None listed
Conditions
Brief summary
Although scalable psychosocial programs are effective for most people, they are limited because (a) many people do not respond to programs, and (b) agencies cannot predict who will be responsive. It is not cost-effective to provide more intensive programs to all people with common psychological disorders. Currently, people only receive single programs and many do not respond to these programs. This study will test how a stepped care program can (a) provide scalable programs to all people who require assistance, and (b) offer much-needed programs to those who do not benefit from initial intervention. This framework tests a cost-effective model of care that addresses the psychological needs of most people, as well as those with persistent mental disorders in humanitarian crises. A randomized controlled trial will randomise distressed people in Jordan to one of two conditions. The intervention arm is a stepped care program in which people initially receive a self-help psychosocial program that comprises an illustrated workbook plus support phone calls from helpers (Doing What Matters), and if they are distressed at the completion of this they will additionally receive small-group based behavioural program that teaches skills in reducing emotional disorders (Problem Management Plus). In the comparator condition participants will receive Dong What Matters and if they are still distressed at the completion of the program, they will receive Enhanced Treatment as Usual. Assessments will occur at pretreatment (week 1), post-DWM (week 7), post-PM+ or EUC (week 13) primary follow-up (week 25), additional follow-up (week 61). It is expected that participants who receive the stepped care program will have greater reductions in mental health problems than those who receive the single intervention.
Interventions
There are two arms to this trial. Arm 1 is the intervention arm, and comprises Stepped Care. Therapy commences with Doing What Matters (DWM), a guided self-management course involving working through an illustrated workbook (including written and audio content) within a 5-week period at a self-paced manner (this workbook is available at: https://www.who.int/publications/i/item/9789240003927). To support use of DWM strategies, participants will be supported by a lay helper who will conduct three
There are two arms to this trial. Arm 1 is the intervention arm, and comprises Stepped Care. Therapy commences with Doing What Matters (DWM), a guided self-management course involving working through an illustrated workbook (including written and audio content) within a 5-week period at a self-paced manner (this workbook is available at: https://www.who.int/publications/i/item/9789240003927). To support use of DWM strategies, participants will be supported by a lay helper who will conduct three phone calls of 15-minutes duration throughout the 5 weeks. Participants who are not distressed following DWM will continue to be assessed but will receive no further assistance. Participants who are distressed at the end of DWM course will be provided with Problem Management Plus (PM+) in a group format (gPM+). PM+ is a program developed by the World Health Organization. PM+ involves once-weekly 120-minute sessions delivered by a facilitator over 5 weeks delivered groups of 8-10 people at a time. DWM will teach participants strategies in mindfulness and acceptance strategies. PM+ will teach the following stress coping strategies: anxiety reduction, problem solving, behavioural activation, and accessing social support. Facilitators will be local non-specialist psychosocial workers trained in Jordan by the authors of DWM and PM+, and will be supplemented by completion of conducting practice groups under supervision. Sessions will be conducted in clinics in Jordan. All participants in the Stepped care condition will also receive Enhanced Treatment as Usual (ETAU), and this involves referral to local psychosocial services for additional assistance. Treatment adherence will be assessed by facilitators monitoring session attendance. Arm 1 participants will receive 10 weeks of intervention (5 weeks of DWM and 5 weeks of PM+ or 5 weeks of DWM and 5 weeks of monitoring) and 52 weeks of follow-up assessment, resulting in a total participation duration of 62 weeks.
Sponsors
UNSW Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria are: (a) Jordanians or refugees residing in Jordan, (b) aged at least 18 years, (c) K10 score of at least 6 (d) Literacy in Arabic
Exclusion criteria
Exclusion criteria will include (a) imminent plans of suicide, (b) psychotic disorders, (c) severe cognitive impairment, (d) identification of risk of the person’s safety (e.g. partner violence), or (e) plans to return to Syria in next 12 months. (f) No access to a telephone
Outcome results
None listed