Feasibility study and pilot trial of an evidence-based low intensity psychosocial intervention delivered by lay therapists for asylum seekers and refugees (PROSPER).
Asylum seekers and refugees experience reduced mental health and wellbeing, related to stresses in their country of origin, experiences in transit and reception on arrival, including exclusion from mainstream services such as income support, housing and healthcare.
Their contact with healthcare is often crisis-driven and mediated through non-governmental organisations (NGOs), whose staff lack knowledge and skills in the management of distress.
This study will test the feasibility of a randomised controlled trial to evaluate an intervention based on Problem Management Plus (PM+), a psychosocial intervention recommended by the World Health Organization for adults impaired by distress in communities exposed to adversity. PM+ provides clients with skills in managing practical problems and mental health problems.
In this context, it is proposed that an adapted PM+ will be delivered by lay therapists with lived experience as asylum seekers and refugees, in NGOs working with asylum seekers and refugees in Liverpool City Region.
Is it feasible to undertake a randomised controlled trial of PM+, delivered by lay therapists in NGOs, for distressed and functionally impaired asylum seekers and refugees?
The research will be undertaken in Liverpool City Region over 24 months.
First, we will refine and adapt PM+ to suit local context. We will do this by a) systematic review of barriers and facilitators to psychosocial interventions led by lay therapists to improve migrant health and wellbeing, and in parallel, b) focused inquiry with local stakeholders to ensure acceptability, linguistic and cultural relevance to target populations.
Second, we will assess the feasibility of the proposed training procedures. These will involve master training and supervision in PM+ provided to a counselling NGO who, in turn, provide training and supervision for lay therapists in NGOs in contact with asylum seekers and refugees.
Then we will assess the feasibility of conducting a randomised controlled trial of five 90 minute sessions of PM+ delivered individually or in groups by lay therapists to asylum seekers and refugees with emotional distress and functional impairment, compared with usual peer support offered by the NGOs. Distress and impairment at baseline will be measured by Hospital Anxiety and Depression Scale (HADS) and WHO Disability Assessment Schedule (WHO-DAS). For this feasibility trial we will have three arms (individual, group and control) and aim for 35 participants per arm.
Primary health outcomes will be anxiety and depressive symptoms at 3 months, measured by HADS. Secondary outcomes will include subjective wellbeing, functional status, progress on identified problems, post-traumatic stress disorder, depressive disorder and service usage. Longer term impact will be assessed at 6 months post baseline assessment on the same parameters.
We will assess the feasibility of conducting a randomised controlled trial in relation to the following elements: recruitment and retention of lay therapists and study participants; fidelity of delivery of the proposed intervention; and suitability of the study measures, including any linguistic or cultural barriers.
We will use these findings to specify the parameters for a full randomised controlled trial to test the effectiveness and cost effectiveness of PM+ in reducing emotional distress and health inequalities, and improving functional ability and wellbeing, amongst asylum seekers and refugees.
The PROSPER project is a collaboration between the University of Liverpool, Liverpool John Moores University and the University of Bangor, funded by the the NHS National Institute for Health Research. We are working with four NGOs across Liverpool: Red Cross, Asylum Link, Refugee Women Connect and Person Shaped Support.