Fiona S. McEwen, Hania El Khatib, Kristin Hadfeld, Karen Pluess, Nicolas Chehade, Tania Bosqui, Stephanie Skavenski , Laura Murray , Roland Weierstall Pust, Elie Karam, and Michael Pluess

Abstract
Background Refugee children are at high risk of mental health problems but face barriers to accessing mental
health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone delivered therapy with refugee children in a humanitarian setting.
Methods An evidence based intervention, Common Elements Treatment Approach, was adapted for telephone
delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements
in the Beqaa region of Lebanon. Following delivery of t-CETA, semi structured interviews were conducted with counsellors (N=3) and with children who received t-CETA (N=11, 45% female, age 8–17 years) and their caregivers (N=11,
100% female, age 29–56 years) (N=25 interviews). Thematic content analysis was conducted separately for interviews
with counsellors and interviews with families and results were synthesized.
Results Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves
and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship
between the counsellor and the child and caregiver is extremely important; the family’s attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling
over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding
an appropriate space, and communication challenges over the phone.
Conclusions Despite some challenges, telephone delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services
by hard to reach populations. Approaches to addressing challenges of telephone delivered therapy are discussed.

Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting

Telepsychiatry, Telephone, Children and adolescents, Refugees, Feasibility and acceptability, Lay counsellors