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How can we overcome common barriers to mental health service access and deliver psychological treatment to children in humanitarian settings? This study, conducted in Lebanon with Syrian refugee children, used both qualitative and quantitative methods to look at effectiveness, feasibility and accessibility of a telephone-based mental health service.

View Research Snapshot

What did the study set out to achieve?

Most Syrian refugee families living in settlements in Lebanon face barriers to accessing healthcare and support, including mental health services. However, most have access to a mobile phone which provides an opportunity for accessing therapy remotely. This study examined whether an existing evidence-based treatment – Common Elements Treatment Approach (CETA) – adapted for delivery over the phone (t-CETA) could overcome these barriers.


MdM volunteers celebrating a beneficiary’s birthday in a in informal settlement in Barr Elias in Bekaa, Lebanon. Credits: Patricia Moghames, Medecins du Monde- Lebanon.
MdM volunteers with beneficiaries in an informal settlement in Zahle in Bekaa, Lebanon. Credits: Lea Telayni, Medecins du Monde – Lebanon
Mental Health team supporting a Syrian refugee woman in a primary health centre in Bekaa
Refugee settlement in the Bekaa valley
Syrian boy in an informal tented settlement in the Beqaa region of Lebanon. Photo credit © Nour Tayeh / Médecins du Monde France, Lebanon (2017)

What were the key findings?

The team found that t-CETA was feasible, acceptable, and reduced symptoms of mental health problems in children, while helping to overcome access barriers. Findings show that phone-based mental health services may be a promising solution for providing mental health support to refugee children in crisis settings. A larger trial could strengthen these findings and improve understanding of efficacy.

Feasibility and acceptability:

  • t-CETA reached more children and was more logistically flexible than standard treatment.
  • Phone delivery reduced the effect of stigma and increased adherence, given that families did not need to visibly attend a clinic.

Overcoming access barriers:

  • Children receiving t-CETA were more likely to start and complete treatment and less likely to miss sessions.

Reducing symptoms:

  • Children presented with post-traumatic stress, anxiety, depression, and conduct problems; comorbidity was typical.
  • There was a greater decrease in symptoms and problems over the course of treatment in children who received t-CETA compared to standard treatment.

What does this mean for policymakers and practitioners?

  • t-CETA can increase access to effective mental health treatment for hard-to-reach populations that otherwise struggle to access services.
  • Flexible scheduling of phone appointments during evenings and weekends can further reduce barriers to access.
  • t-CETA is a scalable solution. Lay counsellors and remote supervision reduces the need for mental health professionals in the area where treatment is needed.
  • Building capacity in phone-delivered services can increase resilience to events that impact mobility, such as the COVID-19 pandemic. t-CETA was provided during nationwide protests and road closures in Lebanon in 2019, with minimal disruption to children’s treatment.
  • Humanitarian practitioners may increasingly need to consider telemedicine while awaiting the COVID-19 vaccine rollout.

The study team also produced practical guidance to support humanitarian actors in delivering telephone-based mental health services, to help overcome common challenges that can arise during service delivery.

Next steps

  • There is a need for larger trials on t-CETA to investigate treatment efficacy in more depth.
  • Trials in other populations and countries are needed to establish where and with whom t-CETA is feasible and effective.
Play video


Article, Peer Reviewed Mental Health and Psychosocial Support

Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting

Guidance COVID-19, Mental Health and Psychosocial Support

Guidance for the delivery of psychological therapy to children by phone

Impact Case Study Mental Health and Psychosocial Support, Research Uptake

Impact Case Study: Evaluation of Phone-Delivered Psychotherapy for Refugee Children

Article, Peer Reviewed Mental Health and Psychosocial Support

The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview for Syrian refugee children and adolescents in Lebanon

Article, Peer Reviewed Mental Health and Psychosocial Support

What drives change in children receiving telephone-delivered Common Elements Treatment Approach?

Article Mental Health and Psychosocial Support

Mental health research among Syrian refugees in Lebanon: challenges and solutions

Latest Updates

Research Impact Case Study published

Aug 2023

This study was selected by the R2HC for our Impact Case Study series. The case study is now available to view online.


Researchers develop new guidance for the delivery of psychological therapy to children by phone

Apr 2020

The team created a free online resource for mental health services now looking to deliver psychological therapy remotely to children amid the current Covid-19 pandemic.


Mental Health Innovation Network (MHIN)

Dec 2019

Details of the study have been posted on the MHIN Innovations database


Why do Syrian refugees in Lebanon not use available mental health services?

Aug 2019

After surveying more than 1,000 families in Lebanon, the team found that many of them agreed to a referral for mental health services but more than half did not enrol into treatment. They went back to ask why.


Providing individual psychological treatment to Syrian refugee children with Common Elements Treatment Approach (CETA): First Impressions from Field Staff

Apr 2019

In this blog we describe the t-CETA project and provide first impression of providing CETA face-to-face by our team in the field in Lebanon.


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