A groundbreaking study led by the University of Surrey has revealed that telephone therapy significantly decreases mental health symptoms in refugee children. The research also indicates a higher completion rate of treatment compared to traditional in-person therapy.
In this pilot randomized controlled trial (RCT), 20 refugee children in the Beqa’a region of Lebanon participated. Ten children received standard in-person treatment, while the other ten received telephone therapy from local trained lay counselors, both provided by Médecins du Monde. Each treatment session began with a questionnaire to assess the children’s symptoms.
Results showed a notable and consistent decline in mental health symptoms among those who received telephone therapy. Sixty percent of these children completed the full treatment course, and 90% received at least some treatment. In contrast, no children in the in-person treatment group completed their therapy, and only 60% received any form of treatment.
Lebanon has hosted many Syrian refugees since the civil war began in 2011, yet mental health services are scarce. Most refugee families own mobile phones, making telephone therapy a more accessible option. The research team aimed to determine if a modified telephone therapy program could effectively reduce mental health symptoms in refugee children compared to traditional in-person sessions.
The study included children aged 8 to 17 from Syrian refugee families living in temporary settlements. Consent was obtained from both the parent or primary caregiver and the child. All participants met the diagnostic criteria for common mental health disorders, including depression, anxiety, and post-traumatic stress disorder.
The researchers employed the Common Elements Treatment Approach (CETA), a well-established cognitive behavioral therapy program, and adapted it for telephone use (t-CETA) with the help of locally trained lay counselors. In the first phase, they modified the original CETA manual for t-CETA, testing and refining it with 23 children—13 receiving face-to-face CETA and 10 receiving t-CETA. The second phase involved piloting this adapted approach in the RCT with a new group of 20 children.
Beyond the positive outcomes, t-CETA increased access to treatment, as families did not need to travel to clinics or adjust their schedules around work. The study also showed that local lay counselors can be effectively trained to deliver t-CETA under the supervision of experienced clinicians.
The research team faced challenges in recruiting participants. Some families struggled to attend in-person appointments, while others experienced stigma around accessing mental health services or lacked understanding of the treatment process. As a result, the sample size was smaller than expected. However, the success of the study suggests that t-CETA is a promising and scalable treatment option.
Professor Michael Pluess commented, “Our study highlights the importance of making mental health services more accessible and culturally relevant in countries with barriers to therapy. Despite the prevalence of mental health issues among refugee children and their families, most do not seek treatment. These trial results are a vital first step toward finding a solution, but a larger trial is needed to confirm these positive effects.”
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