Telephone therapy delivered to refugee children results in a significant drop in mental health symptoms and a much higher treatment completion rate than in-person therapy, according to a first of its kind led by the University of Surrey.

In a pilot randomized controlled trial (RCT) involving 20 refugee children in the Beqa’a region of Lebanon, 10 received in-person treatment as usual (TaU) and 10 received telephone therapy delivered by non-resident counselors. locally trained professionals, both provided by Médecins du Monde. At the start of each treatment session, children’s symptoms were assessed using a questionnaire.

The results show that there was a strong and consistent decrease in mental health symptoms in the group receiving telephone therapy over the course of treatment. Importantly, 60% of this group completed full treatment, with 90% overall receiving treatment, compared to no children completing treatment in the TaU group and only 60% receiving treatment. .

The number of people forcibly displaced by war and emergencies is increasing and refugee children often suffer severe trauma. We need innovative solutions to deliver much-needed therapies in humanitarian settings and make treatments as widely accessible as possible. Our results suggest that telephone therapy may be an effective form of treatment. »

Professor Michael Pluess, co-leader of the study and professor of developmental psychology at the University of Surrey

In Lebanon, which has hosted large numbers of Syrian refugees since the start of Syria’s civil war in 2011, the provision of mental health care is very limited. However, most refugee families own cell phones, which provide a more accessible means of providing treatment. The research team sought to determine whether a tailored telephone therapy program could be effective in reducing mental health symptoms in refugee children compared to in-person treatment.

The study recruited children aged 8 to 17 years from Syrian refugee families living in tent camps in the Bekaa region of Lebanon, with the consent of the parent or primary guardian and the child. All children met diagnostic criteria for common mental health disorders, including depression, anxiety, and post-traumatic stress disorder.

The team used the Common Elements Treatment Approach (CETA), a proven cognitive behavioral therapy program, and adapted it for telephone delivery (t-CETA) with the help of trained lay counselors locally. In the first phase, the original CETA manual was modified for t-CETA, tested and refined with 23 children, of whom 13 received face-to-face CETA and 10 received t-CETA. The second phase then tested this adapted approach in the RCT with a different group of 20 children.

In addition to the main findings, the implementation of t-CETA improved access to treatment, as families did not have to travel to clinics or fit treatment around work hours. It also demonstrated that local lay counselors can be successfully trained to administer t-CETA under the supervision of experienced clinicians.

The team encountered some challenges recruiting study participants, including families being unable to attend appointments in person, perceived stigma related to accessing mental health services, and a lack understanding of what the treatment involves. As a result, the sample size was smaller than expected; however, the success of the study indicates that t-CETA is a promising and scalable therapeutic option.

Professor Michael Pluess says:

“Our study highlights the importance of making mental health services more accessible and culturally relevant in countries where there are barriers to therapy. Despite evidence of mental health problems among refugee children and their families, the Most individuals do not seek treatment Our study results Trials are an important first step in finding a solution, with a larger trial needed to confirm positive effects.

The study was published in the journal Conflict and Health.