The effectiveness, mechanisms of change, and acceptability of Family Focused PsychoSocial Support (FFPSS) for at-risk adolescents in Lebanon

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This mixed-method study is an international collaboration between the American University of Beirut and War Child Holland, supported by project partners the Danish Refugee Council and Terre des Hommes Italy, the Ministry of Public Health Lebanon, UNICEF, and international expertise from University College Dublin, the Boston College School of Social Work, and Queen's University Belfast. The study aims to develop and test a culturally and contextually sensitive Systemic Family Intervention Module for at-risk adolescents that can be run alongside existing focused psychosocial programmes in Lebanon. Focused psychosocial support aims to promote wellbeing and resilience and to reduce mental ill-health in young people at risk of child protection violations, including gender-based violence, child marriage, and child labour.One in five children globally live in conflict affected areas, and these children experience a high incidence of mental disorders. The global burden of disease for mental disorders is 5 times higher in conflict-affected areas than the global average. Young people are affected not only by the violence, loss, and insecurity of war, but the systemic impact on their living conditions, access to school and health care, structural discrimination, and gender-based violence, as well as their caregivers trauma, stress, and compromised parenting capacity. The devastating impact of war, conflict, and extreme adversity on the mental health and wellbeing of children and adolescents has been extensively researched, but with continuing challenges in improving the quality and scope of interventions for these populations. The treatment gap in low resourced settings is as high as 90%, with major barriers of limited infrastructure and trained specialists. As a strategy to close this gap, psychosocial support interventions as part of a stepped care coordinated approach have been developed and widely implemented. There is a small but growing evidence base for psychosocial interventions in conflict and humanitarian emergencies, however adolescent mental health and family-based interventions are drastically under-researched and under-resourced. Nurturing family environments are essential for healthy child development, and parenting and systemic family interventions in other populations and country settings show strong effectiveness for both mental health and protection outcomes. This study therefore aims to develop and evaluate a Family Systemic Intervention Module to use alongside UNICEF Lebanon's focused psychosocial support programme, to enhance current humanitarian programming and addressing a significant weakness of the current evidence base for at-risk adolescents and their families in conflict-affected contexts. Findings will inform the Mental Health System Reform in Lebanon led by the National Mental Health Programme of the Ministry of Public Health. Lebanon is a middle-income country, home to an estimated 1.5 million refugees in a population of around 5.9 million. The majority of refugees come from Syria, as well as almost half a million Palestinian refugees. Almost 60% of Syrian refugees are living in extreme poverty, unable to meet basic survival needs, whilst 30% of Lebanese host communities also live below the poverty line. The many social and economic pressures facing these populations increases the risk of child protection issues, through sexual and gender-based violence, domestic violence, child marriage, child labour and recruitment intro armed groups. In 2015, a 5-year Mental Health and Substance Use strategy for Lebanon 2015-2020 was launched with the aim of reforming the Mental Health System, and whilst much has been achieved, there remains a gap in the provision of family systemic interventions. Lebanon is therefore an ideal location for this study because it has both large vulnerable populations in need of focused support, as well as political will to integrate learning into the national mental health strategy.