Assessing the effect of a Self-Help Model on the Quality of Life and Mental Well-being of School Going Young Caregivers in Pakistan (CARER-HELP)

Brief name: SH+ Feasibility & Efficacy Trial for Distressed Young Carers in Pakistan. This study involves the implementation of the WHO Self-Help Plus (SH+) intervention, tailored to address the needs of young carers (YCs) in Haripur, Pakistan. SH+ is a low-intensity, structured, and scalable psychological program developed by the World Health Organization (WHO) to support individuals experiencing significant psychological distress. Grounded in Acceptance and Commitment Therapy (ACT), the intervention promotes mindfulness, stress management, and values-based action to enhance psychological well-being and build resilience, ultimately aiming to prevent mental health disorders. The intervention consists of five weekly group sessions, each lasting 90–120 minutes, delivered over a period of 1.5 months (35 days). Sessions are held in safe and comfortable settings such as school computer labs, with group sizes ranging from 19 to 20 participants to foster peer interaction and support. A manualized protocol guides the sessions to ensure consistency across facilitators. The content is based on WHO’s standardized SH+ program, a publicly available resource that mainly includes pre-recorded audio materials with evidence-based content and mindfulness exercises, as well as an additional structured self-help booklet with similar content for supplementary home practice. The core focus areas include stress awareness, self-efficacy, and values-based goal setting. Each of the five sessions is complemented by one corresponding practice activity, introduced sequentially during the sessions and assigned for additional practice at home. These include: (1) Grounding—focusing attention on sensory input and reconnecting with the present moment; (2) Unhooking—identifying and labeling difficult thoughts and emotions, followed by mindful refocusing; (3) Acting on Values—choosing small actions aligned with personal values and planning their implementation; (4) Being Kind—cultivating self-compassion through kind inner dialogue and self-soothing gestures; and (5) Making Room—mindfully noticing, naming, and allowing difficult emotions to pass without resistance. These exercises, outlined in the SH+ printed booklet and supported by audio tools, are reinforced through repetition—once during in-person sessions which is mandatory and once through self-directed practice at home. To encourage compliance, participants who miss their home practice are given the opportunity to complete it individually in class before the next session. Facilitators promote engagement by reviewing each participant’s intended home practice at the end of every session and discussing their experiences through self-report checklists and group reflections at the start of the next. A post-assessment form from the SH+ manual is also used to document participation and identify any barriers. Although home practice is voluntary and not directly monitored or assessed as a formal study outcome—since completion remains at the participants’ discretion—it is considered a critical component of the intervention and is actively supported throughout the sessions to ensure effective skill acquisition. Graduate psychologists serve as facilitators and receive in-person training through a two-week Training of Trainers (ToT) program based on WHO’s SH+ training manual and presentation materials available on the WHO website. The training includes didactic lectures on ACT principles, SH+ content, and mental health topics; practical role-plays and mock sessions with trainer feedback; sessions on cultural adaptation, ethical delivery, and safeguarding; and supervised, peer-reviewed practice using SH+ materials. The WHO-recommended training format includes approximately 40 hours of interactive, in-person sessions. This is supplemented by ongoing supervision from experienced mental health professionals, including a licensed clinical psychologist and the project’s co-supervisor. Weekly supervision meetings during the intervention delivery phase ensure fidelity to the manual, provide implementation support, and help facilitators address emerging challenges. Fidelity monitoring tools include facilitator logs, adherence checklists, and participant engagement records. Participant acceptability, feasibility, and therapeutic alliance are also assessed through validated tools such as the FAAIM, WAI-SR, CSQ-8, and CEQ. These strategies collectively ensure that the intervention is delivered consistently, culturally sensitively, and effectively.