence-based interventions for children in resource-limited and conflict-affected settings. In my current role as Postdoctoral Research Associate in the Department of Psychiatry and Human Behavior at Brown University and fellow in the Brown Research on Implementation and Dissemination to Guide Evidence Use (BRIDGE) Program, I work with Dr. Alethea Desrosiers supporting a hybrid type 3 implementation-effectiveness study of a technology-supported, school-based mental health intervention for youth in Sierra Leone. I am also collaborating with colleagues in the BRIDGE Program to develop an implementation research framework and toolkit, the Belief Evidence Learning Implementation Emergence Framework (BELIEF).
Learn more about the YRI in Schools (Dr. Alethea Desrosiers, Principal Investigator):

NIH RePORTER > RePORT

Advancing mHealth-supported Adoption and Sustainment of an Evidence-based Mental Health Intervention for Youth in a School-based Delivery Setting in Sierra Leone

This study will examine a new implementation strategy for the Youth Readiness Intervention (YRI), an evidence-based mental health intervention. The strategy will (a) leverage a delivery setting (schools) and workforce (teachers) used effectively in low- and middle- income countries; and (b) innovate with technology and mHealth tools to enhance mental health service delivery quality. The YRI will be implemented as an extracurricular resilience-building afterschool activity in Sierra Leone. Teachers will deliver the YRI and receive either mobile phone-supported supervision or standard in-person supervision.

Focus
Adapting and implementing evidence-based interventions; co-designing mHealth tools to support non-specialists and and optimizing delivery for resource-constrained settings.
Methods
Integrating a range of methodologies—including quantitative, qualitative, and mixed methods approaches—to address complex global health challenges.
Frameworks
Using existing theories (EPIS, ADAPT-ITT, ADDIE, others) and developing novel frameworks like a Belief Evidence Learning Implementation Emergence Framework (BELIEF).
Mental Health & Psychosocial
Support (MHPSS)
Building on a foundation in implementation science, my mission is to address the mental health and psychosocial support needs of children and youth facing diverse forms of adversity. I have contributed to longitudinal studies investigating post-conflict trajectories of stigma and social acceptance among former child soldiers and operational guidance for incorporating mental health and psychosocial support in child disarmament, demobilization, and reintegration (DDR) programs. In a prospective longitudinal study on the social context of the 2014-15 Ebolavirus Disease (EVD) epidemic in Sierra Leone, we identified key factors (fear, distress, perceived risk) shaping stigma toward EVD survivors—highlighting the interplay between individual psychosocial factors and community responses over the course of a public health emergency.
Social Context of Catastrophic Disease
Examining the social context of infectious disease outbreaks, including dynamics of infectious disease-related stigma towards Ebola survivors

BioMed Central

Fear, distress, and perceived risk shape stigma toward Ebola survivors: a prospective longitudinal study - BMC Public Health

During the 2014–15 Ebola Virus Disease (EVD) epidemic, thousands of people in Sierra Leone were infected with the devastating virus and survived. Years after the epidemic was declared over, stigma toward EVD survivors and others affected by the virus is still a major concern, but little is known about the factors that influence stigma toward survivors. This study examines how key personal and ecological factors predicted EVD-related stigma at the height of the 2014–2015 epidemic in Si

Operational Guidance for Reintegrating Children
Contributing to best practices for MHPSS in reintegration programs for male and female children associated with armed forces and groups (CAAFAG)

The MHPSS Network

Mental Health and Psychosocial Support in Children Associated with Armed Forces and Armed Groups: Programme Resource Package - The Children and Families Mental Health and Psychosocial Support Resource

The MHPSS in CAAFAG Programmes Resource Package (field-test version) is an inter-agency package of resources that aims to support the integration of MHPSS into programmes for the prevention, release, and reintegration of children associated with armed forces and armed groups (CAAFAG). It offers evidence-based guidance on how to support the mental health and well-being of children, families, and communities in emergency, humanitarian, and post-conflict settings through CAAFAG programming. The M

Monitoring & Evaluating MHPSS in Emergencies
Reviewing quantitative, qualitative means of verification to inform IASC Common M&E Framework for MHPSS in Emergencies

Inter-Agency Standing Committee (IASC)

IASC Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings: With means of verification (Version 2.0) | IASC

Mental health and psychosocial support (MHPSS) operations are increasing, with MHPSS an integral part of humanitarian programmes in several countries and across multiple sectors globally. However, there is often wide variation in approaches to monitoring MHPSS and evaluating the impact, if it is monitored or evaluated at all. The lack of a standard system for data collection and monitoring and evaluation of MHPSS in humanitarian settings leads to significant challenges in demonstrating progress

Child Protection & Mental Health in War
Reviewing journal publications and grey literature about the mental health effects of war in children and interventions to prevent or ameliorate its impact

Cambridge Core

Living through war: Mental health of children and youth in conflict-affected areas | International Review of the Red Cross | Cambridge Core

Living through war: Mental health of children and youth in conflict-affected areas - Volume 101 Issue 911

Just-in-Time Adaptive Interventions (JITAI)
My K99/R00 Pathway to Independence Award (submitted to NIMH in Feb '25) further advances this focus on child health through the development and evaluation of a novel mHealth intervention for early adolescents (10-15) in Sierra Leone. Informed by behavioral neuroscience principles, the tailored intervention targets behaviors linked to neural mechanisms underlying stress response and emotional regulation. I will use the findings to optimize the JITAI, aiming to create a scalable, personalized mental health promotion tool for adolescents in low-resource settings.
Co-Design and Micro-randomized Trial of a WhatsApp-based JITAI to Promote Adolescent Mental Health in Sierra Leone (NIMH K99/R00)

Project Narrative

This project will develop and evaluate a culturally adapted, WhatsApp-based just-in-time adaptive intervention (JITAI) to promote emotional regulation and stress management skills in Sierra Leonean adolescents. Informed by principles of behavioral neuroscience and addressing a critical need in a low-resource setting, the research leverages innovative mobile technology and advanced quantitative methods to assess the JITAI’s effect on behaviors linked to neural mechanisms, with a focus on understanding brain-behavior relationships in real-world contexts. Through rigorous research and mentored training, this project will contribute to the development of scalable, technology-enabled mental health interventions.

Abstract

This K99/R00 proposes to develop and evaluate a culturally adapted, mobile health (mHealth) intervention for early adolescents in Sierra Leone, a population impacted by significant adversity and limited mental health resources. The project leverages a WhatsApp-based Just-In-Time Adaptive Intervention (JITAI) to deliver an adaptation of the WHO’s Early Adolescent Skills for Emotions (EASE) program, designed to promote emotional regulation and stress management skills. The intervention’s content and delivery will be informed by principles of behavioral neuroscience, targeting behaviors linked to underlying neural mechanisms involved in stress response and emotion regulation (e.g., self-regulation, cognitive reappraisal, positive reinforcement learning). Aim 1 involves co-designing the JITAI with adolescents through participatory workshops, ensuring cultural relevance and acceptability. Aim 2 will employ a micro-randomized trial (MRT) to assess the JITAI’s preliminary efficacy, feasibility, and acceptability, and to identify time-varying moderators of intervention effects. Advanced quantitative methods, including Bayesian hierarchical modeling and latent growth mixture modeling, will be used to analyze longitudinal data collected through ecological momentary assessments (EMA) and behavioral tasks delivered through the JITAI platform, providing insights into intervention mechanisms. Aim 3 will use qualitative data and reinforcement learning algorithms, informed by Aim 2 findings, to refine and optimize the JITAI’s content, delivery, and engagement strategies. Leveraging innovative technologies to understand the relationship between brain, behavior, and environment in real-world settings, this project will develop a novel intervention to promote adaptive behaviors during early adolescence. The K99 phase will provide the candidate with mentored training in intervention adaptation, JITAI development, behavioral neuroscience, advanced quantitative methods, and the ethical considerations of mHealth research, with a focus on low-resource settings. The R00 phase will focus on conducting the MRT and optimizing the JITAI, with findings informing refinements to the intervention to maximize its effects on behaviors associated with neural circuits implicated in emotional regulation. This research will contribute to the development of scalable, technology-enabled mental health interventions for a wide range of populations, and the ultimate goal is to translate these findings into effective, accessible interventions that promote mental health and prevent disorder. The project has the potential to significantly advance our understanding of how mobile technology can be used to modify behaviors linked to neural mechanisms and improve mental health outcomes.

Specific Aims
1
Adapt, Co-design, & Develop
To adapt the WHO's Early Adolescent Skills for Emotions (EASE) program as a Just-In-Time Adaptive Intervention (JITAI) and co-design content for delivery via WhatsApp in participatory workshops with adolescents
2
Implement
To conduct an eight-week pilot Micro-Randomized Trial (N=75) using ecological momentary assessments (EMA) and behavioral tasks to assess preliminary efficacy, feasibility, and acceptability
3
Evaluate & Optimize
To evaluate the JITAI's effects on emotional self efficacy, stress, and mental health using Bayesian hierarchical modeling and latent growth mixture modeling; and optimize qualitative feedback and reinforcement learning (RL) algorithms to create a scalable, personalized mental health tool for early adolescents
Evidence-Based Supportive Care
The complex risks facing children in the aftermath of conflict and catastrophic infectious disease share parallels with the experiences of children facing cancer. This understanding, confirmed by research and lived experience, informs my work on childhood cancer survivorship and evidence-based supportive care practices. My personal experience as a pediatric bone and brain cancer survivor, which I reflect on in a 2021 JAMA Oncology editorial, fuels my commitment to improving the quality of life for children diagnosed with cancer and other catastrophic diseases. My research draws clear connections between diverse forms of childhood adversity and the universal need for effective, compassionate support.
Survivorship at
Muhimbili National Hospital
2015
Qualitative research study on unmet needs of survivors and caregivers in Tanzania for information and support with physical and psychosocial late effects
Lived Experience
Perspective
2021

JAMAOnc

On Trauma, Resilience, and Survival—Lessons From 15 Years of Pediatric Cancer and Remission

As I approach the 10-year anniversary of my second pediatric cancer diagnosis, ...

Evidence-Based
Supportive Care
Manuscript under review
Systematic review of peer-reviewed evidence for common clinical practices like bell-ringing ceremonies at the end of treatment and other ad hoc psychosocial interventions in oncology
Child Health & Human Security
Underpinning all of these areas is a deep understanding of the systemic challenges of protecting children and delivering evidence-based interventions in fragile and conflict-affected settings. My research confronts proximal operational risks by approaching operational safety and human security as an implementation outcome, analyzing the impact of sexual violence and attacks on health care infrastructure and personnel in regions like the Eastern DRC and South Sudan. In this area, I apply advanced computational methods, including spatial epidemiology and Bayesian inference, to understand macro- and micro-level spatiotemporal dependencies and identify high-risk areas for different types of violence against civilians and health care. This work has direct implications for evidence-based protection strategies and seeks to inform the development of data-driven early warning systems to advance health and human security in humanitarian settings.
Epidemiology
of Conflict-Related Sexual Violence
Analyzing and mapping hotspots and diffusion dynamics of conflict-related sexual violence (Manuscript in preparation, preliminary results mapped)

Mapbox

CRSV in Eastern DRC

Spatiotemporal clusters of conflict-related sexual violence (CRSV) in Eastern DRC from 2018-2013

Human Security as an
Implementation Outcome
Developing data-driven protection strategies like early warning systems, and informing anticipatory action to confront health system risks in complex humanitarian settings like Eastern DRC and South Sudan

Watchlist on Children and Armed Conflict

Everyone and Everything Is a Target

The impact on children of attacks on health care and denial ...

Bayesian Inference
& Spatial Risk Prediction
Using Log-Gaussian Cox Process modeling via MCMC methods to develop interactive, real-time risk maps to inform protection of health care and prevention of attacks on personnel and facilities in Eastern DRC. First study in a series on human security as an implementation outcome and violence/conflict as key contextual determinants

(Manuscript in preparation)
Human-Centered Design (HCD) &
mHealth Innovations
My research uses a human-centered design approach to co-design and evaluate innovative health care solutions like mHealth tools for non-specialists delivering an evidence-based intervention in rural Sierra Leone. I lead participatory modeling and co-design workshops with specialists and nonspecialists to inform epidemic preparedness and other public health system strengthening efforts, and advocate for the use of HCD as a tool for evidence-based decision-making. My work in this area offers implications for improving the cultural relevance of evidence-based interventions, enhancing quality and reach.
Human-Centered Design
Applying a human-centered approach co-design novel solutions like mHealth tools for non-specialists delivering evidence-based interventions

United Nations University

UN World Data Form - 2023 - News

Parallel session on data, digital technologies and human-centred design for decision-making...

mHealth Supervision Tools
Examining the feasibility and acceptability of HCD processes to develop mHealth tools with CHWs and supervisors in a resource-constrained setting

Cambridge Core

mHealth Supervision Tool Usability and Acceptability

Applying user-centered design to enhance the usability and acceptability of an mHealth supervision tool for community health workers delivering an evidence-based intervention in rural Sierra Leone

Enhancing Quality & Reach
Improving quality and reach of home-visiting interventions to reduce violence and promote positive parenting through user-centered mHealth tools for CHWs

AcademyHealth - 2024 Annual Research Meeting

Co-designing mHealth Tools for CHWs

Examining the benefits of using a participatory co-design process to develop an mHealth tool for CHWs and supervisors

Alignment with St. Jude Department of
Global Pediatric Medicine
My multifaceted research program—spanning implementation science, MHPSS in humanitarian emergencies, advanced computational and participatory modeling, mHealth intervention development, cancer survivorship and supportive care, and health system strengthening in fragile contexts—dovetails with the mission and work of the Department of Global Pediatric Medicine and St. Jude Global. I am enthusiastic about the opportunity to contribute to St. Jude's vibrant global research community, expand the department's implementation science capacity, and collaborate on developing and scaling innovative, resource-adapted interventions to improve the care and outcomes for children with catastrophic diseases worldwide.
Implementation Science
Developing and applying frameworks and tools to bridge evidence-practice gaps
Childhood Cancer Survivorship
Improving supportive care for pediatric cancer survivors, globally
Computational & Participatory Modeling
Using Bayesian methods, spatial epidemiology, and participatory modeling techniques to address complex global health challenges
Child Health in Complex Emergencies
Understanding and fulfilling the health-related and psychosocial needs of children facing extreme adversity
mHealth Tool Co-design & Evaluation
Co-designing innovative digital solutions for increasing access in resource-constrained settings
Child Health and Human Security
Approaching human security and operational safety as an implementation outcome; modeling dynamics of operational risk in humanitarian emergencies
Technical Skills for Global Pediatric Medicine
Epidemiology & Biostatistics
Proficient in R, Stata, Mplus, and Python for advanced statistical analysis and data visualization.
Qualitative & Mixed Methods Analysis
Proficient in MaxQDA; advanced qualitative and mixed methods approaches to coding, analyzing, and visualizing qualitative information.
GIS & Spatial Analysis
Skilled in R, ArcGIS, Mapbox, and GeoJSON for spatial epidemiology and visualization.
Project Management
Experienced with Qualtrics, RedCap, and KoboCollect for secure data collection and management.
Web & App Development
Proficient in designing and deploying web- and mobile-based apps written in F# and compiled to JavaScript using next.js, including interactive dashboards using real-time data.
Get in Touch!
Contact
Reach me at antonaccio@brown.edu for any inquiries.
Connect on Social Media
Twitter Updates
Follow @caraantonaccio for quick updates and thoughts.
Academic Stuff
View my publications on Google Scholar.