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

这项混合方法研究是贝鲁特美国大学和荷兰战争儿童组织之间的国际合作，得到项目伙伴丹麦难民理事会和地球社意大利、公共卫生部黎巴嫩、儿童基金会以及来自都柏林大学学院、波士顿学院社会工作学院和贝尔法斯特女王大学的国际专家的支持。该研究旨在为高危青少年制定和测试一个对文化和背景敏感的系统性家庭干预模块，该模块可以与黎巴嫩现有的重点心理社会方案一起运行。有针对性的心理社会支持旨在促进福祉和复原力，并减少面临性别暴力、童婚和童工等违反儿童保护行为风险的年轻人的精神疾病。全球五分之一的儿童生活在受冲突影响的地区，这些儿童的精神障碍发病率很高。受冲突影响地区的全球精神障碍疾病负担是全球平均水平的5倍。青年人不仅受到战争的暴力、损失和不安全的影响，而且受到其生活条件、上学和获得保健的机会、结构性歧视和基于性别的暴力的系统性影响，以及其照顾者的创伤、压力和育儿能力受损的影响。战争、冲突和极端逆境对儿童和青少年心理健康和福祉的破坏性影响已得到广泛研究，但在改善这些人群干预措施的质量和范围方面仍存在挑战。在资源匮乏的环境中，治疗差距高达90%，主要障碍是基础设施和训练有素的专家有限。作为缩小这一差距的一项战略，制定并广泛实施了心理社会支助干预措施，作为分步护理协调办法的一部分。在冲突和人道主义紧急情况下进行心理社会干预的证据基础虽小，但不断增加，然而，对青少年心理健康和基于家庭的干预措施的研究严重不足，资源不足。养育家庭环境对儿童的健康发展至关重要，在其他人口和国家环境中，养育子女和系统的家庭干预措施对心理健康和保护成果都显示出很强的效力。因此，本研究旨在开发和评估一个家庭系统干预模块，与儿童基金会黎巴嫩的重点心理社会支助方案一起使用，以加强目前的人道主义方案拟订工作，并解决受冲突影响环境中面临风险的青少年及其家庭目前证据基础的重大弱点。调查结果将为公共卫生部国家精神卫生方案领导的黎巴嫩精神卫生系统改革提供信息。黎巴嫩是一个中等收入国家，在大约590万人口中，估计有150万难民。大多数难民来自叙利亚，还有近50万巴勒斯坦难民。近60%的叙利亚难民生活在极端贫困中，无法满足基本的生存需求，而30%的黎巴嫩收容社区也生活在贫困线以下。这些人口面临的许多社会和经济压力增加了儿童保护问题的风险，包括性暴力和基于性别的暴力、家庭暴力、童婚、童工和武装团体招募儿童。2015年，启动了黎巴嫩2015-2020年五年期精神卫生和物质使用战略，旨在改革精神卫生系统，虽然取得了很大成就，但在提供家庭系统干预方面仍存在差距。因此，黎巴嫩是进行这项研究的理想地点，因为它既有大量需要重点支持的弱势群体，又有将学习纳入国家精神卫生战略的政治意愿。

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.