What drives change in children receiving telephone-delivered Common Elements Treatment Approach (t-CETA)? A multiple n = 1 study with Syrian refugee children and adolescents in Lebanon

Although the evidence-base for mental health and psychosocial support (MHPSS) interventions in humanitarian settings is growing rapidly, their mechanisms of change remain poorly understood. This study aimed to explore the mechanisms or factors that drive change in a telephone-delivered mental health intervention, Common Elements Treatment Approach (t-CETA).

Through a pilot randomised controlled trial with Syrian refugee children in Lebanon, this study found:

• Children with historical war-related trauma were more likely to show significant improvement across symptom clusters by the end of treatment compared to children presenting with depression related to daily living conditions.
• Children showed fluctuating symptoms during the early stages of treatment but significant decline in symptoms after the trauma module and depression module.
• Salient external life events identified were starting or dropping out of school, working, change in living conditions, family conflict and the October Revolution.
• Interpersonal factors of parental engagement and counsellor skills in building rapport were also identified as having an impact on treatment success.

This paper discusses the implications of these findings for MHPSS programming in humanitarian settings.