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To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the "Competence and Adherence Scale for CBT for Anxiety Disorders in Youth." Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < 0.001 and p = 0.010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.

Digital technologies are important for expanding access to mental health support in low-resource settings. The current study tests the feasibility of a blended learning mental health intervention that was implemented for adolescents in Lebanon (N = 1,234), most of whom were Syrian refugees. The intervention features a digital game called The Helping Hand, which teaches adolescents how to respond to psychosocial challenges healthily and develop effective coping strategies. The blended learning intervention was tested using a single-arm, non-blinded, mixed-methods approach, through the analysis of pre-post questionnaires and key informant interviews. Results showed that the intervention was well accepted and popular among participating adolescents and the team that implemented it. After completing the intervention, adolescents showed a significant decrease in anxiety and depression symptoms and a significant increase in overall well-being. The feasibility and potential impact observed in this study demonstrate the benefits of continuing to refine and expand digital interventions that improve access to mental health support for vulnerable populations. [ABSTRACT FROM AUTHOR]

Syrian adolescent refugees are one of the largest forced displaced populations in the world. Displaced adolescents experience significant stressors on their mental health, including high poverty and severely limited access to mental health services. Studies show that game-based learning interventions offer the potential for increasing access to mental health supports. We employed a mixed-method pilot and feasibility study to explore how the Happy Helping Hand (HH) game app contributed to improved well-being and emotional problem-solving skills in displaced Syrian adolescents in Lebanon. A 5-week, 10-session digital learning HH psychosocial program was administered by teachers. Adolescent and teacher focus groups were used to assess how emotional problem-solving skills were applied in-depth. A single group pre-post design measured well-being using the World Health Organization's Well-Being Index (WHO-5). Thematic analysis was used for qualitative analysis. Descriptive and bivariate t-tests were used for quantitative analyses. Qualitatively, adolescents´ demonstrated increased emotional problem-solving skills and well-being, and attributed the changes to the usefulness of the app. Quantitative findings show well-being significantly increased at post-test compared to pretest. The study supports the use of e-health and role-playing games for Syrian adolescents. Future research should examine an up-scaled implementation of the app with displaced adolescents. [ABSTRACT FROM AUTHOR]

Background: Caring for children with disabilities in Tanzania involves significant challenges, including stigma, limited support and mental health risks. A cultural collective for caretakers of children with disabilities enrolled at a primary school was established to address these issues. Objectives: The study aims to explore the experiences of caregivers who started a cultural collective and to assess its impact on their lives in the short term. Method: This study used a community-based participatory research (CBPR) approach with a sequential mixed-methods design. Data were collected over a period of 8 weeks, while the participants in this study established a collective in Dar es Salaam. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using Braun and Clarke's method for thematic analysis. Results: As assessed by a validated and normed questionnaire, Patient Health Questionnaire-9 (PHQ-9), 63% of the caregivers showed signs of depression before starting work in the collective. Economic needs, education and the desire for support were the primary motivations for joining. Starting the collective improved social support, fostered agency and began to enhance caregivers' financial conditions. Conclusion: The collective addressed caregivers' needs for economic improvement, social support and mental support, and the experience was vitalising for the caretakers. Contribution: This study deepens our understanding of holistic interventions for children with disabilities and their families in urban Africa. It offers valuable insights into a crucial stage of developing contextually relevant interventions for vulnerable, poverty-stricken populations. It provides a model that can be adapted for similar interventions in comparable contexts. [ABSTRACT FROM AUTHOR]