The effectiveness, mechanisms of change, and acceptability of Family Focused PsychoSocial Support (FFPSS) for at-risk adolescents in Lebanon

Lead Research Organisation: American University of Beirut
Department Name: Faculty of Arts and Sciences

Abstract

This mixed-method study is an international collaboration between the American University of Beirut and War Child Holland, supported by project partners the Danish Refugee Council and Terre des Hommes Italy, the Ministry of Public Health Lebanon, UNICEF, and international expertise from University College Dublin, the Boston College School of Social Work, and Queen's University Belfast. The study aims to develop and test a culturally and contextually sensitive Systemic Family Intervention Module for at-risk adolescents that can be run alongside existing focused psychosocial programmes in Lebanon. Focused psychosocial support aims to promote wellbeing and resilience and to reduce mental ill-health in young people at risk of child protection violations, including gender-based violence, child marriage, and child labour.
One in five children globally live in conflict affected areas, and these children experience a high incidence of mental disorders. The global burden of disease for mental disorders is 5 times higher in conflict-affected areas than the global average. Young people are affected not only by the violence, loss, and insecurity of war, but the systemic impact on their living conditions, access to school and health care, structural discrimination, and gender-based violence, as well as their caregivers trauma, stress, and compromised parenting capacity. The devastating impact of war, conflict, and extreme adversity on the mental health and wellbeing of children and adolescents has been extensively researched, but with continuing challenges in improving the quality and scope of interventions for these populations.
The treatment gap in low resourced settings is as high as 90%, with major barriers of limited infrastructure and trained specialists. As a strategy to close this gap, psychosocial support interventions as part of a stepped care coordinated approach have been developed and widely implemented. There is a small but growing evidence base for psychosocial interventions in conflict and humanitarian emergencies, however adolescent mental health and family-based interventions are drastically under-researched and under-resourced. Nurturing family environments are essential for healthy child development, and parenting and systemic family interventions in other populations and country settings show strong effectiveness for both mental health and protection outcomes. This study therefore aims to develop and evaluate a Family Systemic Intervention Module to use alongside UNICEF Lebanon's focused psychosocial support programme, to enhance current humanitarian programming and addressing a significant weakness of the current evidence base for at-risk adolescents and their families in conflict-affected contexts. Findings will inform the Mental Health System Reform in Lebanon led by the National Mental Health Programme of the Ministry of Public Health.
Lebanon is a middle-income country, home to an estimated 1.5 million refugees in a population of around 5.9 million. The majority of refugees come from Syria, as well as almost half a million Palestinian refugees. Almost 60% of Syrian refugees are living in extreme poverty, unable to meet basic survival needs, whilst 30% of Lebanese host communities also live below the poverty line. The many social and economic pressures facing these populations increases the risk of child protection issues, through sexual and gender-based violence, domestic violence, child marriage, child labour and recruitment intro armed groups. In 2015, a 5-year Mental Health and Substance Use strategy for Lebanon 2015-2020 was launched with the aim of reforming the Mental Health System, and whilst much has been achieved, there remains a gap in the provision of family systemic interventions. Lebanon is therefore an ideal location for this study because it has both large vulnerable populations in need of focused support, as well as political will to integrate learning into the national mental health strategy.

Planned Impact

The direct and immediate impact of the study is that 351 at-risk adolescents and their caregivers will receive Focused Psychosocial Support (FPSS) plus our systemic family intervention module. The programme is the first systemic focused psychosocial intervention for at-risk populations in Lebanon, and findings from other contexts indicates that this intervention is likely to be more effective and accessible than what is currently available. The intervention is targeted at families with high risks of child protection issues, and helps to address endemic issues facing vulnerable young people in Lebanon, such as domestic violence, gender-based violence, child marriage, and child labour.
Other direct impacts include the integration of the systemic family module into existing FPSS activities across Lebanon. This scale up will be achieved primarily through the Psychosocial Committee, chaired by UNICEF and Terre des Hommes Italy (both of whom are field partners in this project) who conduct monthly meetings with all psychosocial support providers to coordinate and improve activities; and through the Community Advisory Board who will support local and community engagement. Workshops will be completed directly with stakeholders who have oversight for psychosocial programming in the country (e.g. Ministry of Public Health) or who are actively delivering interventions (e.g. Save the Children), in order to spread awareness of the study's results, the intervention, and training methods. A training package, developed with the support of the Global Health Institute (GHI) at the American University of Beirut (AUB), will be accessible through an online platform. Key facilitators in each participating organisation will be provided with additional training and supervision in order to build capacity to be able to train and supervise new facilitators, through a Train the Trainer model. Through engaging with the main implementing organisations and providing the first round of training at no cost, we aim to disseminate the family module to the majority of at-risk youth accessing focused psychosocial support in Lebanon.
In addition to active engagement of implementing organisations, we will also engage with the Ministry of Public Health (MoPH) for longer term impact on psychosocial support provision. By improving the evidence base for systemic interventions in at-risk populations, we will provide a rationale to include such interventions in the country's Mental Health Reform Strategy, as part of the National Mental Health Programme (NMHP). We will inform the MoPH of the results of the study and intervention aims directly through the director of the NMHP, who has provided a letter of support for this study, and through a workshop with key stakeholders in NMPH and the wider MoPH.
Beyond improving and informing public mental health policy in Lebanon, wider regional and international dissemination will be achieved through the research findings report, peer reviewed open access publication, press and media, oral presentations and workshops at relevant conferences, and through the open access online platform for the delivery of training to interested regional and international organisations. In addition, field partners WCH, Danish Refugee Council (DRC) and Terre des Hommes (TDH) work in multiple countries with war affected children, and the programme can be contextually adapted and applied in these different contexts.
 
Description Significant achievements

Between June 2020 and February 2021 the most significant achievements for this project were a program review of family interventions in low and middle income countries, a qualitative exploration of family challenges and coping, and the development of the Family Systemic Intervention Module - now named the 'Sawa Aqwa (Stronger Together) Family Program' - through workshops, expert review and Community Advisory Board (CAB) meetings. Since then, between March 2021 and February 2022, we have adapted measures of family functioning and emotional regulation, developed the family program training, piloted the program with 10 families, adapted the program based on the pilot outcomes and implementation findings, finalized the randomized control trial (RCT) protocol, and begun the trial with currently 346 families, of the total 351 target, enrolled in the study. We have also had a UKRI and IRB approved amendment in which we removed the child-only Focused Psychosocial Support program due to COVID-19 restrictions, but added a group version of the family program for the control group. We have begun adaptations of the manual for group (multi-family) delivery. These achievements are detailed below:

• Study set-up: A research team was set up at the American University of Beirut and War Child Holland, subcontracts set up with partners War Child Holland, the Danish Refugee Council and Terre des Hommes Italia, and IRB approval granted for both phases of the study, including three amendments. A 6 month no cost extension was also granted in order to be able to complete the trial and the added arm of the group version of the program. Within this new timeline, we are on track despite the worsening economic disaster in Lebanon - impacting on fuel and electricity access, the Beirut port explosions and the COVID-19 pandemic.

• Phase 1 systematic review and qualitative interviews: The first phase of the study involved the development of the family program, based on a systematic review of programs and qualitative interviews. The program review protocol was registered with the PROSPERO database. We searched multiple academic databases and regional and international service mapping exercises, as well as conducting a grey literature search through key implementing organizations in Lebanon. We identified 75 studies of 50 programs. We conducted practice element coding, using PracticeWise methodology, to identify the key components of effective programs for child and adolescent mental health outcomes. We also conducted an Implementation Component Analysis to identify best practice in implementing family interventions, and to pre-empt challenges. The final analysis has now been completed and the findings are being prepared for publication in the journal Clinical Child and Family Psychology Review. The qualitative interviews involved interviews and follow-up interviews with 32 families of at-risk adolescents (adolescents and caregivers) and mental health and psychosocial support facilitators. We transcribed and translated all interviews and analyzed them using Thematic Content Analysis. The findings are being prepared for publication in the Journal of Family Psychology.

• Phase 1 intervention development: Findings from the program review and interviews were used to inform the intervention development. We held a series of three workshops to develop our Theory of Change and a detailed intervention concept; workshops were attended by the research and implementing partner team and by a number of local and international leaders and experts in the field of family therapy and mental health and psychosocial support. Findings were synthesized and applied to the context of at-risk adolescents in Lebanon. Two Community Advisory Boards (CAB) were set up in different locations in Lebanon (Tripoli and North Beqa'a), made up of adolescents and caregivers, to provide additional discussion and amendments to the Theory of Change and intervention outline, based on lived experiences. The intervention first draft of the manual was then drafted by co-lead Dr Felicity Brown, and this draft was reviewed by the research team, implementing partners, and CABs.

• Phase 1 training and pilot: The program was first tested by run-throughs in both mock sessions with the project team, and live with CAB families, before piloting. In addition, we conducted a full adaptation of two of our outcome measures, as they had never been adapted and validated in Arabic or in Lebanon before. We conducted a rigorous translation and contextualization process of the SCORE (for measuring family functioning) and the DERS (for measuring emotional regulation), along with visual aids to support assessments conducted over the phone. The process involved multiple forward and back translations and translation workshops with lay persons and bilingual mental health professionals, as well as cognitive interviewing with adolescents and caregivers. We also developed a 9-day training package, supervision model and observation schedule, as well as a competency checklist, to train non-mental health specialists to deliver the family program. We trained 4 facilitators, and delivered the program to 10 families in the Tripoli area. We conducted multiple baselines, during and post assessments using our core primary and secondary measures, we interviewed all families after the program as well as all facilitators and supervisors. We also collected implementation data based on the Implementation Component checklist (Acceptability, Adoption, Appropriateness, Feasibility, Fidelity, Implementation cost, Intervention complexity, Penetration, Reach and Sustainability). Using all of this data, further changes were made to the family program manual, training, supervision and observation package, and the randomized control trial (RCT) protocol.

• Phase 2 RCT: For the trial we ran an updated training with 12 facilitators. Enrollment for the trial started in November 2021 split equally between our three implementing partners. We trained additional research assistants (RAs) in conducting assessments, maintaining blinding and reporting breaches. We enrolled families over 2 cycles and randomized them using a computer algorithm and allocated by an independent staff member in the War Child Holland Amsterdam office. We are conducting pre, post and 3 month follow up assessments as planned, and collecting implementation data in line with the pilot. So far, we have recruited 346 families, and delivered the program to 146 families, 139 of whom have conducted the post assessment. We also set up a Data Safety Monitoring Committee to review reports of adverse events and to ensure appropriate follow-up. Finally, we developed interview guides to conduct interviews with 20 families in the trial, 10 after receiving the individual family program, 5 after the group (multi-family) program, and 5 families who dropped out of the program.

• Group (multi-family) program: Originally we had planned to deliver the UNICEF focused psychosocial support program (FPSS) with the family program (treatment group) and without the family program (control group). War Child Holland led on revising the FPSS manual to ensure that delivery is standardized across different implementing NGOs, and that extensive feedback from field testing is taken into account. However, due to COVID-19 containment measures, which were strict in Lebanon at the time of the beginning of the trial, our partners were not running FPSS. We therefore gained UKRI and IRB approval to run the trial without FPSS, and focus on the family program (treatment group) compared to a waitlist (control group). At the same time, we added a group (multi-family) version of the manual for the control group to receive, with an additional post-assessment for this arm. While the individual family delivery of the program had been agreed upon due to logistical and acceptability reasons identified in phase 1, the added value of peer and social support, as well as implementation factors of cost per family, was sufficient to warrant testing of different delivery models.

Objectives

All the objectives of Phase 1 have been met, and we are on track to meet the objectives of Phase 2. The only exception is that we had to remove FPSS from the pilot and trial due to COVID-19 restrictions, but we have compensated for this by running the program as a stand-alone program, and adding additional testing of the delivery model (individual family vs multi-family). Minor delays due to IRB approvals, analysis of larger than expected amounts of quantitative and qualitative data in Phase 1, and recovery time needed by the Lebanon based team after the Beirut port explosions, means that we needed to apply for a 6 month no cost extension in order to meet our objectives. According to this new timeline, we are on currently on track to meet our remaining objectives.
Exploitation Route Moving forward

We are currently focused on completing enrollment in the trial, and meeting our tight timeline before the end of facilitator contracts to deliver the group (multi-family) version of the family program to the control group. We are also focused on submitted for publication papers in preparation from Phase 1. In addition, we are continuing to plan for our dissemination strategy, which includes multiple presentations at the International Society for the Study of Behavioral Development (ISSBD), the International Society for Traumatic Stress Studies (ISTSS), and the Association for Contextual Behavior Science (ACBS) conferences, a workshop in Lebanon with the National Mental Health Program, PSS Committee, UNICEF Lebanon and the regional office, and child protection and mental health and psychosocial support implementing organizations in Lebanon, as well as engagement with communities through the studies Community Advisory Boards.
Sectors Communities and Social Services/Policy,Healthcare

URL https://www.aub.edu.lb/fas/psychology/Pages/FFPSS.aspx
 
Description In phase 1, findings of the program review and qualitative interviews were shared to a large audience of academics, practitioners and families through the Theory of Change and Intervention Development workshops and Community Advisory Board meetings, as well as through additional engagements with key stakeholders in UNICEF Lebanon and the National Mental Health Program. This was particularly relevant after the Beirut port explosions when such agencies wanted to react quickly to the needs of families affected by the blast. We were consulted and our findings drawn on to inform immediate family and parental support in the aftermath of the blasts. In phase 2, we shared phase 1 findings and phase 2 plans through national, regional and international taskforces, committees and conferences (as listed in the 'Influence on Policy, Practice, Patients & the Public' section), as well as case studies for graduate students at the American University of Beirut, the University of Amsterdam and Trinity College Dublin. We have also maintained public updates on the project through the American University of Beirut, War Child Holland, and ResearchGate websites. We are also in open communication with UNICEF Lebanon, who have been involved through the entirety of the research cycle. We are aiming for the family program to be endorsed and recommended by UNICEF Lebanon and the Psychosocial Support (PSS) Committee to all providers of focused psychosocial support (FPSS) for at-risk families with adolescents in Lebanon. Our main challenge has been that of COVID-19's impact on program delivery, leading to our amendment to remove the standard child-only FPSS component from the study. While we have still been able to test the effectiveness of the family program and it's implementation, including different delivery models, we will not be able to identify the added value of the family program delivered with FPSS, compared to FPSS alone. To overcome this challenge, we are exploring options to compare our findings to existing UNICEF evaluation data of FPSS, and to advocate for the program - depending on the outcomes of the RCT - based on the high quality evidence we are generating as a standalone program, which will be particularly relevant for at-risk families as the situation in Lebanon worsens. The addition of the group (multi-family) version of the program may also help to address implementation challenges (feasibility, cost, sustainability), and the team is in agreement to plan for a follow-up trial in the future that focuses specifically on the merging of the family program with standard services. Finally, while we were not able to include it in our trial, we have also been able to provide consolidated feedback from all three implementing partners and the PSS Committee to UNICEF Lebanon on the FPSS UNICEF curriculum, currently endorsed for use by child protection actors. This is an additional output from our study, and is expected to provide a stronger curriculum. In the longer term, the team are also strengthening stakeholder engagement, such as through the UNICEF regional office, WHO and UNODC, to integrate the program and other elements (such as the training and family competency checklist for facilitators) into existing international and local guidance. We are also working closely with partners and the Global Health Institute to ensure the sustainability of the family program and training package as part of their existing programs.
First Year Of Impact 2020
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal,Policy & public services

 
Description Dissemination through meeting with UNICEF Middle East and Northern Africa Regional Office
Geographic Reach Asia 
Policy Influence Type Contribution to new or Improved professional practice
 
Description Global Forum on Humanitarian Health Research (GFH2R)
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to new or Improved professional practice
 
Description Inter-Agency Standing Committee (IASC) Mental Health and Psychosocial Support (MHPSS) global reference group
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description International Society for Traumatic Stress Studies (ISTSS) Conference
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to new or Improved professional practice
 
Description Presentation at the No Lost Generation MHPSS Task Force meeting
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description Theory of Change and Intervention Development workshops
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description War Child Holland Global Meeting
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to new or Improved professional practice
 
Description Program Implementing Partnerships 
Organisation Danish Refugee Council
Country Denmark 
Sector Charity/Non Profit 
PI Contribution The AUB research team provided the technical and research expertise to develop and run the project and trial. The team conducted the systematic review and qualitative interviews to inform the development of the program, set up the pilot and RCT, co-developed the training, conducted all pre- during- post- and follow-up- assessments, and interviews, with families, facilitators, supervisors and other key informants. The team will also lead analyzed resulting data and will lead the write-up of publications, alongside researchers from one of our partners War Child Holland (co-lead Felicity Brown).
Collaborator Contribution Implementing partners helped to advise on the logistics of the research study and design, content of the intervention, delivery, and dissemination of the intervention and findings. Partners supported the recruitment of members of the Community Advisory Board and participants for phase 1 interviews (up to 20 families/clinicians/community leaders) and phase 2 (key informants); responsible for the recruitment of participants for the pilot in Phase 1 (up to 10 families) and randomized control trial in Phase 2 (351 families); responsible for the delivery of the intervention to included participants (pilot and randomized control trial - for both the treatment group and the control group at the end of the study); provide support and assistance as appropriate to facilitate access to participants for Research Assistants to conduct pre- and post- and follow-up assessments and interviews; conduct fidelity assessments in 10% of intervention sessions; provide support and assistance as appropriate in disseminating materials through relevant channels.
Impact All outputs from the study are a result of these collaborations and partnerships.
Start Year 2020
 
Description Program Implementing Partnerships 
Organisation Terre des Hommes
Country Switzerland 
Sector Charity/Non Profit 
PI Contribution The AUB research team provided the technical and research expertise to develop and run the project and trial. The team conducted the systematic review and qualitative interviews to inform the development of the program, set up the pilot and RCT, co-developed the training, conducted all pre- during- post- and follow-up- assessments, and interviews, with families, facilitators, supervisors and other key informants. The team will also lead analyzed resulting data and will lead the write-up of publications, alongside researchers from one of our partners War Child Holland (co-lead Felicity Brown).
Collaborator Contribution Implementing partners helped to advise on the logistics of the research study and design, content of the intervention, delivery, and dissemination of the intervention and findings. Partners supported the recruitment of members of the Community Advisory Board and participants for phase 1 interviews (up to 20 families/clinicians/community leaders) and phase 2 (key informants); responsible for the recruitment of participants for the pilot in Phase 1 (up to 10 families) and randomized control trial in Phase 2 (351 families); responsible for the delivery of the intervention to included participants (pilot and randomized control trial - for both the treatment group and the control group at the end of the study); provide support and assistance as appropriate to facilitate access to participants for Research Assistants to conduct pre- and post- and follow-up assessments and interviews; conduct fidelity assessments in 10% of intervention sessions; provide support and assistance as appropriate in disseminating materials through relevant channels.
Impact All outputs from the study are a result of these collaborations and partnerships.
Start Year 2020
 
Description Program Implementing Partnerships 
Organisation War Child
Country Netherlands 
Sector Charity/Non Profit 
PI Contribution The AUB research team provided the technical and research expertise to develop and run the project and trial. The team conducted the systematic review and qualitative interviews to inform the development of the program, set up the pilot and RCT, co-developed the training, conducted all pre- during- post- and follow-up- assessments, and interviews, with families, facilitators, supervisors and other key informants. The team will also lead analyzed resulting data and will lead the write-up of publications, alongside researchers from one of our partners War Child Holland (co-lead Felicity Brown).
Collaborator Contribution Implementing partners helped to advise on the logistics of the research study and design, content of the intervention, delivery, and dissemination of the intervention and findings. Partners supported the recruitment of members of the Community Advisory Board and participants for phase 1 interviews (up to 20 families/clinicians/community leaders) and phase 2 (key informants); responsible for the recruitment of participants for the pilot in Phase 1 (up to 10 families) and randomized control trial in Phase 2 (351 families); responsible for the delivery of the intervention to included participants (pilot and randomized control trial - for both the treatment group and the control group at the end of the study); provide support and assistance as appropriate to facilitate access to participants for Research Assistants to conduct pre- and post- and follow-up assessments and interviews; conduct fidelity assessments in 10% of intervention sessions; provide support and assistance as appropriate in disseminating materials through relevant channels.
Impact All outputs from the study are a result of these collaborations and partnerships.
Start Year 2020
 
Description Research Consultants 
Organisation Boston College
Country United States 
Sector Academic/University 
PI Contribution The AUB research team reached out to senior researchers in family therapy, mental health and psychosocial support and public health to provide additional supports and direction to the AUB research team.
Collaborator Contribution Consultants Prof Alan Carr, from University College Dublin, and Prof Theresa Betancourt, from the Boston College School of Social Work, as well as co-I Prof Michael Donnelly, from Queen's University Belfast, have been involved in the study since 2019. They have provided technical assistance on research design, methodology, and analysis in both phase 1 and 2.
Impact All study outcomes are related to these partnerships.
Start Year 2020
 
Description Research Consultants 
Organisation Queen's University Belfast
Country United Kingdom 
Sector Academic/University 
PI Contribution The AUB research team reached out to senior researchers in family therapy, mental health and psychosocial support and public health to provide additional supports and direction to the AUB research team.
Collaborator Contribution Consultants Prof Alan Carr, from University College Dublin, and Prof Theresa Betancourt, from the Boston College School of Social Work, as well as co-I Prof Michael Donnelly, from Queen's University Belfast, have been involved in the study since 2019. They have provided technical assistance on research design, methodology, and analysis in both phase 1 and 2.
Impact All study outcomes are related to these partnerships.
Start Year 2020
 
Description Research Consultants 
Organisation University College Dublin
Country Ireland 
Sector Academic/University 
PI Contribution The AUB research team reached out to senior researchers in family therapy, mental health and psychosocial support and public health to provide additional supports and direction to the AUB research team.
Collaborator Contribution Consultants Prof Alan Carr, from University College Dublin, and Prof Theresa Betancourt, from the Boston College School of Social Work, as well as co-I Prof Michael Donnelly, from Queen's University Belfast, have been involved in the study since 2019. They have provided technical assistance on research design, methodology, and analysis in both phase 1 and 2.
Impact All study outcomes are related to these partnerships.
Start Year 2020
 
Description Technical Support Partners 
Organisation UNICEF
Country United States 
Sector Public 
PI Contribution The research team reached out to UNICEF Lebanon and the National Mental Health Program at the early stages of the project development and have facilitated meetings and research protocol development in consultation and collaboration with both organizations.
Collaborator Contribution UNICEF Lebanon has worked in the country for over 70 years, with close ties to the Government of Lebanon, other UN agencies, international and local NGOs, and universities, with the aim of meeting the needs of disadvantaged children in Lebanon. The national Psychosocial Support (PSS) Committee is Co-Chaired by UNICEF Lebanon, and aims to improve the response to the mental health and psychosocial needs of refugees and host communities in the country, with a focus on community and focused programmes, and improving the inclusion of caregivers. UNICEF Lebanon has provided technical assistance in developing the research design and approving the use of their focused-psychosocial manual. They will continue to provide technical expertise or training when needed, and will be actively involved during the dissemination of the program, in terms of identifying key organisations and promoting the family program. The National Mental Health Program, linked to the Ministry of Public Health, is supportive of this study and programme, and has been invaluable in the approvals for implementation, and is integral in the dissemination strategy for the study findings, and sustainability of the programme.
Impact All study outputs are linked to this collaboration.
Start Year 2020
 
Title The Sawa Aqwa (Stronger Together) Family Program 
Description The Sawa Aqwa (Stronger Together) Family Program is 6 weekly sessions and 1 booster session, delivered by trained non specialist providers, for at-risk adolescents and their families in Lebanon. The program involves family systemic sessions on; family roles and strengths, emotional regulation, communication, problem management and conflict resolution. 
Type Therapeutic Intervention - Psychological/Behavioural
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2021
Development Status Under active development/distribution
Clinical Trial? Yes
UKCRN/ISCTN Identifier https://lbctr.moph.gov.lb/Trials/Details/4870
Impact The program is till being tested through an RCT but the pilot demonstrated trends of positive outcomes for adolescent and caregiver mental health, family functioning and emotional regulation, as well as evidence of feasibility and acceptability. 
 
Description Community Advisory Board 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact 2020-2021
A Community Advisory Board was set up in Tripoli through War Child Holland and in North Beqaa through Terre des Hommes Italia, made-up of at-risk adolescents and their parents, from refugee or host communities. Monthly meetings were held in person and then online due to COVID-19, to 1) introduce the study, team, and intervention plans, 2) to share findings from phase 1 and discuss integration into the intervention, 3) to share measures selected for the research and discuss their relevance and phrasing in local Arabic, and 4) to review and feedback on intervention manual drafts. Future meetings are envisaged to maintain community relationships, and to continue to collaborate with families in developing and testing the family intervention. Families on the Community Advisory Board will also continue to be compensated for their time and acknowledged in all study and intervention-related outputs and publications.

2021-2022
Our Community Advisory Boards (CABs) set up in phase 1 have continued to engage in the program development and research activities in phase 2. The CABs are based in Tripoli through War Child Holland and in North Beqaa through Terre des Hommes Italia, made-up of at-risk adolescents and their parents, from refugee or host communities. Monthly meetings have been held online due to COVID-19, or through Whatsapp voicenotes and messages when electricity and fuel shortages made online meetings limited. In phase 2, the CABs have been engaged in 1) feedback and discussion on drafts of the intervention manual and training, 2) support the wording of outreach materials to inform families about the program, 3) run-through of sessions before the pilot and giving detailed feedback, 4) cognitive interviewing for measures of family functioning and emotional regulation, and 5) troubleshooting for challenges as they arise in the trial. The CAB members have and will continue to be part of the process of preparing publications, and are acknowledged by name (with permission) on our first submission (the RCT protocol). In the future, the CA will be engaged in dissemination activities. Families on the Community Advisory Board will also continue to be compensated for their time and acknowledged in all study and intervention-related outputs and publications.
Year(s) Of Engagement Activity 2020,2021,2022