Year : 2021 | Volume
: 19 | Issue : 1 | Page : 1--3
Bridging the Gap Between Science and the Field
Wendy Ager1, Camila Perera2, Naser Morina3, Mohammad Abo-Hilal4,
1 Editor in Chief, Intervention Journal, Amsterdam, The Netherlands
2 Researcher, Centre for Global Health, Trinity College, Dublin, Ireland
3 Senior Researcher and Head of the Outpatient Clinic for Victims of Torture and War, University Hospital Zurich, University of Zurich, Switzerland
4 Founder and Consultant, Syria Bright Future, Gaziantep, Turkey
Editor in Chief, Intervention Journal, Nienoord 5-13, 1112XE Diemen
|How to cite this article:|
Ager W, Perera C, Morina N, Abo-Hilal M. Bridging the Gap Between Science and the Field.Intervention 2021;19:1-3
|How to cite this URL:|
Ager W, Perera C, Morina N, Abo-Hilal M. Bridging the Gap Between Science and the Field. Intervention [serial online] 2021 [cited 2021 Apr 18 ];19:1-3
Available from: https://www.interventionjournal.org/text.asp?2021/19/1/1/312730
Welcome to the first issue of Intervention in 2021. We have 19 articles in this issue, including a special section on Problem Management Plus (PM+) and related interventions. I would like to express my thanks to the team of guest editors − Dr. Camila Perera, Dr. Naser Morina and Dr. Mohammad Abo Hilal − for their enthusiastic support and collective wisdom in reviewing and guiding the publication of the special section. They have contributed to the writing of this editorial where it relates to PM+.
The first three articles have a broader focus than those in the special section. The first by Dückers (see pp. 4-14) reviews methods used for disaster response evaluation and barriers to scale up. One of the reviewers commented that this is a very relevant but understudied area of work in mental health and psychosocial support and so we hope this article will contribute to the field. The second by Verghis et al. (see pp. 15-20) describes the experiences of Health Equity Initiatives, a nongovernmental organisation, in providing mental health and psychosocial support to refugees and asylum seekers during the COVID-19 pandemic in Malaysia. The third by Olmert (see pp. 21-25) has an unusual focus and is probably a first for Intervention in describing an animal-assisted psychosocial intervention for survivors of the war in Uganda through the facilitation of human-dog companionship.
The Special Section on Problem Management Plus
We are very pleased to present 16 articles in the special section on PM+. We were seeking to document learning in the implementation of PM+ in various settings and feel we have achieved this goal. The collection here − written by a diverse range of authors − provides a rarely offered account of PM+ outside of randomised controlled settings and one that orients itself toward solving the practical problems of providing mental health and psychosocial support interventions in low resource and humanitarian settings. This is illustrated by the participation of local, national and international organisations and institutions, including articles from teams who have not published before as well as those from more experienced writers.
PM+ itself was developed by the World Health Organization for use in settings affected by adversity and in humanitarian crises. PM+, in individual and group format, is an innovative, fast, cost-effective, transdiagnostic, evidence-based, psychological intervention that aims to improve mental health, functioning and psychosocial wellbeing of adults impaired in communities exposed to adversity. It provides clients with skills to improve their management of practical problems (e.g. unemployment, interpersonal conflict) and associated common mental health problems (e.g. stress, anxiety, depression). In PM+, aspects of cognitive behavioural therapy have been changed to make them feasible in different communities.
PM+ is composed of four core strategies: stress management (Managing Stress), problem solving (Managing Problems), behavioural activation (Get Going, Keep Doing) and strengthening social support. It includes a psychoeducation component delivered in the first session where individuals learn about common reactions to adversity. The manual also includes a relapse prevention which, while not a core strategy of PM+, involves identifying signs of relapse and testing individuals’ knowledge of the strategies of PM+ and how they can continue to apply them in the future.
PM+ has been tested and found effective in various large randomised controlled trials across the world. Since it is very easy to learn, it can be used in both health and social sectors and delivered by both professional and lay workers. Thus, it is scalable and can be used to reach many people with common mental health problems in a range of countries, cultures and settings.
The Articles in the Special Section
Learning from the Challenges of COVID-19
As might be expected after the rigours of 2020, several articles refer to the challenges raised by COVID-19 in planning or implementing PM+. McBride et al. (pp. 37-47), for example, focus directly on the adaptation of PM+ for remote training in a variety of settings. The authors discuss how despite its challenges, remote training also offers potential for greater access to PM+ and an opportunity for geographical, social, cultural and economic diversity in training. Sabry et al. (pp. 121-124) provide a personal reflection on their team’s experience of providing counselling by phone to refugees living in Cairo, Egypt, when the pandemic hit. They suggest that using PM+ has provided a practical means of supporting their clients at this time. The field report written by Rodríguez-Cuevas et al. (pp. 75-83) also touches on the impact of the pandemic − in this case in a rural setting, in Chiapas, Mexico. They indicate the positive impact of PM+ on patients’ symptoms and community health workers’ attitudes towards mental health and themselves. However they also highlight complex problems such as intimate partner violence, stress due to structural adversity and grief related to the emerging COVID-19 pandemic which remain in underserved areas such as the one in which they are located.
Improving access to brief psychological interventions entails providing interventions that contribute to the psychological wellbeing without overlooking their cultural background, values and norms. A crucial but so far under-researched element of PM+ concerns adapting its manuals and delivery to the local culture and context. Many of the articles referred to this important aspect but there are three we would like to highlight here which focus on this aspect in detail. The article by Akhtar et al. (pp. 48-57) describes the process and results of making a cultural adaption of Group PM+ for two groups of Syrian refugees, one living in camp settings in Jordan and the other in urban settings in Turkey within the framework of the STRENGTHS Consortium. Coleman et al. (pp. 58-66) in their article detail the process that Partners in Health use as an international nongovernmental organisation in Rwanda, Peru, Mexico and Malawi across multiple public sector primary care and community settings in partnership with Ministries of Health. Both studies contribute to the literature on cross-country cultural adaptations and respond to calls for increasing transparency in documenting processes and methods of cultural adaptation of psychological interventions. Finally, Ghimire and Shrestha (pp. 125-130) document their experiences of introducing Group PM+ in Nepal in their personal reflection. Identifying metaphors which made sense in Nepal helped participants to understand the four core strategies used in PM+. They developed a toolkit with images representing a tension framework to help facilitators and participants to remember and practise the strategies.
Training, Supervision and Implementation
These topics attracted many submissions. Ensuring quality is one of the key issues in training lay providers and keeping the knowledge transfer sustainable. Those that we have published here include accounts of training lay providers on PM+, the first from the Centre for Victims of Torture in Ethiopia and the second from the PROSPER study in Liverpool describing the training of people with lived experience of asylum and migration in the UK. Gebrekristos et al. (pp. 101-106), writing about the work done in Ethiopia particularly highlight the importance of supervision in contexts where training participants come from the same communities as their clients. The authors document the challenges of providing PM+ in protracted refugee settings and discuss the ethical implications of providing PM+ to persons with more severe mental health difficulties. Chiumento et al. (pp. 67-74) describe very well the testing and implementation of PM+ within a large study in the UK in training peer lay helpers who have lived experience of seeking refuge or of migration. The authors highlight key messages and challenges of training lay helpers and give recommendations on how to address these challenges. One challenge in training is ensuring that participants have gained the necessary skills and knowledge to deliver the intervention they have learned. The field report by Pedersen et al. (pp. 107-117) reports on a structured competency rating tool for use with observed role plays which was piloted with the Centre of Victims of Torture programme in Ethiopia.
The case studies presented by Nemiro et al. (pp. 84-90) in their field report featuring Ethiopia, Syria and Honduras indicate how vital a strong supervision system is within humanitarian organisations along with practising the intervention before it is delivered. Careful planning is needed for the entire process in giving sufficient time for training and supervision in order to deliver quality services at scale.
Action contre la Faim implemented an adapted version of PM+ in a very difficult humanitarian context in the Central African Republic (CAR). Dozio et al. (pp. 91-100) present results on outcomes for internally displaced persons, using both quantitative and qualitative methods, as well as some information on their adaptation procedures and the cultural acceptance of the intervention in CAR.
Developments in PM+
In this special issue, there are two articles from the STRENGTHS Consortium which discuss innovations in relation to PM+. The first by Woodward et al. (pp. 26-36) proposes a system innovation perspective on scaling up new psychological interventions for refugees arguing for change within existing mental health systems to integrate new interventions in a sustainable way. The second by Fuhr et al. (pp. 141-143) is a commentary on the neglected issue of alcohol misuse in conflict-affected populations. It describes a proposed programme of work to be implemented in Uganda and the Ukraine, complementing PM+ with components addressing alcohol misuse. This is also a possible future strategy in terms of how PM+ could be further developed by adding and adapting different modules, which address specific mental health problems.
Reflections About PM+
There are five personal reflections published in this issue of Intervention. Two of them feature the voices of refugees. In the reflection by Basil et al. (pp. 118-120), the Syrian authors − now living in Rotterdam, The Netherlands − write about the benefits and challenges in doing a PM+ training. And in the personal reflection written by Ali and Ari (pp. 136-140), one a MHPSS officer and the other a psychosocial support community worker, both share their stories about the PM+ training in the Kurdistan region of Iraq. Goloktionova and Mukerjee (pp. 131-135) describe the experience of two mental health programme coordinators supporting the implementation of PM+ in conflict-affected Eastern Ukraine. They highlight the successes and challenges experienced throughout several phases of implementation. The other two personal reflections have been introduced in other sections of the editorial.
This special section shows that there is a small but prolific and growing body of work on the feasibility and scaling up of PM+ in humanitarian field settings. It not only demonstrates the need for brief, transdiagnostic, readily scalable interventions delivered by supervised lay providers, but also reflects the ability and motivation of MHPSS humanitarian actors to rapidly adopt novel interventions in humanitarian settings and thereby filling the gap.
Financial support and sponsorship
ARQ International which hosts Intervention is a partner of the STRENGTHS Consortium and is responsible for the dissemination work package. ARQ International acknowledges with thanks the financial support received from the European Union and the STRENGTHS Consortium in disseminating findings on PM+.
The STRENGTHS Consortium consists of 15 partners. It has adapted PM+ for use with Syrian refugees and is testing different versions of PM+ and related scalable psychological interventions, including EASE and a self-help application for phones. It is also looking at cost effectiveness and strategies for implementing PM+ in different country contexts in Europe and the Middle East. The STRENGTHS Consortium has received funding from the European Union’s Horizon 2020 Research and Innovation Programme Societal Challenges under Grant Agreement No. 733337.
The content of the special section reflects only the authors’ views and the European Commission is not liable for any use that may be made of the information contained therein.
Conflicts of interest
There are no conflicts of interest.