Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan

Akhtar, Aemal; Malik, Aiysha; Ghatasheh, Maha; Aqel, Ibrahim Said; Habashneh, Rand; Dawson, Katie; Watts, Sarah; Jordans, Mark J. D.; Brown, Felicity L.; Sijbrandij, Marit; Cuijpers, Pim; Bryant, Richard A.

doi:10.1080/20008198.2021.1901408

Cited by 14 publications

(25 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings of this feasibility trial resulted in several improvements to study procedures to inform a forthcoming larger definitive trial [ 24 ]. Firstly, recommendations from this feasibility study (along with concurrent studies conducted in Jordan [ 23 ] and Tanzania [ 26 ]), lead WHO developers to make the following modifications to the EASE intervention: (i) more interactive activities were added to adolescent sessions, (ii) the storybook used in adolescent sessions was re-written by a creative writer to enhance engagement, (iii) caregiver sessions were shortened and revised to reduce the need for literacy. For the Lebanon context specifically, guidance was added to hold the first caregiver session prior to the first adolescent session, to allow a clearer explanation to caregivers about the content of the adolescent sessions including confidentiality expectations, and the extent to which ‘taboo’ topics such as suicide and traumatic events will be discussed.…”

Section: Discussionmentioning

confidence: 99%

“…We expect that these amendments will lead to improved implementation of the EASE intervention and trial procedures for the RCT. A simultaneous feasibility trial of EASE in Jordan found similar lack of movement on outcomes, and similar possible floor effects [ 23 ]. This sample was similar in terms of past traumatic events experienced, although there were no adverse events reported throughout this study, more adolescents were currently attending school, and less were working to provide income for the family.…”

Section: Discussionmentioning

confidence: 99%

“…This feasibility trial and a simultaneous study in Jordan [ 23 ] were conducted in preparation for the first full-scale evaluations of EASE in Lebanon and Jordan [ 24 , 25 ]. Additional studies have been conducted in Tanzania [ 26 ] and Pakistan [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Globally, there is a vast mental health treatment gap, whereby the majority of adolescents living in low- and middle-income countries requiring mental health services, do not have access to adequate care. To improve access, the World Health Organization (WHO) developed a range of interventions, designed to be low-cost and delivered by non-specialists. We conducted a two-arm, individually randomised group treatment feasibility trial of a new WHO group intervention for young adolescents with emotional distress (‘Early Adolescent Skills for Emotions’; EASE) in Lebanon. Method The aim of this study was to determine the feasibility of the intervention and study procedures. Adolescents aged 10 to 14 years were eligible to take part if they scored above a validated cut-off on the Child Psychosocial Distress Screener. Participants were randomized to EASE or enhanced treatment as usual (ETAU) control using a 1:1 ratio. EASE consisted of seven group sessions with adolescents and three sessions with caregivers. ETAU consisted of a single brief psychoeducation home visit. Child and caregiver outcomes were measured by blind assessors at baseline, endline (8 weeks post-randomisation), and three month follow-up (20 weeks post-randomisation), with the primary outcome measure being child psychological symptoms on the Pediatric Symptom Checklist. Qualitative interviews were conducted with adolescents (n = 13), caregivers (n = 17), facilitators (n = 6), trainers (n = 3), and outreach staff (n = 1) at endline to assess barriers and facilitators related to the feasibility and delivery of EASE and study procedures. Results Of 154 adolescents screened, 67 (43%) were eligible, completed baseline, and were randomized. Sixty adolescents (90%) completed endline assessments (31 EASE, 29 ETAU), and fifty-nine (88%) completed three-month assessments (29 EASE, 30 ETAU). Qualitatively, participants provided overall positive feedback about the intervention. Several challenges and suggestions for improvement were raised around logistics, intervention content, and acceptability of assessment measures. Implementation data highlighted challenges with intervention uptake and attendance. Outcome measures generally had strong psychometric properties (range: α = 0.77 to α = 87), however did not demonstrate change over time in either group. Conclusions The EASE intervention and study procedures are acceptable and feasible for implementation with vulnerable adolescents in Lebanon, however several improvements are necessary prior to full-scale evaluation. Trial registration #ISRCTN60799626, retrospectively registered on 04/10/2022.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Initial adaptation workshops were conducted with Syrian adolescents in Lebanon to agree upon necessary amendments [17], and subsequent adaptation workshops were conducted in Jordan with community representatives and health providers to determine the need for local adaptations. A pilot trial was then conducted to determine feasibility and acceptability of the EASE intervention [18]. All assessment instruments and the EASE protocol were adapted to be acceptable for cultural appropriateness, language, metaphors, and context.…”

Section: Randomisation and Maskingmentioning

confidence: 99%

Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Millions of young adolescents in low- and middle-income countries (LMICs) affected by humanitarian crises experience elevated rates of poor mental health. There is a need for scalable programs that can improve the mental health of young adolescents. This study evaluated the effectiveness of a nonspecialist delivered group-based intervention (Early Adolescent Skills for Emotions (EASE)) to improve young adolescents’ mental health. Methods and findings In this single-blind, parallel, controlled trial, Syrian refugees aged 10 to 14 years in Jordan were identified through screening of psychological distress as defined by scores ≥15 on the Paediatric Symptom Scale. Participants were randomised to either EASE or enhanced usual care (EUC) involving referral to local psychosocial services (on a 1:1.6 ratio). Participants were aware of treatment allocation but assessors were blinded. Primary outcomes were scores on the Paediatric Symptom Checklist (PSC; internalising, externalising, and attentional difficulty scales) assessed at week 0, 9 weeks, and 3 months after treatment (primary outcome time point). It was hypothesised that EASE would result in greater reductions on internalising symptoms than EUC. Secondary outcomes were depression, posttraumatic stress, well-being, functioning, school belongingness, and caregivers’ parenting and mental health. Between June 2019 and January 2020, 1,842 young adolescent refugees were screened for eligibility on the basis of psychological distress. There were 520 adolescents (28.2%) who screened positive, of whom 471 (90.6%) agreed to enter the trial. Overall, 185 were assigned to EASE and 286 to EUC, and 169 and 254 were retained at 3 months for EASE and EUC, respectively. Intent-to-treat analyses indicated that at 3 months, EASE resulted in greater reduction on the PSC-internalising scale than EUC (estimated mean difference 0.69, 95% CI 0.19 to 1.19; p = 0.007; effect size, 0.38) but there were no differences for PSC-externalising (estimated mean difference 0.24, 95% CI −0.43 to 0.91; p = 0.49; effect size, −0.10), PSC-attentional problem (estimated mean difference −0.01, 95% CI −0.51 to 0.54; p = 0.97; effect size, −0.01) scores, or on depression, posttraumatic stress, well-being, functioning, or school belongingness. Relative to EUC, caregivers in EASE had less psychological distress (estimated mean difference 1.95, 95% CI 0.71 to 3.19; p = 0.002) and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < 0.001). Secondary analyses that (a) focused on adolescents with probable internalising disorders; (b) completed the 3-month assessment; and (c) controlled for trauma exposure did not alter the primary results. Mediation analysis indicated that for caregivers in the EASE condition, reduction in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) and internalising (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) problems in their children. No adverse events were attributable to the intervention. A limitation was that EUC was not matched to EASE in terms of facilitator attention or group involvement. Conclusions EASE led to reduced internalising problems in young refugee adolescents and was associated with reduced distress and less inconsistent disciplinary parenting in caregivers. This intervention has the potential as a scalable intervention to mitigate young adolescents’ emotional difficulties in LMIC. Trial registration Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619000341123.

show abstract

“…Testing the feasibility and effectiveness of WHO EASE is taking place in many low resource and war affected settings including Jordan, Lebanon and Tanzania. Early findings suggest the intervention is acceptable in adolescents with psychological distress and their caregivers in refugee camps and schools of Tanzania [ 17 ] and for urban-residing Syrian refugees in Jordan [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT)

Hamdani

Huma

Tamizuddin-Nizami

et al. 2022

Child Adolesc Psychiatry Ment Health

Self Cite

View full text Add to dashboard Cite

Background Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization’s Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. Methods A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. Results The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. Conclusions The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.

show abstract

Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan

Cited by 14 publications

References 37 publications

Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon

Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon

Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial

Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT)

Contact Info

Product

Resources

About