A System Innovation Perspective on the Potential for Scaling Up New Psychological Interventions for Refugees
Aniek Woodward1, Marjolein A Dieleman2, Egbert Sondorp3, Bayard Roberts4, Daniela C Fuhr4, Peter Ventevogel5, Marit Sijbrandij6, Jacqueline E.W Broerse2, On behalf of the STRENGTHS consortium7
1 KIT Royal Tropical Institute, KIT Health, Amsterdam; Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
2 Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
3 KIT Royal Tropical Institute, KIT Health, Amsterdam, The Netherlands
4 London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Health Services Research and Policy, London, UK
5 Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
6 Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
KIT Royal Tropical Institute, KIT Health, Mauritskade 64, 1092 AD, Amsterdam
Source of Support: None, Conflict of Interest: None
In recent years, a range of brief protocolised psychological interventions like Problem Management Plus have been developed. Such “scalable psychological interventions” are meant to be delivered by nonspecialists which can greatly increase access to psychological therapies for people affected by adversity, including forced displacement. However, embedding new interventions into mainstream practices is challenging. Novel interventions can remain in the research phase for a long time or stop altogether, which minimises their intended impact and reach. In this conceptual paper we propose a “system innovation perspective” on scaling up new psychological interventions for refugees and argue that existing mental health systems often need to change to integrate new interventions in a sustainable way. We present a conceptual framework, which includes ideas on cycles of deepening (learning by doing), broadening (repeating and linking), and scaling up (embedding) and the multilevel and constellation perspective. This framework has been operationalised in our scalability research as part of the STRENGTHS study in which we increase our understanding of the opportunities for scaling up four new psychological interventions in eight countries hosting Syrian refugees, including in Europe (Germany, Netherlands, Sweden and Switzerland) and the Middle East (Egypt, Jordan, Turkey and Lebanon).
Key implications for practice
- Researchers and practitioners involved in implementing and evaluating scalable psychological interventions such as Problem Management Plus should consider the inclusion of scalability assessments to increase understanding about the potential for integrating such innovations into mainstream services.
- A system innovation perspective views scaling up as the integration of an innovation into mainstream practices and suggests that mental health systems commonly need to change in order to effectively adopt new interventions, allowing them to reach their desired impact at scale and in a sustainable way.
- An improved understanding of the scalability of novel psychological interventions, including the potential (systemic) barriers and facilitators for scaling up, will provide essential knowledge for those involved in decision-making, implementation and evaluation of the further scale up of such interventions.