Planning the scale up of brief psychological interventions using theory of change
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RESEARCH ARTICLE
Open Access
Planning the scale up of brief psychological interventions using theory of change Daniela C. Fuhr1* , Ceren Acarturk2, Marit Sijbrandij3, Felicity L. Brown4,5, Mark J. D. Jordans4,5, Aniek Woodward6, Michael McGrath1,6, Egbert Sondorp6, Peter Ventevogel7, Zeynep Ikkursun2, Rabih El Chammay8,9, Pim Cuijpers3 and Bayard Roberts1
Abstract Background: A large mental health treatment gap exists among conflict-affected populations, and Syrian refugees specifically. Promising brief psychological interventions for conflict-affected populations exist such as the World Health Organization’s Problem Management Plus (PM+) and the Early Adolescent Skills for Emotions (EASE) intervention, however, there is limited practical guidance for countries of how these interventions can be taken to scale. The aim of this study was to unpack pathways for scaling up PM+ and EASE for Syrian refugees. Methods: We conducted three separate Theory of Change (ToC) workshops in Turkey, the Netherlands, and Lebanon in which PM+ and EASE are implemented for Syrian refugees. ToC is a participatory planning process involving key stakeholders, and aims to understand a process of change by mapping out intermediate and long-term outcomes on a causal pathway. 15–24 stakeholders were invited per country, and they participated in a one-day interactive ToC workshop on scaling up. Results: A cross-country ToC map for scale up brief psychological interventions was developed which was based on three country-specific ToC maps. Two distinct causal pathways for scale up were identified (a policy and financing pathway, and a health services pathway) which are interdependent on each other. A list of key assumptions and interventions which may hamper or facilitate the scaling up process were established. Conclusion: ToC is a useful tool to help unpack the complexity of scaling up. Our approach highlights that scaling up brief psychological interventions for refugees builds on structural changes and reforms in policy and in health systems. Both horizontal and vertical scale up approaches are required to achieve sustainability. This paper provides the first theory-driven map of causal pathways to help support the scaling-up of evidence-based brief psychological interventions for refugees and populations in global mental health more broadly. Keywords: Scaling up, Brief psychological interventions, Common mental disorders, Conflict-affected populations
Background There is substantial evidence that conflict-affected populations are vulnerable to psychosocial distress and are at risk of considerably higher levels of mental disorders than non-conflict-affected populations [1–3]. Recent * Correspondence: [email protected] 1 London School of Hygiene and Tropical Medicine; Public Health and Policy, Department of Health Services Research and Policy, 15-17 Tavistock Place, London, UK Full list of author information is available at the end of the article
estimates suggest that the prevalence of mental disorders is 22·1% at any point in tim
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