A Psychosocial Program Impact Evaluation in Jordan

Study Overview
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Brief Summary
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The study aims to deliver a robust pre-post evaluation of the wellbeing impacts of an innovative, brief, and scalable psychosocial intervention, delivered to refugee youth living in urban settlements in Jordan. The study was conducted using two waves of data collection: the first featured an intervention and a matched control group, the second featured a full randomized control trial.

Detailed Description
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This study will provide a robust evaluation of the Mercy Corps 'Advancing Adolescents, No Lost Generation' program that targets stress alleviation in refugee youth (12-18 years) with specific measures of psychosocial stress, biological stress, and cognitive function.

Official Title
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Measuring the Health and Wellbeing Impacts of a Scalable Program of Psychosocial Intervention for Refugee Youth

Conditions
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Stress, Psychological, Mental Health Impairment

Intervention / Treatment
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* Behavioral: Advancing Adolescents


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligible and enrolled in Mercy Corps Advancing Adolescents program Syrian refugee and Jordanian host-community youth residing in 4 urban centers in northern Jordan Exclusion Criteria: Not available for study recruitment (started sessions or deferred sessions before study start date).

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Advancing Adolescents<br>Received structured eight-week psychosocial sessions | Behavioral: Advancing Adolescents<br>* The Advancing Adolescents programme is a structured 8-week psychosocial intervention for adolescents in humanitarian crises, based on profound stress attunement processes. It features three elements that are widely viewed as important to support youth adjustment in contexts of complex emergencies: (i) safety: establishment of a 'safe space' within the community as a base for activities and site of protection; (ii) support: facilitation of social support and self-expression; and (iii) structured activities: access to scheduled group activities.<br>|
| No Intervention: Control<br>Controls wait-listed for the intervention, matched for age and urban residence | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychosocial Stress: Insecurity (Regional Measure) | Insecurity was measured with The Human Insecurity (HI). This tool was developed for use in the West Bank (Ziadni, Hammoudeh et al. 2011, Hamayel, Ghandour et al. 2014). The 10-item scale is a 5-point Likert scale with scores expressed as percentages on a scale of 0-100. The HI covers issues such as worries regarding inability to obtain daily life necessities, losing a source of income, fears about the future, and family safety. | 11 weeks | 
| Psychosocial stress: Distress (Regional Measure) | Distress was measured with the Human Distress scale (Hamayel & Ghandour, 2014), developed for use with conflict-affected adolescents in the West Bank. The 12-item scale is a 5-point Likert scale with scores expressed as percentages on a scale of 0-100. Sample items include, To what extent have you felt worried, To what extent did you feel humiliated, and To what extent did you feel angry. Scores are presented as percentages (0-100%), with higher scores indicating greater distress. | 11 weeks | 
| Psychosocial Stress (International Measure) | Stress was measured using the Arabic version of the Perceived Stress Scale (Cohen, Karmarck, & Mermelstein, 1983), validated with a Jordanian sample (Almadi, Cathers, Hamdan Mansour, & Chow, 2012). This 14-item, 5-point Likert scale measures perceived stress over the last month, with higher scores indicating greater stress. Items include, How often have you been upset because of something that happened unexpectedly? and How often have you been able to control irritations in your life? (reverse-scored) (1 = Never, 5 = Very often). | 11 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mental Health Difficulties: Regional Measure | Mental health was assessed using the 21-item Arab Youth Mental Health questionnaire (Mahfoud et al., 2011; Mahkoul et al., 2011). This measure includes questions such as, During the last week I was upset, During the last week I was bored and hated my life, and During the last week, I was having a lot of headaches, stomach-aches, and nausea (1 = Rarely, 3 = Always). Higher scores indicate more symptoms of anxiety and depression. | 11 weeks | 
| Mental Health Difficulties: International Measure | The Arabic version of the Strengths and Difficulties Questionnaire (SDQ), a brief screening tool for psychiatric difficulties (Alyahri & Goodman, 2006) was used. The 20 items include emotional, conduct, and hyperactivity symptom scores (range 0-40). We summed score of the Arabic version of the SDQ subscales relating to hyperactivity, emotional symptoms, conduct problems, and peer problems (Alyahri & Goodman, 2006). | 11 weeks | 
| Prosocial Behavior: International Measure | The Strengths and Difficulties Questionnaire (SDQ) Prosocial Score, which featured 5 items to assess prosociality was used. Items include I try to be nice to other people. I care about their feelings and I am helpful if someone is hurt, upset, or feeling sick (0 = Not true, 2 = Certainly true). Higher scores indicate greater prosociality. | 11 weeks | 
| Resilience: Cross-cultural Measure | Resilience was measured using the CYRM-28 (Liebenberg et al., 2012; Ungar & Liebenberg, 2011), which had been translated and culturally grounded for use into Arabic. Responses ranged from 1 (Not at all) to 5 (A lot), with higher scores indicating greater resilience. | 11 weeks | 
| Biological Stress: Cortisol | Cortisol was obtained from immunoassays of scalp hair cortisol that provide useful measures of the altered activity of the hypothalamic-pituitary-adrenal axis. Scalp hair is collected non-invasively ( 100 strands, 0.5 cm area). This measure indicates chronic stress over the last month, and examined per individual for pre/post intervention levels. These analyses are being undertaken by Professor van Uum at Western Ontario University. | 11 weeks | 
| Biological Stress: Cell-mediated Immune Function | Cell-mediated immune function was measured in field settings, using systemic suppression of immune function in response to chronic stress is measured via immunoassays for Epstein Barr Virus antibodies, in conjunction with C-Reactive Protein, from dried blood spots collected from pricking the finger with a sterile disposable lancet. Three drops of blood on filter paper are dried at room temperature, then frozen until lab assay. This measure reflects compromised immune response due to psychosocial stress over the past week, and examined per individual for pre/post intervention levels. | 11 weeks | 
| Cognitive function | Cognitive function was assessed using tablet-based cognitive skill tasks, testing hippocampal function (long term memory) and prefrontal executive function. Children play short games (1-4 min each) during which they press the tablet in response to geometric shapes. Responses during game play are recorded and used to measure cognitive function. | 11 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Insecurity, Stress, Mental Health