Phone-Delivered Psychological Treatment for Syrian Refugee Children in Lebanon

• In Event: Psychological Interventions to Improve Mental Health and Well-Being of Refugee Children living in Refugee Settlements

Abstract

Background: There are currently more than two million displaced Syrian refugee children in the countries surrounding Syria, with more than 500,000 living in Lebanon. Children exposed to war and displacement are at increased risk for the development of mental health problems. Many children in war-affected settings with a need for psychological treatment do not have access to mental health services. Humanitarian health organisations working in these settings face many obstacles, including difficulties in recruiting qualified local staff and limited freedom of movement restricting refugee populations from accessing primary health care centres. These challenges are difficult to address with conventional mental health services, which tend to be provided by mental health specialists in centralised primary health care centres. The current project aimed at adapting and piloting the transdiagnostic cognitive-behavioural treatment programme Common Elements Treatment Approach (CETA) for delivery by trained lay counsellors over the telephone to Syrian refugee children in Lebanon.

Methods: We applied a mixed methods approach to evaluate the feasibility of telephone-delivered Common Elements Treatment Approach (t-CETA). After a structured process of adaptation of the CETA manual for phone delivery and the context of Syrian refugees living in informal tented settlements, t-CETA was tested with a small number of children in person before conducting a pilot randomised controlled trial with 20 Syrian refugee children diagnosed with mental health problems. Half of the sample were randomly allocated to t-CETA delivered entirely over the phone by trained lay counsellors whilst the other half received treatment as usual (i.e., in the clinic by experienced case workers and psychologists). Child mental health outcomes (PTSD, depression, anxiety, externalizing problems) were assessed by independent raters over the phone before and after the treatment. In addition, we collected qualitative data through individual interviews with all three t-CETA counsellors as well as with all children (and their caregivers) that received t-CETA. Interviews were transcribed and evaluated with thematic content analysis.

Results: Preliminary analysis of the quantitative data suggests that mental health of children in the t-CETA condition improved over the course of treatment. However, analysis of the randomised controlled trial is still on-going; it will be completed in time for the conference. In the qualitative analyses, similar themes emerged from the separate analyses of counsellor and beneficiary interview data. Counsellors reported that t-CETA both solves and creates practical challenges, but that t-CETA seems to work well and is needed. Beneficiaries had similar views and also emphasised the importance of the relationship between the counsellor and the child for the success of the treatment. Further, caregivers’ attitudes towards mental health played an important role regarding their engagement in the treatment of their children.

Conclusion: The current study provides some of the first evidence for the feasibility of psychological treatment delivered over the phone by trained lay counsellors in humanitarian settings. Although there are benefits as well as challenges, phone-delivered treatment has promising potential to facilitate the provision of psychological treatment for children in humanitarian emergency and other low-resource settings where there is limited access to mental health services.

Authors

• Michael Pluess, Queen Mary University of London
  Presenting Author

• Fiona S McEwen, Queen Mary University of London
  Non-Presenting Author

• Tania Bosqui, American University of Beirut
  Non-Presenting Author

• Nicolas Chehade
  Non-Presenting Author

• Stephanie Skavenski
  Non-Presenting Author

• Laura Murray, Johns Hopkins University
  Non-Presenting Author

• Hania El Khatib, McGill University
  Non-Presenting Author

• Kristin Hadfield, Trinity College Dublin
  Non-Presenting Author

• Patricia Moghames, Médecins du Monde, Lebanon
  Non-Presenting Author

• Paul Bolton, Johns Hopkins University
  Non-Presenting Author

• Roland Weierstall
  Non-Presenting Author

• Alaa Hijazi, American University of Beirut
  Non-Presenting Author

• Elie Karam, Institute for Development, Research, Advocacy and Applied Care
  Non-Presenting Author