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   Table of Contents - Current issue
January-June 2023
Volume 21 | Issue 1
Page Nos. 1-85

Online since Thursday, April 27, 2023

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From the Editors: Celebrating 20 Years of Bridging Research and Practice p. 1
Rina Ghafoerkhan, Wendy Ager
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Lessons Learned in Using the Score of Perceived Outcomes (ScoPeO) Tool in Mental Health and Psychosocial Support Programmes to Measure Quality of Life p. 3
Blanche Mattern, Maximilien Zimmerman, Lise Archambaud
Following the launch of the Impact and Quality of Life project in December 2012 by the Luxembourg Ministry of Foreign and European Affairs, Humanity & Inclusion − formerly Handicap International (HI) − developed a new monitoring tool, the score of perceived outcomes (ScoPeO), which is now widely used across HI programmes to measure the quality of life. The tool was used to evaluate service-users’ quality of life in four countries (Lebanon, Madagascar, Sierra Leone and Togo) in the Touching Minds, Raising Dignity (TMRD) programme which aims to end the stigmatisation of people living with mental health issues and to improve their quality of life. This field report documents lessons learned in using the ScoPeO tool, specifically in relation to quality of life. It describes the methods used to survey the interventions in the four different settings and discusses the challenges and limitations in using the ScoPeO tool.
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Posttraumatic Stress Disorder among University Students of Mosul, Iraq: An After Effect of War Atrocities p. 9
Maha Sulaiman Younis, Amina Saad Abdullah, S.M. Yasir Arafat
People in Mosul, Iraq faced many acts of violence between 2014 and 2017 when the city was seized by the terrorist group of Islamic State of Iraq and Syria (ISIS). We aimed to determine the prevalence of symptoms of posttraumatic stress disorder (PTSD) among university students in Mosul. This cross-sectional study was conducted between the period of 15 April and 29 December 2020. Data were collected from 305 university students by face-to-face interview. The Iraqi modified version of the Harvard Trauma Questionnaire was used to assess the prevalence and degree of PTSD symptoms. The mean age of the participants was 21.46 ± 2.76 years; 224 (73.4%) of the students were females and 259 (84.9%) were single. 12% of the students met the threshold criteria for symptoms of PTSD. Symptoms were associated with the type of injury and frequency of traumatic events experienced. This lower rate than expected for those who had been exposed to life-threatening and violent war warrants further studies to identify the attributing factors and preventive measures.
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Psychosocial Programming in Uganda: Adaptations during COVID-19 p. 14
Gary Samuel Agaba, Ben Otto, Rehema Kajungu, Grace Obalim, Katie Hindes, Flora Cohen
The COVID-19 pandemic brought concerns about mental health to the fore. While more and more people struggle with the mental health effects of experiencing a global pandemic, people in humanitarian settings may be even more at risk. In humanitarian settings, it may be more challenging to ensure accessible to mental health services and support staff who are implementing essential programmes amidst concerns for their own health. We present a report of programme adaptations during COVID-19, including measures to support staff wellbeing, communicate with donors to support protective measures, and adapt programmes to be safer and more accessible for beneficiaries. Lessons learned from adaptations during COVID-19 can inform additional programming in humanitarian settings, especially in sub-Saharan Africa.
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Decolonising Mental Health and Psychosocial Support (MHPSS) Interventions in the Humanitarian System p. 20
Roei Shaul Hillel
Mental health is an increasing concern around the world, but there is a substantial gap in terms of access to quality mental healthcare between Western and non-Western countries. To help close this gap and improve the delivery of mental health and psychosocial support services (MHPSS), the UN’s 2016 Grand Bargain declared a new approach of prioritising the localisation of these services. This paper examines the effects of the Grand Bargain on the localisation of mental health and psychosocial support services in non-Western countries, as a means to decolonise mental health. An outcome evaluation to measure the amount of funding received by local and national agencies that provide MHPSS services in less economically developed countries was carried out. All data were gathered from the UN Financing Track System (FTS), and looked at financial contributions over time in six humanitarian sectors: health; water, sanitation and hygiene (WASH); gender-based violence; nutrition; protection and shelter. The results show that only 3% of international donors’ MHPSS-related humanitarian funding is received by local and national agencies between 2017 and 2021. Most of the localised MHPSS-related funding is driven by country-based pooled funds, with Middle Eastern countries as the primary beneficiaries, and localised MHPSS funding predominantly went to the health, WASH and protection sectors. This study found that limited localisation of MHPSS services in less economically developed countries, and a limited focus on community capacity building through associated humanitarian sectors. Based on this study, it is recommended that humanitarians should advocate for increased localisation and culturally competent practices in the MHPSS space.
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Development and Psychometric Testing of the Student Learning in Emergencies Checklist (SLEC): Measuring Promotors of Academic Functioning and Wellbeing in Palestinian Youth Affected by War and Conflict p. 30
June T Forsberg, Carly Tubbs Dolan, Jon-Haakon Schultz
Youth living with war and ongoing conflict are frequently exposed to potentially traumatic events and cumulative stress which can result in temporarily impaired academic functioning and reduced wellbeing in school. In Palestine, the Ministry of Education has included psychosocial support programmes in the schools for the purpose of reducing stress reactions and improving school functioning amongst students. The Student Learning in Emergencies Checklist (SLEC) was developed in a psychometric testing study for monitoring and evaluating school-based psychosocial support in the Palestinian context—self-perceived academic functioning and wellbeing in particular. The study included 789 Palestinian students (12–16 years of age) living in Gaza, the West Bank and East Jerusalem, using an instrument that monitors five theoretical constructs considered to promote school functioning in emergencies. The analysis revealed a different factor structure than hypothesised: 1) safety and adaptability, 2) emotion regulation, 3) school support, 4) family support and 5) wellbeing and hope. The SLEC satisfies monitoring and evaluation purposes for fieldwork regarding programme planning, design and evaluation. Further, it appears well-suited for use by teachers for raising awareness of the need for and guiding their delivery of psychosocial support. The present study discusses practical implications and limitations of the SLEC.
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Competency Assessment of Non-Specialists Delivering a Psychological Intervention in Lebanon: A Process Evaluation p. 47
Rozane El Masri, Frederik Steen, April R Coetzee, May Aoun, Brandon A Kohrt, Alison Schafer, Gloria A Pedersen, Rabih El Chammay, Mark J.D Jordans, Gabriela V Koppenol-Gonzalez
There is an increasing need to improve the competency and quality of non-specialists delivering psychological interventions. As part of the Ensuring Quality in Psychological Support (EQUIP) initiative, this study evaluates the process of roleplay-based competency assessments using three tools to assess the competencies of facilitators delivering a psychological intervention for children in Lebanon. With a group of five competency raters, five facilitators and four actors, this study uses a mixed methods approach, comprising competency assessment data, qualitative interviews and focus group discussions. Data were collected during a two-phase process. Findings of the study showed inter-rater agreement was generally acceptable after additional training of raters. Eventually, it is feasible to prepare actors, facilitators and raters on roleplays for effective implementation of competency-driven training. As for the non-specialists, it was found that overall the experience of taking part in competency assessments was useful to understand their points of improvement. Pre- to post-training improvements in competencies showed that despite reported feelings of anxiety, the facilitators benefited from the feedback given on their competencies. We concluded that using roleplay-based competency assessments and preparing for competency-based training is feasible and useful to ensure quality control in mental health and psychosocial support (MHPSS) service provision.
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Testing a Screening, Brief Intervention, and Referral to Treatment Intervention Approach for Addressing Unhealthy Alcohol and Other Drug Use in Humanitarian Settings: Protocol of the Ukuundapwa Chapamo Randomised Controlled Trial p. 58
Jeremy C Kane, Muzi Kamanga, Stephanie Skavenski, Laura K Murray, Mbaita Shawa, Bertha Bwalya, Kristina Metz, Ravi Paul, Namuchana Mushabati, Peter Ventevogel, Stephanie Haddad, Grace Kilbane, Megan Sienkiewicz, Veronica Chibemba, Princess Chiluba, Nkumbu Mtongo, Mildred Chibwe, Caleb J Figge, Michelle Alto, David Mwanza, Elizabeth Mupinde, Shira Kakumbi, Wietse A Tol, Kelsey Vaughan, Zaliwe Banda, Anja Busse, Nadine Ezard, Allan Zulu, Henry Loongo, M. Claire Greene
Refugees and other displaced persons are exposed to many risk factors for unhealthy alcohol and other drug (AOD) use and concomitant mental health problems. Evidence-based services for AOD use and mental health comorbidities are rarely available in humanitarian settings. In high income countries, screening, brief intervention and referral to treatment (SBIRT) systems can provide appropriate care for AOD use but have rarely been used in low- and middle-income countries and to our knowledge never tested in a humanitarian setting. This paper describes the protocol for a randomised controlled trial to compare the effectiveness of an SBIRT system featuring the Common Elements Treatment Approach (CETA) to treatment as usual in reducing unhealthy AOD use and mental health comorbidities among refugees from the Democratic Republic of the Congo and host community members in an integrated settlement in northern Zambia. The trial is an individually randomised, single-blind, parallel design with outcomes assessed at 6-months (primary) and 12-months post-baseline. Participants are Congolese refugees and Zambians in the host community, 15 years of age or older with unhealthy alcohol use. Outcomes are: unhealthy alcohol use (primary), other drug use, depression, anxiety and traumatic stress. The trial will explore SBIRT acceptability, appropriateness, cost-effectiveness, feasibility, and reach.
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A Brief Reflection on Paper Titled “Mental Health Training of Primary Health Care Workers: Case Reports from Sri Lanka, Pakistan, and Jordan” p. 70
Boris Budosan
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How Process Matters in Strengthening MHPSS: A Reflection p. 72
Michael G Wessells
In developing the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings, attention to social process was key for success. In retrospect, humility was crucial for reflecting on one’s own dogmas, opening up to different points of view and avoiding ideological fixity and unproductive debates. Inclusivity was the key for enabling learning from diverse perspectives and areas of expertise, drawing on understandings from different countries and developing richly contextual approaches. Effective leadership from Mark van Ommeren and participating agencies enabled a highly collaborative, transformative process. As the developing mental health and psychosocial support (MHPSS) field has become institutionalized and respected for its importance, expertise and expanding evidence base, increased attention to the process is needed. Key process considerations at present include power sharing with local people, listening to and co-learning with affected people and collective critical reflection, including on issues of process and relationships with local people. Greater attention to process can help to complement needed technical approaches, avoid unintended harm and enable more contextual, effective and sustainable humanitarian action. With attention to both technical aspects and human processes, the field of MHPSS can develop and implement comprehensive approaches and make its greatest contributions to affected people.
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Us and Us: Reflections of the Wellbeing of Church-based Volunteers Working with Refugees and Asylum-seekers, Edinburgh, Scotland p. 76
Megan Douglas
Over the past 5 years, Scotland has seen numbers of refugees and asylum-seekers increase significantly. Churches and other faith-based organisations have been key players in aiding with the reception and integration of these “New Scots”. Although many volunteers characterise their experiences as positive, there have also been unique challenges presented for their mental health and emotional wellbeing as they navigate complex relationships and stories of hardship. Drawing from first-hand experience of working within a faith-based charity that aims to support refugees and asylum-seekers in Edinburgh, Scotland, the author provides her personal reflections on the dynamics of working within the context of refugee resettlement and implications for the wellbeing of both volunteers and New Scots.
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Workshops on Trauma and Loss, Coping and Resilience, to Support Afghani Refugee Women Living in Limbo in Greece p. 80
Jane Shackman, Khatera Saeedi
These joint reflections are from Jane, who designed and delivered the workshops for Afghani refugee women, and Khatera, one of the participants, who supported and helped with communication in advance and throughout. They describe the main elements of the workshops and their impact. The workshops acknowledged the enormous losses and traumas the women had experienced, but also looked at ways of keeping hope alive and the importance of recognising and building on the strengths and resilience the women already had. The workshops were organised by the International Bar Association, UK.
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Groupwork with Refugees and Survivors of Human Rights Abuses: The Power of Togetherness by Boyles, Ewart-Biggs, Horn and Lamb. London: Imprint Routledge p. 84
Marian Tankink
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