Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador.

Autor: Moyano A; HIAS Ecuador, Quito, Ecuador., Vergara D; HIAS Ecuador, Quito, Ecuador., Mirti A; Columbia University Mailman School of Public Health, New York, USA., Bonz AG; HIAS, Silver Spring, USA., Monar A; HIAS, Silver Spring, USA., Astudillo E; HIAS Ecuador, Quito, Ecuador., Vaca S; HIAS Ecuador, Quito, Ecuador., Cordova K; HIAS Ecuador, Quito, Ecuador., Armijos A; HIAS, Silver Spring, USA., Barroso A; HIAS Ecuador, Quito, Ecuador., Cherrez C; United Nations High Commissioner for Refugees, Quito, Ecuador., Cottle J; HIAS, Silver Spring, USA., DuBois A; Pan American Health Organization, Quito, Ecuador., Capriles IF; New York State Psychiatric Institute, New York, USA., Grandes JP; HIAS Ecuador, Quito, Ecuador., Irarrazaval M; Pan American Health Organization, Washington, DC, USA., Jaramillo B; HIAS Ecuador, Quito, Ecuador., Kane JC; Columbia University Mailman School of Public Health, New York, USA., Martinez-Viciana C; Pan American Health Organization, Washington, DC, USA., Mascayano F; New York State Psychiatric Institute, New York, USA., Rodríguez Y; HIAS, Silver Spring, USA., Schojan M; HIAS, Silver Spring, USA., Sikkema K; Columbia University Mailman School of Public Health, New York, USA., Susser E; Columbia University Mailman School of Public Health, New York, USA.; New York State Psychiatric Institute, New York, USA., Ventevogel P; United Nations High Commissioner for Refugees, Geneva, Switzerland., Wessells M; Columbia University Mailman School of Public Health, New York, USA., Zambrano López A; HIAS Ecuador, Quito, Ecuador., Lovero KL; Columbia University Mailman School of Public Health, New York, USA., Greene MC; Columbia University Mailman School of Public Health, New York, USA. mg4069@cumc.columbia.edu.
Jazyk: angličtina
Zdroj: Conflict and health [Confl Health] 2024 Nov 06; Vol. 18 (1), pp. 68. Date of Electronic Publication: 2024 Nov 06.
DOI: 10.1186/s13031-024-00629-x
Abstrakt: Background: Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.
Methods: We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.
Results: We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.
Conclusions: This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.
(© 2024. The Author(s).)
Databáze: MEDLINE
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