An evaluation of a common elements treatment approach for youth in Somali refugee camps

Abstract

Background.This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.Methods.This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.Results.Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d = 1.37), externalizing (d = 0.85), and posttraumatic stress (d = 1.71), and improvements in well-being (d = 0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.Conclusions.This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.

Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial

“…CETA has been described elsewhere in greater detail (https://www.cetaglobal.org) [24]. CETA has also shown effectiveness in reducing internalizing symptoms, externalizing behaviors, and posttraumatic stress, and improving well-being, among Somali refugee youth in Ethiopia in an open trial [32].…”

“…Currently, CETA is the only modular, flexible, multi-problem, transdiagnostic approach delivered by lay providers that has multiple RCT evaluations in LMICs. Adding to the existing evidence showing CETA's effectiveness on a range of mental and behavioral health issues [30][31][32], this trial provides evidence of the broader effectiveness of CETA in addressing social issues of IPV and alcohol misuse. Collectively, the evidence suggests that this transdiagnostic model can more effectively, efficiently, and economically address naturally occurring comorbidity in the human population to reduce the mental and behavioral health treatment gap in LMICs than interventions that focus on a single problem.…”

Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial

“…These findings provide some evidence of effectiveness for CETA with adults, as well as ability of lay providers to learn this type of modular, flexible approach. In Ethiopia, results showed significant decreases in symptoms of internalizing ( d = 1.37), externalizing ( d = 0.85), and post-traumatic stress ( d = 1.71) symptoms, and improvements in well-being ( d = 0.75) (Murray et al under review ). The modular nature of CETA allowed us to develop and adapt the elements and flows to fit our study population.…”

Common Elements of Practice, Process and Implementation in Out-of-School-Time Academic Interventions for At-risk Children: a Systematic Review

“…Results from these studies have been used for design of modular and element-based interventions tailored to individual needs (e.g., Murray et al 2018), empirical testing of singular elements (e.g., Leijten et al 2015), and to inform training and consultation in children's mental health services (e.g., Dorsey et al 2016). To our knowledge, no prior study has systematically identified the common elements of effective OSTA interventions for children at risk.…”