Evaluating the Evidence Base for Psychosocial Support Programs in Low-Resource Humanitarian Settings

Introduction. Humanitarian programs frequently address ‘psychosocial problems’ in affected populations, yet there is little scientific evidence on how this should be done. Despite this, psychosocial support (PSS) programming – defined as broadly supportive activities and basic counseling - forms the major part of humanitarian programming directed at mental health and wellbeing. Given the range and reach of PSS, it is essential to demonstrate the effects of these programs. Past literature reviews have focused specifically on RCTs and found that such studies have rarely been conducted for PSS interventions. The purpose of this systematic review is to identify the range of PSS interventions being implemented and evaluate all available evidence for their effectiveness.

Methods. We completed an initial scoping review to identify gaps in existing research. In developing the search strategy we also consulted with 69 PSS experts and established an Advisory Board and a Steering Committee. Drawing from both peer reviewed and grey literature, we conducted a systematic search for reports evaluating PSS programs. Reports were eligible for inclusion if they included primary data at any unit of measurement and evaluated a program or intervention through any type of research design. Programs must have been designed to address a psychosocial problem or outcome. Small N case studies, structured individual psychotherapies, and treatment for a diagnosable mental illness were excluded. Searches were conducted in PubMed PsychInfo, Embase, PILOTS, and Global Health.

Results. The scoping review indicated that most previous reviews had focused on specialized services, failed to search the grey literature and were limited to RCTs. These findings guided our more inclusive search strategy. Our initial search resulted in a total of N=42435 references. Following title/abstract screening, n=2723 were included for full-text review. Preliminary results suggest that the PSS programs most rigorously evaluated are brief individual interventions, family-focused interventions, and those incorporating standalone or adapted elements from evidence-based treatments. Full results will be presented at the conference.

Conclusions. Following completion of the review, we plan to hold two regional meetings with key stakeholders to review results and jointly identify a research strategy to assess the impact of high-priority PSS programs through a Delphi consensus procedure. To justify continued funding with scarce resources it is critical that Psychosocial Support (PSS) programs be evaluated using rigorous methods. This research can lead to doing less harm, increasing benefits, and making the best use of limited resources by shifting implementation to interventions known to be effective.