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Contemporary scalable psychological interventions utilise task-shifting approaches that enable non-specialists such as social workers, nurses and lay persons to deliver structured interventions after a brief training and ongoing supervision by professionals. This field report describes a training-implementation approach we used to train lay counsellors to implement a psychological intervention, Integrative Adapt Therapy (IAT), with Rohingya Refugees in Malaysia. IAT is a theoretically guided programme based on the Adaptation and Development After Persecution and Trauma (ADAPT) model. Unlike existing cognitive behavioural treatment (CBT)-based interventions, IAT helps refugees trace their emotional and behavioural problems to the underlying psychosocial disruptions (reflected in the core ADAPT ‘Pillars’) they experience. We assessed implementation outcomes by conducting a focus group with the twelve lay IAT counsellors who completed a training workshop followed by six-month supervised implementation of the IAT programme with Rohingya refugees. The implementation outcomes focused on the value and benefits of the programme to the counsellors’ clients and broader community, implementation challenges, cultural acceptability, and recommendations for improvement in training. There was a strong agreement amongst the counsellors that both the clients and they themselves benefited from the programme. Furthermore, the general consensus was that the clients reported improvements in their relationships with people (ADAPT Pillar 2: Bonds and Networks), in having a more realistic view about their Roles and Identities (Pillar 4) and in gaining a sense of purpose and meaning in life (Pillar 5: Existential Meaning). In addition, the focus group agreed that the programme fitted well with the culture and values of the Rohingya people. Implementation challenges include ensuring that the intervention team reflects gender balance, that the programme is sustainable and refining strategies to facilitate programme attendance and adherence.

A main gap in the delivery of mental health and psychosocial (MHPSS) services to Rohingya refugees in Cox’s Bazar district in Bangladesh is the limited coverage of psychotherapeutic interventions. There is a shortage of mental health professionals who can provide culturally adapted and linguistically appropriate psychotherapeutic interventions that are congruent with the refugee experience. This article describes preliminary work on training Bangladeshi psychologists and para-professionals in applying a novel group-based psychological intervention for refugees, Group Integrative Adapt Therapy (IAT-G). This is a pragmatic, eclectic and transdiagnostic approach, based on the Adaptation and Development After Persecution and Trauma (ADAPT) model. It aims to help refugees to develop resilience and capacities for managing maladaptive reactions to trauma and post-migration living difficulties. This paper describes the key strategies and challenges during the first phase of the project. Activities included an extensive desk review, a one-week training workshop with competency assessments, cultural adaptation of the treatment manual and assessment measures, training on digital literacy and electronic data collection and a blended supervisory model (involving onsite and online sessions). It proved to be generally feasible but not easy to introduce IAT-G in this population. Key implications for practice The introduction of a brief scalable psychological intervention within an acute and ongoing emergency was feasible, but faced considerable challenges including high staff turnover. Implementation involves multiple components including stakeholder engagement, contextual adaptation of tools and materials, training and supervision and setting up a monitoring system. Setting up a supervision is of critical importance but can be complicated in the context of an unfolding emergency.