Syrian Refugee Young Adults as Community Mental Health Workers-Lebanon

Study Overview
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Brief Summary
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In this pilot study, we aim to evaluate the feasibility, acceptability and fidelity of Syrian refugee young adults as community mental health workers (Y-CMHW), and the impact of this work on outcomes of wellbeing, coping and stress. In addition, we aim to assess the mechanisms leading to any changes in these outcomes.

Detailed Description
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Involving youth and young adults (YYA) in work that impacts their communities has positive outcomes for youth wellbeing; and for their communities. But, YYA are often marginalized, particularly in humanitarian settings. YYA wellbeing is linked to seven key protective factors: positive emotions, hope, relationships, meaning, accomplishments, autonomy, and engagement. Understanding protective factors as potential mechanisms for intervention-related change in wellbeing is a priority for research in humanitarian settings. Humanitarian crises increase mental health disorders; and 'normal' distress and psychological reactions affect a large percentage of the population. Yet, human resources for health are often insufficient to meet needs. Understanding the capacities of YYA to support communities in the context of disasters has been noted as a research imperative. Globally, task-sharing interventions train non-professional lay community members to provide mental health care. As one example, Problem Management Plus (PM+) trains community mental health workers (CMHW) and is effective in humanitarian settings for common mental disorders and other problems that emerge in response to crises. The investigators propose to engage Syrian refugee young adults (YA) - aged 18-24 years, as YA CMHW, to implement PM+ with at-risk adults (18+ years) in their communities. The Syrian refugee crises, one of the worst humanitarian crises in recent history, provides a relevant setting to implement this project. Lebanon hosts  1.5 million Syrian refugees, and about 60% of Syrian refugees aged 15-24 years are not employed, and not in school. The Specific Aims are: Aim 1: Assess the effectiveness of being a YA-CMHW on their wellbeing, coping, and stress levels; as compared to (i) an active comparator group of Syrian refugee peers providing tutoring services; and (ii) a group of Syrian refugee peers that receives no intervention. Aim 2: Identify the mechanisms associated with changes in wellbeing, coping, and stress. The conceptual model describes links between the intervention, the mechanisms, and outcomes. Aim 3: Evaluate the feasibility, acceptability and fidelity of Syrian refugee YA as CMHW implementing PM+ with clients. Results will (a) elucidate critical mechanisms through which engagement of YYA to support their community enhances their own wellbeing; (b) inform research around humanitarian/refugee settings, mental health, and Y-CMHW interventions; and (c) provide a robust basis for a follow-up study via a larger RCT.

Official Title
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Youth as Community Mental Health Workers in Humanitarian Settings: A Pilot Test of the Mechanisms of Effect on Their Own Well Being

Conditions
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Mental Health, Stress, Psychological

Intervention / Treatment
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* Behavioral: low intensity psychosocial intervention - Problem Management Plus (PM+)
* Behavioral: Tutoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Syrian refugee 18-24 years have completed high school at the time of screening, live in one of the 3 catchment areas of the field-based NGO partner (MAPs) in the Bekaa region of Lebanon have been involved in NGOs or service to their community' motivation to be a Community Mental Health Worker

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 24 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Young Adult Community Mental Health Worker<br>Syrian refugee young adults will be trained to implement Problem Management Plus (PM+): a WHO evidence-based low intensity mental health intervention to Syrian refugee adults in their community. They will complete 4 surveys to measure outcomes and mechanisms. | Behavioral: low intensity psychosocial intervention - Problem Management Plus (PM+)<br>* Syrian refugee young adults will be trained to implement Problem Management Plus (PM+). PM+ is a low-intensity mental health intervention, developed by WHO, and delivered by non-specialized CMHW. It is a transdiagnostic treatment approach that includes four evidence-based problem solving and behavioral treatment techniques: managing stress, managing problems, get going/get doing, and social support. These strategies are implemented over five weekly sessions, of 90 minutes each.<br>|
| Active Comparator: Young Adult Tutors<br>Syrian refugee young adults will be trained to tutor elementary school students in their community.They will complete 4 surveys to measure outcomes and mechanisms. | Behavioral: Tutoring<br>* Young adults will be trained to tutor students in elementary school.<br>|
| No Intervention: Young Adut Control Group<br>Syrian refugee young adults in the control group will only complete the surveys. They will complete 4 surveys to measure outcomes and mechanisms. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wellbeing | Self report through survey | Year 2 month 6- Year 3 month 12 | 
| Stress | Self report through survey and Hair Cortisol | Year 2 month 6 - Year 3 month 12 | 
| Coping/Resilience | Self report through survey | Year 2 month 6 - Year 3 month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanism-Positive emotions | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Supportive relationships | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Engagement | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Accomplishments | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Optimism/Hope | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Meaning/Purpose in life | Self report through survey | Year 2 month 6 - Year 3 month 12 | 
| Mechanism-Control/Autonomy | Self report through survey | Year 2 month 6 - Year 3 month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lebanon, Refugee, Problem Management Plus, RCT, Psychosocial intervention