2024 Articles

Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador

Moyano, Arianna; Vergara, Daniela; Mirti, Amaleah F.; Bonz, Annie G.; Monar, Adriana; Astudillo, Efrén; Vaca, Sara; Cordova, Karen; Armijos, Andrea; Barroso, Adrian; Cherrez, Cesar; Cottle, Jennie; DuBois, Aimée; Capriles, Isabella Fernandez; Grandes, Jean Pierre; Irarrazaval, Matias; Jaramillo, Belen; Kane, Jeremy C.; Martinez-Viciana, Carmen; Mascayano, Franco; Rodríguez, Yescárleth; Schojan, Matthew; Sikkema, Kathleen; Susser, Ezra; Ventevogel, Peter; Wessells, Mike; Zambrano López, Aaron; Lovero, Kathryn L.; Greene, M. Claire

Background
Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.

Methods
We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.

Results
We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.

Conclusions
This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.