Low Intensity Family Support for Refugees in an LMIC
Condition: Depression; Anxiety; PTSD; Family Dynamics
MeSH terms: Depression
Study type: Interventional

Summary: 
      The rapidly growing scale of humanitarian crises requires new response capabilities geared
      towards addressing populations with prolonged high vulnerability to mental health
      consequences and little to no access to mental health, health, and social resources. This R21
      develops and pilot tests a novel model for helping urban refugee families in LMICs with
      little to no access to evidence-based mental health services, by delivering a transdiagnostic
      family intervention for common mental disorders in health sector and non-health sector
      settings. The project is located in Istanbul, Turkey. Aim 1 forms a Family Support Design
      Team (FSDT) to adopt the PM+ and CAFES manuals into a family support (FS) intervention for
      use with refugee families by lay providers in community sites and nurses in clinical sites
      using a four-session multiple family group format. Aim 2 pilots FS with families in community
      and clinical sites, and then through observations and qualitative interviews, assesses FS's
      feasibility, fidelity, the impact of context and local capacity, the experiences of
      intervention delivery, and practitioner and organizational perspectives on scale up. Aim 3
      conducts pre, immediate post, and 3-month post assessments of the refugee families who
      received FS through all the sites, to demonstrate the kind of pre-post changes that have been
      reported for comparable interventions and to determine key parameters of interest with
      sufficient accuracy and precision. This exploratory investigation, conducted with the support
      and advice of the World Health Organization, will strengthen the research capabilities of the
      academic and community partners in Istanbul and will develop new evidence-based mental health
      services for refugees in Turkey and other LMICs, as well as for refugees and migrants in low
      resource communities in the United States.
    

Detailed description: 
      RATIONALE The rapidly growing scale of global humanitarian crises requires new response
      capabilities geared towards addressing populations with prolonged high vulnerability to
      mental health consequences and little access to health and social resources. The World Health
      Organization (WHO), under the leadership of Dr. Mark van Ommeren, has been advocating for low
      resource-intensity cognitive behavioral therapy (LICBT) for such conditions. They conducted
      two large RCTs of Problem Management Plus (PM+), a brief, basic, one-on-one,
      paraprofessional-delivered version of LICBT for adults, which demonstrated clinically
      significant reductions in anxiety and depressive symptoms at 3 months. LICBT could help to
      address some needs among Syrian refugees, but our recent D43 supported longitudinal study of
      30 Syrian refugee families in Istanbul, found that one key challenge is its fit with the
      strong family context of Syrians. The investigators found evidence of families with adult
      and/or children with CMD symptoms and challenges managing stress, but also evidence of family
      strengths and resilience, and families facing multiple adverse challenges. In August 2017,
      Dr. Weine met with Dr. van Ommeren at the WHO, and they agreed to work in partnership to
      extend the WHO's LICBT approach to families. In September 2017, Weine et al convened a
      roundtable with key stakeholders in Istanbul, which reached a consensus about the need for a
      new family intervention that included elements of PM+ but also of family interventions, for
      delivery in a group format. Specifically, the investigators chose to incorporate elements of
      Coffee and Families Education and Support (CAFES), a NIMH funded family support and education
      intervention that the investigators previously developed and evaluated with refugee families
      from Bosnia and Kosovo. Other key implementation challenges are who will conduct the
      intervention, what training do they require, what organizational capacity is required, and
      how to best integrate FS into community and clinical sites.

      AIM 1 To form a Family Support Design Team (FSDT) to adopt the PM+ and CAFES manuals into a
      family support (FS) intervention for use with Syrian refugee families by lay providers in
      community sites and nurses in clinical sites using a four-session multiple family group
      format.

      AIM 2 To pilot FS with families in community and clinical sites, and then through
      observations and qualitative interviews, to assess FS's feasibility, fidelity, the impact of
      context and local capacity, the experiences of intervention delivery, and practitioner and
      organizational perspectives on scale up.

      AIM 3 To conduct pre, immediate post, and 3-month post assessments of the Syrian refugee
      families who received FS through all the sites, to demonstrate the kind of pre-post changes
      that have been reported for comparable interventions and to determine key parameters of
      interest with sufficient accuracy and precision.
    

Intervention name(s): Family Support Group
Intervention type(s): Behavioral
Intervention description(s): Family Support Groups will be piloted with families in community and clinical sites. Each pair of facilitators will pilot two groups of 6 families each. Each group is 4 sessions lasting 2 hours each. Each of the sessions incorporates didactic talks, family discussion, and separate breakout groups for adolescents and adults. Family Support intervention incorporates cognitive-behavioral theory of PM+ which underlies evidence-based techniques focused on stress management and behavioral activation. Family support intervention also incorporates resilience theory, which explains family protective processes that can ameliorate the negative consequences of hardships and challenges and enable healing and growth in families.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention