After the randomized controlled trial: Implementing Problem Management Plus (PM+) through humanitarian agencies

WHAT IS THE HUMANITARIAN NEED?

During and after emergencies and humanitarian crisis, there are large numbers of people who are impaired for prolonged periods by distress. Grief and acute stress are usually transient psychological reactions to adversity and loss, but prolonged states of anxiety and depression may also be triggered by extreme stressors. These chronic problems undermine the functioning of individuals and their communities, which can be essential for their survival and is essential for socioeconomic recovery. In these periods of crisis, the health systems also tend to be overwhelmed and unable to meet the demand for basic services, and often the existing supportive care systems in the communities have also been damaged.

WHAT IS THE INNOVATIVE SOLUTION?

Problem Management (PM+) was found effective in two randomised controlled trials, (RCTs) funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) programme and by Grand Challenges Canada. PM+ can improve mental health, functioning and psychosocial well-being of people in humanitarian settings. It is a scalable, manualised, evidence-based intervention that can be used by both the health and social sector to reduce distress and improve functioning. It has proven to be effective in diminishing depression and anxiety and improving people’s functioning and self-selected, culturally relevant outcomes. Some of its very distinct and innovative features include:

• a transdiagnostic intervention, addressing a range of client identified emotional (eg depression, anxiety, traumatic stress, general stress) and practical problems
• designed for low-resource settings
• designed for people in communities affected by any kind of adversity (eg violence, disasters), not just focussing on a single kind of adversity
• it is empowering as it teaches adult participants to self-manage their distress for sustainable, long-term solutions.

WHAT WERE THE EXPECTED OUTCOMES?

In collaboration with eight humanitarian organisations, the project enabled them to implement PM+ in their agencies, through a capacity building intervention using PM+ and thereby providing evidence based care.
The capacity building workshops focused on (a) cultural adaptation of the manual, (b) training of trainers in an apprenticeship training and supervision approach, with a strong emphasis on on-the-job learning, and (c) regular measurement of outcomes.
The outputs of the capacity training workshop included:

• an availability of 20 PM+ trainers, clinical supervisors, programme supervisors
• PM+ implementation plans in the partnering humanitarian organisations
• a roster of independent PM+ trainers that can be consulted by agencies that do not have PM+ trainers
• a community of practice on the intervention
• three qualitative case studies on the experience of implementing PM+.