Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon
Authors: Brown Felicity L. , Taha Karine , Steen Frederik , Kane Jeremy , Gillman Aviva , Aoun May , Malik Aiysha , Bryant Richard , Sijbrandij Marit , El Chammay Rabih , Servili Chiara , van Ommeren Mark , Akhtar Aemal , Zoghbi Edwina ,   EASE Intervention Development, Training Team, Dawson Katie S. , Watts Sarah , Ghatasheh Maha , Aoun May , Malik Aiysha , Brown Felicity L. , Jordans Mark J. D. ,   on behalf of the STRENGTHS Consortium, Acarturk Ceren , Akhtar Aemal , Akinçi Ibrahim , Bawaneh Ahmed , Bird Martha , Brown Felicity L. , Bryant Richard , Burchert Sebastian , Cuijpers Pim , de Graaff Anne , Drogendijk Annelieke , Fuhr Daniela , Hessling Jonas Maria , Ilkkursun Zeynep , Jordans Mark J. D. , Knaevelsrud Christine , Kurt Gülşah , McDaid David , Martinmäki Saara , Mirzanlı Cansu , Mooren Trudy , Morina Naser , Park A.-La , Pfaltz Monique , Roberts Bayard , Schick Matthis , Schnyder Ulrich , Sijbrandij Marit , Sondorp Egbert , Spaaij Julia , Steen Frederik , Taha Karine , Ventevogel Peter , Whitney Claire , Wiedemann Nana , Woodward Aniek 
Published: March 2023

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.