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

EASE Intervention Development, Training Team; STRENGTHS-consortium

doi:10.1186/s12888-023-04571-9

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

EASE Intervention Development, Training Team
, STRENGTHS-consortium

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Article number	131
Pages (from-to)	1-18
Number of pages	18
Journal	BMC Psychiatry
Volume	23
Early online date	1 Mar 2023
DOIs	https://doi.org/10.1186/s12888-023-04571-9
Publication status	Published - 2023

Bibliographical note

Publisher Copyright:
© 2023. The Author(s).

Funding

We firstly express our gratitude to all adolescents and caregivers who dedicated their time to this research and shared their experiences with us. We would also like to thank the EASE and ETAU facilitators (Rana Wehbe, Fatima Ali Anka, Imane Adnan El Tabaa, Samia Khodor Seif, Moemen Mohamad Cherif Shanan, Wisal Mohamad Yaser, Alaa El Jarrach, Hiba Hindawi, Moujahed Ahmad El Mouzawek, and Ranine Wajih El Omar) who worked in challenging conditions to support adolescents and their caregivers and provided invaluable feedback to improve implementation. Thank you to Reem Masri and Hasan Mortada who co-lead the facilitator training and provided supervision and conducted observations; outreach workers Walid Najib, Bassel Meksassi, and Nour El Cheikh who supported the recruitment and coordination of the sessions; Abeer Hudery and the rest of the child protection team for following up on cases needing support and referral; and the research assistant team who conducted all assessments with families (Ahmad Al-Hajj, Fadi Matar, Grace Harb, Mohammad Safsouf, Hala Rashid Dalal, Asma Ghassan Kammoun, Mohamad Khalaf, Nadine El Homsi, Reve Assaad Abou Rjeily, Mathiew Harran, Bilal El Asaad, Sasha Hilani, Hazar Khodor, Khaled Chkhaidem, Mireille Chamoun, Hana Chrayteh, Hilane El Zarif, Lamia Allaoui, Mostafa Amin Al Sabin). We appreciate the important and careful oversight of the safety of the study by our Data Safety Management Committee: Nayla Nahas, Samar Zebian, and Frank Elbers. Lastly, we acknowledge the support from the full team at War Child Holland in Lebanon for making this study possible. We firstly express our gratitude to all adolescents and caregivers who dedicated their time to this research and shared their experiences with us. We would also like to thank the EASE and ETAU facilitators (Rana Wehbe, Fatima Ali Anka, Imane Adnan El Tabaa, Samia Khodor Seif, Moemen Mohamad Cherif Shanan, Wisal Mohamad Yaser, Alaa El Jarrach, Hiba Hindawi, Moujahed Ahmad El Mouzawek, and Ranine Wajih El Omar) who worked in challenging conditions to support adolescents and their caregivers and provided invaluable feedback to improve implementation. Thank you to Reem Masri and Hasan Mortada who co-lead the facilitator training and provided supervision and conducted observations; outreach workers Walid Najib, Bassel Meksassi, and Nour El Cheikh who supported the recruitment and coordination of the sessions; Abeer Hudery and the rest of the child protection team for following up on cases needing support and referral; and the research assistant team who conducted all assessments with families (Ahmad Al-Hajj, Fadi Matar, Grace Harb, Mohammad Safsouf, Hala Rashid Dalal, Asma Ghassan Kammoun, Mohamad Khalaf, Nadine El Homsi, Reve Assaad Abou Rjeily, Mathiew Harran, Bilal El Asaad, Sasha Hilani, Hazar Khodor, Khaled Chkhaidem, Mireille Chamoun, Hana Chrayteh, Hilane El Zarif, Lamia Allaoui, Mostafa Amin Al Sabin). We appreciate the important and careful oversight of the safety of the study by our Data Safety Management Committee: Nayla Nahas, Samar Zebian, and Frank Elbers. Lastly, we acknowledge the support from the full team at War Child Holland in Lebanon for making this study possible. EASE Intervention development & training team The EASE Intervention Development and Training Team consists of Katie S Dawson7, Sarah Watts6, Maha Ghatasheh12, May Aoun3, Aiysha Malik6, and Felicity L Brown1,2STRENGTHS consortium The STRENGTHS Consortium members in alphabetical order are: Ceren Acarturk13, Aemal Akhtar7, Ibrahim Akinçi14, Ahmed Bawaneh15, Martha Bird16, Felicity L Brown1,2, Richard Bryant7, Sebastian Burchert17, Pim Cuijpers8, Anne de Graaff8, Annelieke Drogendijk18, Daniela Fuhr19, Jonas Maria Hessling17, Zeynep Ilkkursun13, Mark J.D. Jordans1,2, Christine Knaevelsrud17, Gülşah Kurt13, David McDaid20, Saara Martinmäki18, Cansu Mirzanlı14, Trudy Mooren18, Naser Morina21, A-La Park20, Monique Pfaltz22, Bayard Roberts19, Matthis Schick21, Ulrich Schnyder21, Marit Sijbrandij8, Egbert Sondorp23, Julia Spaaij21, Frederik Steen1, Karine Taha3, Peter Ventevogel24, Claire Whitney15, Nana Wiedemann16, Aniek Woodward231Research and Development Department, War Child Holland, Amsterdam, The Netherlands2Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands3War Child Lebanon, Beirut, Lebanon6Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland7School of Psychology, University of New South Wales, Sydney, NSW, Australia8Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands12Institute for Family Health, Amman, Jordan13Koc University, Istanbul, Turkey14Refugees and Asylum Seekers Assistance and Solidarity Association, Istanbul, Turkey15International Medical Corps, Amman, Jordan16International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark17Freie Universität Berlin, Berlin, Germany18ARQ International, Amsterdam, The Netherlands19London School of Hygiene and Tropical Medicine, London, UK20London School of Economics and Political Science, London, UK21University of Zurich, Zurich, Switzerland22Mid Sweden University, Sundsvall, Sweden23KIT Royal Tropical Institute, Amsterdam, The Netherlands24United Nations High Commissioner for Refugees, Geneva, Switzerland

Funders	Funder number
EASE
ETAU
Jordan16International Federation of Red Cross and Red Crescent Societies
Moemen Mohamad Cherif Shanan
Turkey15International Medical Corps
UK20London School of Economics and Political Science, London, UK21University of Zurich
Wisal Mohamad Yaser
World Health Organization
Vrije Universiteit Amsterdam
Horizon 2020	733337

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 1 No Poverty

Keywords

Feasibility trial
Psychological intervention
Refugee mental health
Young adolescents

Access to Document

10.1186/s12888-023-04571-9

Persistent URL (handle)

Persistent link

Cite this

@article{7522a52322f94936be60d0ffc6b2f74d,

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

abstract = "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.",

keywords = "Feasibility trial, Psychological intervention, Refugee mental health, Young adolescents",

author = "Brown, \{Felicity L.\} and Karine Taha and Frederik Steen and Jeremy Kane and Aviva Gillman and May Aoun and Aiysha Malik and Richard Bryant and Marit Sijbrandij and \{El Chammay\}, Rabih and Chiara Servili and \{van Ommeren\}, Mark and Aemal Akhtar and Edwina Zoghbi and Jordans, \{Mark J.D.\} and \{EASE Intervention Development, Training Team\} and STRENGTHS-consortium",

note = "Publisher Copyright: {\textcopyright} 2023. The Author(s).",

year = "2023",

doi = "10.1186/s12888-023-04571-9",

language = "English",

volume = "23",

pages = "1--18",

journal = "BMC Psychiatry",

issn = "1471-244X",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon

AU - Brown, Felicity L.

AU - Taha, Karine

AU - Steen, Frederik

AU - Kane, Jeremy

AU - Gillman, Aviva

AU - Aoun, May

AU - Malik, Aiysha

AU - Bryant, Richard

AU - Sijbrandij, Marit

AU - El Chammay, Rabih

AU - Servili, Chiara

AU - van Ommeren, Mark

AU - Akhtar, Aemal

AU - Zoghbi, Edwina

AU - Jordans, Mark J.D.

AU - EASE Intervention Development, Training Team

AU - STRENGTHS-consortium

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - Feasibility trial

KW - Psychological intervention

KW - Refugee mental health

KW - Young adolescents

UR - https://www.scopus.com/pages/publications/85149427540

UR - https://www.scopus.com/pages/publications/85149427540#tab=citedBy

U2 - 10.1186/s12888-023-04571-9

DO - 10.1186/s12888-023-04571-9

M3 - Article

C2 - 36858980

AN - SCOPUS:85149427540

SN - 1471-244X

VL - 23

SP - 1

EP - 18

JO - BMC Psychiatry

JF - BMC Psychiatry

M1 - 131

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

Persistent URL (handle)

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