A System Innovation Perspective on the Potential for Scaling up New Psychological Interventions for Refugees

Aniek Woodward*, Marjolein Dieleman, Egbert Sondorp, Bayard Roberts, Daniela Fuhr, Peter Ventevogel, Marit Sijbrandij, Jacqueline Broerse

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review


In recent years, a range of brief protocolised psychological interventions like Problem Management Plus have been developed. Such 'scalable psychological interventions' are meant to be delivered by nonspecialists which can greatly increase access to psychological therapies for people affected by adversity, including forced displacement. However, embedding new interventions into mainstream practices is challenging. Novel interventions can remain in the research phase for a long time or stop altogether, which minimises their intended impact and reach. In this conceptual paper we propose a 'system innovation perspective' on scaling up new psychological interventions for refugees and argue that existing mental health systems often need to change to integrate new interventions in a sustainable way. We present a conceptual framework, which includes ideas on cycles of deepening (learning by doing), broadening (repeating and linking), and scaling up (embedding) and the multilevel and constellation perspective. This framework has been operationalised in our scalability research as part of the STRENGTHS study in which we increase our understanding of the opportunities for scaling up four new psychological interventions in eight countries hosting Syrian refugees, including in Europe (Germany, Netherlands, Sweden and Switzerland) and the Middle East (Egypt, Jordan, Turkey and Lebanon). Key implications for practice Researchers and practitioners involved in implementing and evaluating scalable psychological interventions such as Problem Management Plus should consider the inclusion of scalability assessments to increase understanding about the potential for integrating such innovations into mainstream services. A system innovation perspective views scaling up as the integration of an innovation into mainstream practices and suggests that mental health systems commonly need to change in order to effectively adopt new interventions, allowing them to reach their desired impact at scale and in a sustainable way. An improved understanding of the scalability of novel psychological interventions, including the potential (systemic) barriers and facilitators for scaling up, will provide essential knowledge for those involved in decision-making, implementation and evaluation of the further scale up of such interventions.

Original languageEnglish
Pages (from-to)26-36
Number of pages11
Issue number1
Early online date31 Mar 2021
Publication statusPublished - Mar 2021

Bibliographical note

Funding Information:
This project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme Societal Challenges under grant agreement No 733337. The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.

Copyright 2021 Elsevier B.V., All rights reserved.


  • mental health
  • Problem Management Plus (PM+)
  • psychological interventions
  • refugees
  • scalability
  • system innovation perspective
  • theory


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