Planning the scale up of brief psychological interventions using theory of change

Daniela C Fuhr,Michael Mcgrath,Rabih El Chammay,Egbert Sondorp,Pim Cuijpers,Ceren Acarturk,Marit Sijbrandij,Bayard Roberts,Felicity L Brown,Aniek Woodward,Mark J D Jordans,Peter Ventevogel,Zeynep Ikkursun

doi:10.1186/s12913-020-05677-6

Abstract

BackgroundA large mental health treatment gap exists among conflict-affected populations, and Syrian refugees specifically. Promising brief psychological interventions for conflict-affected populations exist such as the World Health Organization’s Problem Management Plus (PM+) and the Early Adolescent Skills for Emotions (EASE) intervention, however, there is limited practical guidance for countries of how these interventions can be taken to scale. The aim of this study was to unpack pathways for scaling up PM+ and EASE for Syrian refugees.MethodsWe conducted three separate Theory of Change (ToC) workshops in Turkey, the Netherlands, and Lebanon in which PM+ and EASE are implemented for Syrian refugees. ToC is a participatory planning process involving key stakeholders, and aims to understand a process of change by mapping out intermediate and long-term outcomes on a causal pathway. 15–24 stakeholders were invited per country, and they participated in a one-day interactive ToC workshop on scaling up.ResultsA cross-country ToC map for scale up brief psychological interventions was developed which was based on three country-specific ToC maps. Two distinct causal pathways for scale up were identified (a policy and financing pathway, and a health services pathway) which are interdependent on each other. A list of key assumptions and interventions which may hamper or facilitate the scaling up process were established.ConclusionToC is a useful tool to help unpack the complexity of scaling up. Our approach highlights that scaling up brief psychological interventions for refugees builds on structural changes and reforms in policy and in health systems. Both horizontal and vertical scale up approaches are required to achieve sustainability. This paper provides the first theory-driven map of causal pathways to help support the scaling-up of evidence-based brief psychological interventions for refugees and populations in global mental health more broadly.

Highlights

A large mental health treatment gap exists among conflict-affected populations, and Syrian refugees
Rationale and objectives This paper reports findings from the STRENGHTS (Syrian Refugees Mental Health Care Systems) research consortium which evaluates the effectiveness of PM+ and Early Adolescent Skills for Emotions (EASE) for Syrian refugees in countries neighbouring Syria and major European host countries, and examines its potential for scale up [26]
The cross-country Theory of Change (ToC) map on scaling up brief psychological interventions for refugees is presented in Fig. 1 while legends describing interventions, assumptions, rationales, and Pathways to scale up

Summary

Introduction

A large mental health treatment gap exists among conflict-affected populations, and Syrian refugees . Promising brief psychological interventions for conflict-affected populations exist such as the World Health Organization’s Problem Management Plus (PM+) and the Early Adolescent Skills for Emotions (EASE) intervention, there is limited practical guidance for countries of how these interventions can be taken to scale. The accessibility and availability of MHPSS interventions in countries neighbouring Syria with large refugee populations (such as Turkey, Lebanon Jordan and Egypt) is limited [12]. Lack of awareness of MHPSS services in European countries have been reported as barriers to accessing care, in addition to health systems barriers such as long waiting times for treatment, lack of appropriately trained staff (including those who speak Arabic) and lack of interpreters [13]

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Conclusion