Early Adolescent Skills for Emotions Tanzania Pilot
Condition: Mental Health Wellness 1
Study type: Interventional

Summary: 
      The goal of this pilot is to test the World Health Organization (WHO) Early Adolescent Skills
      for Emotions intervention, a new psychological intervention. The pilot in Tanzania adapted
      the manual for young adolescent Burundian refugees in Tanzania (ages 10 - 14) with prolonged
      disabling distress living in communities affected by adversity. We conducted a formative
      study to adapt the EASE material, followed by small feasibility RCT (M=72) along with a
      process evaluation.
    

Detailed description: 
      WHO is developing a set of scalable brief psychological programs: a new generation of
      shorter, less expensive and trans-diagnostic programs that can be delivered by
      non-specialized providers (e.g. without formal education or experience in mental health), to
      reduce common mental health symptoms and improve psychosocial functioning. In this pilot in
      Tanzania, the IRC, JHU and WHO seek to assess EASE, a much needed, brief psychological
      intervention developed specifically for young adolescents and their caregivers, and
      applicable in different humanitarian contexts.

      The IRC, JHU and WHO, in collaboration with UNHCR, Muhimbili University of Health and Allied
      Sciences in Tanzania, and Village Health Works , adapted and contextualized the EASE
      intervention for Burundian refugee young adolescents in Tanzania. The adaptation had three
      steps:

      First, the IRC conducted a desk review focusing on the cultural context for mental health
      research among Burundian refugees, covering local concepts, beliefs and practices associated
      with psychosocial support.

      Second, the IRC conducted a formative qualitative study, consisting of 88 semi-structured
      qualitative interviews (free listing (n=61) and key informant interviews (n=25)), including
      with Burundian adolescent boys and girls (See Tables 1 & 2 in Annex for breakdown of
      interview participants). This was followed by four focus group discussions (n=20) using
      cognitive interviewing techniques with adolescents and caregivers to seek feedback
      specifically on example intervention materials.

      Third, the IRC and its partners used findings from the desk review and the qualitative study
      to inform an adaptation workshop in May 2018 held in Kibondo, Tanzania. For the adaptation
      workshop, the IRC convened the WHO, IRC mental health field staff, Village Health Works
      staff, and Dr Samuel Likindikoki from the Muhimbili University of Health and Allied Sciences.
      The adaptation workshop included a review of the data collected during the ethnographic
      study, as well as a mock run-through of the EASE materials, which allowed for an in-depth
      review of the intervention content.

      The EASE pilot implementation and testing phase had eight main activities: 1) initial
      screening of adolescents for eligibility into the EASE program; 2) baseline data collection
      with the eligible participants and caregivers; 3) facilitator training; 4) development of a
      referral protocol to ensure adequate services for participants who experienced violence or
      were at high risk of suicide; 5) implementation of the EASE sessions; 6) implementation of
      the "Enhanced treatment as usual" sessions (our control condition, conducted at the same time
      as the EASE sessions); 7) endline data collection; and 8) process evaluation.
    

Intervention name(s): Early Adolescent Skills for Emotions EASE)
Intervention type(s): Behavioral
Intervention description(s): EASE is conducted in 7 weekly group sessions with adolescents. EASE sessions help adolescents:
Identify their feelings and body reactions
Practice breathing exercises
Get active: Make a plan to positively change their actions
Manage their problems
Other intervention name(s): Enhanced Treatment as Usual (ETAU)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research study compared the EASE treatment (7 weekly sessions for adolescents and 3 for their caregivers) against an Enhanced Treatment as Usual (ETAU) consisting of a single psychoeducation individual session, jointly for eligible adolescents and their caregivers. ETAU included information on: (i) the results of the screening; (ii) self-care strategies; and, (iii) seeking services from local health or community services offering psychosocial / mental health care support.
Masking: Double (Participant, Investigator)
Primary purpose: Treatment