Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM

Abstract

Background: Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. Methods: This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these interventions. Studies included varying interventions and modes of delivery within refugee camp and urban settings. A comprehensive search strategy led to the inclusion and analysis of 11 unique studies. Results: While current research documents adaptation strategies, feasibility, and fidelity checks through routine monitoring, there is still a dearth of evidence regarding capacity building of lay providers in humanitarian settings. Barriers to this data collection include a lack of homogeneity in outcomes across studies, and a lack of comprehensive adaptation strategies which account for culture norms in the implementation of interventions. Furthermore, current funding prioritizes short-term solutions for individuals who meet criteria for mental illnesses and therefore leaves gaps in sustainability, and more inclusive programming for psychosocial services for individuals who do not meet threshold criteria. Conclusion: Findings contribute to the literature about task-shifting for MHPSS in humanitarian contexts, especially illuminating gaps in knowledge about the lay counselor experiences of these interventions. Plain language summary: There is a growing number of refugees forced to make homes in temporary camps or urban centers as they await resettlement, a process that can last decades. These refugees are at risk of serious mental health outcomes due to ongoing stress and trauma. One strategy commonly used in global mental health is the training of lay providers to deliver basic mental health and psychosocial programming to communities. While this tactic is currently being tested in refugee settings, there is limited evidence about the implementation of this strategy. The following scoping review aims to assess the implementation of task-shifting interventions within refugee settings, through the use of a robust implementation science framework.

Provision of Mental Health and Psychosocial Support Services to Health Workers and Community Members in Conflict-affected Northwest Syria: A Mixed-Methods study

“…Communities would accept such approaches if deemed effective in reducing their mental health problems. This nding is consistent with the conclusions of a scoping review by Cohen and Yaeger (2021) that considered the delivery of MHPSS interventions by lay counsellors in humanitarian settings within low-middle income countries (LMICs)[19]. However, the review highlighted the need for a strong framework for implementation and to engage the providers in the evaluation of the approach.…”

A Complex Intervention for Alcohol Misuse Among Conflict-Affected Populations in Uganda and Ukraine: Study Protocol for the Qualitative Components in the CHANGE Trial

“…Additionally, this protocol provides a framework on how to integrate multiple serial qualitative components into a coherent whole to ensure that different components build upon each other and to reduce disjointedness of qualitative components in similar trials. Given the paucity of systematic implementation science research within the MHPSS field as a whole (Cohen & Yaeger, 2021; Dickson & Bangpan, 2018), improving our understanding of implementation and scaling up processes through the proposed qualitative components of CHANGE is crucial.…”

Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: A study protocol

“…Task shifting may be a particularly important approach to employ in refugee resettlement communities (Cohen & Yaeger, 2021). Shifting service delivery to trusted community members can eliminate the most instransigent barriers (language, culture, lack of trust), but the approach poses its own challenges including quality concerns, safety concerns (depending on the tasks), and professional and institutional resistance (Fulton et al, 2011).…”