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Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions

Periodic Reporting for period 1 - RE-DEFINE (Refugee Emergency: DEFining and Implementing Novel Evidence-based psychosocial interventions)

Reporting period: 2018-01-01 to 2019-06-30

There is a growing body of research demonstrating the effectiveness of psychological therapies for refugees and asylum seekers. However, psychological treatments require extensive training and supervision, and sufficient time to be delivered in full (e.g. up to 12 weeks). Additionally, most interventions targeted the symptoms of mental disorders, without a specific focus on prevention.
Recently, the World Health Organization (WHO) has developed a novel, low-intensity five-session self-help intervention for managing stress and coping with adversity, which is designed to be delivered by non-specialist facilitators and does not require extensive training. This psychosocial intervention, called Self-Help Plus (SH+), is intended to help and support people with and without mental disorders to cope with distress stemming from diverse types of adversity. SH+ has not been tested as a preventive intervention.

RE-DEFINE aims to generate a strong evidence-base for Self Help Plus (SH+), and to create a scientific framework to adapt and equip health care systems in countries inside and outside Europe with this low-intensity intervention.
The RE-DEFINE project started on January 1, 2018, and will continue until December 31, 2020.
In summary, the project started by analyzing migration flows and conducting a situational analysis of refugees and asylum seekers within RE-DEFINE countries (WP2; D2.1 and D2.2) coordinated by the partner WHO.
WP3 was focused on translation and cultural adaptation of the SH+ programme into three different languages, in accordance with the results of the situational analysis WP2 (D3.1). Cultural adaptation of SH+ required the WHO to develop both the intervention and training materials in the appropriate languages (D3.1 D3.2 D3.4) and to provide training of SH+ trainers (Training of Trainers). Expert clinicians, in turn, provided SH+ training to facilitators (D3.3). The WP4 and WP5 are the randomized trials in Europe and Turkey respectively, and are currently being implemented in the following sites: UNIVR, UULM, UTU, ULIV, YORK, MUW, and Turkey (SEHIR). The first study subject approvals packages for Europe and Turkey have been submitted by UNIVR as deliverables D4.1 and D5.1 as well as the mid-term recruitment report D4.2 and D5.2. In parallel, UULM developed a cost-effectiveness analysis plan (D6.1) with details on the methodology that will be adopted for the cost-effectiveness analysis.
Dissemination activities are organized in WP7 and started with the preparation of a detailed dissemination and communication plan (D7.1 and D7.6) and with the creation/activation of a project website (D7.2). UNIVR coordinated the activities related to WPs 1 and 8.
The work performed since the beginning of the project is reported below, and is organized according to the activities planned in each WP:

Work Package 1- Overall project management. During the first 18 months of the project, UNIVR efficiently managed and coordinated the project activities, ensuring the achievements of all the objectives listed in each WP.
Work package 2 consisted of analyzing migration flows across countries inside and outside Europe, in order to understand socio-cultural characteristics of asylum seekers and refugees resettled in those countries where Consortium partners are: Italy, Germany, Austria, Finland, the UK (in which there are two sites), and Turkey.
Work package 3: Cultural adaptation of SH+ programme: SH+ consists of a pre-recorded audio course and illustrated book, which contains all of the main messages and information from the SH+ audio. Based on results from WP2, SH+ has been translated and adapted into 3 different languages: Urdu for Pakistani participants, Arabic for Syrian and Iraqi participants, and Dari for Afghan participants. In addition, the SH+ package in English was adapted for use with refugees from Nigeria. This was narrated by a Nigerian voice actor.
Work package 4: Implementation of SH+ programme in European countries. WP4 work performed during the first 18 months consisted of: Conducting a large, pragmatic, multicentre RCT comparing SH+ programme delivered by peer refugee facilitators versus enhanced usual care, in asylum seeker and refugee populations resettled in Europe. The SH+ programme is being delivered within health care institutions and community centres. Beneficiaries will be 600 RAS (300 per study arm) with increased psychological distress (General Health Questionnaire (GHQ) > 3) and without a diagnosis of mental disorder according to the Mini International Neuropsychiatric Interview (MINI).
Work package 5: Implementation of SH+ programme in Turkey. WP5 work performed during the first 18 months consisted of:
The conduction of a large, pragmatic, multicentre RCT comparing SH+ programme delivered by peer refugees versus enhanced usual care, in asylum seeker and refugee populations resettled in Turkey. The SH+ programme is being delivered within health care institutions and/or community centres. Beneficiaries will be 600 RAS (300 per study arm) with increased psychological distress (General Health Questionnaire (GHQ) > 3) and without a diagnosis of mental disorder according to the MINI.
Work package 6: As a common basis for the assessment of the use and costs of health and social care ressources in the participating countries, the European version of the Client Socio-Demographic and Service Receipt Inventory CSSRI has been adapted to the application in asylum seekers and refugees by means of interviews with asylum seekers and refugees and staff members from health and social care facilities providing services for this population. Within this WP, expert interviews with representatives from relevant governmental and nongovernmental health and social care institutions have been conducted, in order to assess the organizational as well as the time and other resource requirements of implementing SH+ in the participating countries.
Work package 7: Development of a detailed dissemination plan related to each phase of the project, and to the reporting of overall results. The plan has been developed by WHO, DRC and UNIVR, and consists of a detailed description of the dissemination and communication strategy and related activities.
Work package 8 is related to the ethical aspects of the RE-DEFINE project.
As originally stated, we expect that the results obtained at the end of this project will have an enormous impact in terms of availability and access to mental health care and on the quality of evidence-based mental health services for vulnerable populations. This project will improve Europe's capacity to respond to diverse emergencies using cost-effective, pragmatic strategies. Results of each individual phase are having the expected impact from a scientific point of view, and also from a clinical and implementation perspective. This project represents a unique opportunity to improve the quality of life and psychological wellbing of vulnerable populations, and of preventing the incidence of newly diagnosed psychiatric disorders. In addition, RE-DEFINE will have a significant impact on health system and stakeholders, contributing to the equity in preventative interventions for reducing the incidence of mental health diagnoses, promoting health, and providing effective, equitable, and affordable health services.
The plan for exploitation and dissemination of results is being implemented as originally planned.
Graphical representation of the overall project
RE-DEFINE presentation at ENMESH, Lisbon, June 2019
Training of facilitators, Verona, June, 2018
Training of facilitators, Verona, June, 2018
RE-DEFINE presentation at ENMESH, Lisbon, June 2019
RE-DEFINE kick-off meeting. Verona, January 15, 2018
Training of Trainers, Verona, May 22-25, 2018
Training of Trainers, Verona, May 22-25, 2018
RE-DEFINE mid-term meeting in Geneva, 4-5 Februaty, 2019