Measuring the health and wellbeing impacts of a scalable program of psychosocial intervention for refugee youth

Purpose

This research assessed the health impact of Advancing Adolescents, a psychosocial intervention of structured, group-based activities for youth affected by the Syria and Iraq crises. This programme is a brief, scalable intervention, implemented by Mercy Corps in Jordan, Lebanon, Iraq, Syria, and Turkey as part of the No Lost Generation initiative.  It is strategic in focusing on adolescence, a key time for protecting the next generation and building its future, and innovative in serving both refugee & host communities.

The  impact evaluation was a randomized controlled trial, measuring the impacts of profound stress attunement for 11-15 year old Syrian refugee and Jordanian youth, living in five urban centers in northern Jordan.  It examined psychosocial, physiological and cognitive outcomes – stress in the mind, the body, and the brain – as well as levels of resilience, at three time-points (pre-intervention, post-intervention, 1-year follow-up).

Youth-focused interventions in humanitarian crises had never previously measured stress alleviation in ways that go beyond subjective self-reports, through measuring ‘stress under the skin’ or ‘toxic stress’ in the brain.  This mixed-method study was the first to do so, including measures of stress biomarkers and tablet-based tests of cognitive function.  Robust scientific assessments are essential in order to inform potential scale up strategies.

Outcomes

The study evaluated two iterations of the Advancing Adolescents programme and assessed:

• psychosocial outcomes, including mental health, stress, and insecurity
• biological outcomes, including hair cortisol and immune function;
• cognitive outcomes, using tablet-based tests of inhibitory control and working memory;
• levels of individual, relational, and cultural resilience
• genetic signatures of exposure to war-related trauma.

Key Findings

• A structured approach to stress attunement, implemented by trained community workers can be effective in reducing psychosocial stress and insecurity for war-affected youth;
• A brief intervention is also effective in regulating stress physiology: cortisol levels were reduced hair cortisol by a third;
• Culturally-relevant tools such as the Human Insecurity Scale and the Child Youth Resilience Measure are among the most useful for evaluating risk and resilience in humanitarian contexts;
• A strong partnership between local and international actors is essential to overcome challenges in the field and deliver a robust, ethical, and multi-disciplinary impact evaluation.

The study demonstrated the effectiveness of methods of assessment that go beyond self-reports.  The use of hair cortisol, as a marker of chronic physiological stress, is a compelling indicator of stress regulation, which is an important outcome for crisis-affected populations.

Key Outputs

• Six peer-reviewed articles on mental health, resilience, biological, and cognitive health outcomes (see below).
• The brief (12-item), reliable, and culturally-grounded Child Youth Resilience Measure (CYRM), developed in Arabic for use with war-affected children and adolescents, and available free of charge. See https://crh.macmillan.yale.edu/news/new-tool-measures-resilience-adolescent-syrian-refugees
• A ‘proof-of-concept’ tool-kit to support academic and humanitarian actors to make informed choices around innovative methods for project evaluation.
• Project Website: http://campuspress.yale.edu/sfr/projects/research-for-health-in-humanitarian-crises/
• A Documentary Film by Ron Bourke: https://www.ronbourkefilms.com/terror-and-hope 

Next Steps

• Mercy Corps has incorporated key study findings into regional programming, and expanded the inclusion of psychosocial support as part of larger livelihoods interventions in Lebanon, Iraq, Jordan and Palestine
• Mercy Corps adopted three Arabic-language tools – the Child Youth Resilience Measure, the Human Insecurity scale and the Strength and Difficulties Questionnaire – in ongoing programming in the Middle East Region, as this study demonstrated their relevance for research monitoring and impact evaluations.