ECUADOR | PANAMA

Integrating coping skills training into a group psychosocial intervention for migrant and host communities

PROJECT
OVERVIEW

Mental health and psychosocial problems affecting migrant women are inextricable from other multisectoral priorities such as safety, security, meeting basic needs, protection from violence, and discrimination and xenophobia. To improve psychological well-being and reduce intimate partner violence (IPV) among forced migrants in Ecuador and Panama, we implemented, and evaluated an integrated psychosocial intervention.    

Lead Implementation Partner: HIAS 
Lead Research Partner: Columbia University, Johns Hopkins University  
Population: Forced female migrants in Ecuador and Panama 

Study Design

Cluster-randomized feasibility trial

Participants

Displaced and host community women

Setting

Community sites providing services for forcibly displaced persons in Guayaquil and Tulcan, Ecuador, and Panama City and Panama West, Panama
ABOUT THE INTERVENTION

Problem: Panamá hosts refugees and migrants from the Northern Triangle (Guatemala, Honduras, El Salvador), Nicaragua, Colombia, and Venezuela, among other countries. Ecuador has long been a host country for displaced persons from Colombia and, more recently, Venezuela. Migrants in these contexts face mental health and psychosocial problems, protection risks, and disrupted social and community support systems. Gaps in the provision of psychosocial services, despite the high prevalence of psychosocial problems and threats to the safety and well-being of refugees and migrants, persist in both countries and have been exacerbated by the COVID-19 pandemic.

Question: This work adapted Nguvu, an integrated IPV and mental health intervention, from a focused, non-specialized psychological and protection intervention into a psychosocial intervention integrated into basic, evidence-based protection services for women in forcibly displaced communities. The intervention, Entre Nosotras, was designed to address salient psychosocial needs of migrant women in these communities, namely psychological distress, lack of social support and isolation, xenophobia and discrimination, and safety and protection concerns.

Design & Methods: Entre Nosotras is a five-session intervention implemented by HIAS in 11 communities in Ecuador and Panamá. It combined elements of psychoeducation, problem solving, stress management/coping, safety planning, and mobilizing social support and resources. Entre Nosotras was delivered by pairs of trained community members to groups of 6-10 women. The study evaluated the feasibility of delivering the standard and enhanced version of the intervention in the study communities using a cluster randomized comparative effectiveness feasibility trial. Each of the communities were randomly allocated to receive the standard or the enhanced version of Entre Nosotras. 225 women were enrolled and evaluated for their psychosocial wellbeing, psychological distress, social support, coping strategies, and functioning pre-intervention, post-intervention, and five weeks after the intervention had been completed using existing survey tools.

Research Findings:

  • Psychological distress, depression, xenophobia and discrimination, and gender-based violence are important psychosocial problems facing migrant women in Ecuador and Panamá. 
  • It is feasible to integrate community-based participatory methodologies to design and deliver psychosocial interventions that align with the needs and preferences of populations in humanitarian settings 
  • Non-specialists can deliver a group psychosocial intervention to community members with high fidelity and competency. 
  • Mental health and psychosocial problems affecting migrant women are inextricable from other multisectoral priorities such as safety, security, meeting basic needs, protection from violence, and discrimination and xenophobia. Thus, a multisectoral approach to MHPSS policy is critical for impact and sustainability.

Policy & Practice Achievements:

HIAS implemented a cross-divisional Global Learning Group, comprised of program staff, strategy and measurement staff, and public affairs and advocacy staff, to work toward:

  • Evidence-Based Practice
  • Thought Leadership
  • Policy Influence
  • Research Capacity 
PUBLICATIONS and Products

Study Protocol: Evaluating the feasibility of a group psychosocial intervention for migrant and host community women in Ecuador and Panama: protocol for a multi-site feasibility cluster trial

Community-based participatory design of a psychosocial intervention for migrant women in Ecuador and Panama

Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America

Mixed-methods evaluation of a group psychosocial intervention for refugee, migrant and host community women in Ecuador and Panamá: Results from the Entre Nosotras cluster randomized feasibility trial

Improving Retention in Mental Health and Psychosocial Support Interventions: An Analysis of Completion Rates across a Multi-Site Trial with Refugee, Migrant, and Host Communities in Latin America

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status

“Before I was in the group, I felt insecure in all aspects; I felt uneasy; I was very afraid of what could happen to me. I feel good today. It helped me a lot.”

– Anabel, Program Participant

STUDY COLLABORATORS

Alejandro Angulo
Program Focal Point
HIAS

Alejandra De la Cruz
Program Officer
HIAS

Andrea Veronica Armijos Navarro, MSc
MHPSS Coordinator
HIAS

Arianna Moyano Morillo
Research Assistant
HIAS

Carolina Vega Legarda, MD
Regional Research Program Coordinator for MHPSS
HIAS

Claire Greene, PhD
Assistant Professor
Columbia University Mailman School of Public Health

Lena Skovgaard Andersen, PhD
Postdoctoral Fellow
University of Copenhagen Department of Public Health

Liliana Andrea Murcia, MD
Program Officer
HIAS

Lucia Benavides
Project Officer
HIAS

Maria Cristobal
MHPSS Regional Advisor for Latin America and the Caribbean
HIAS

Maria Jose Lopez Alvarado, MSc
Research Assistant
HIAS

Maria Jose Noboa Muñoz
Research Assistant
HIAS

Maria Vergara
Research Assistant
HIAS

Wietse Tol, PhD
Professor
University of Copenhagen Department of Public Health