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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

PM+: evidensbasert intervensjon for problemløsning for flyktninger (PEIL-FORSK)

Alternative title: PM+: evidence-based intervention for problem management among refugees (PEIL-FORSK)

Awarded: NOK 7.0 mill.

Norway is facing a new wave of refugees, adding further pressure on the healthcare system. To address the mental health needs of newly arrived refugees, culturally sensitive healthcare services are being developed to help alleviate an already strained system. A key initiative in this regard is the implementation of the Problem Management Plus (PM+) intervention program, developed by the World Health Organization (WHO). The program has previously been successful in countries such as Kenya, Pakistan, Turkey, and the Netherlands, and is now being adapted to the Norwegian context, with Bergen and Fredrikstad serving as pilot municipalities. PM+ is based on cognitive-behavioral techniques and has an especially innovative approach: refugees act as "helpers" for other refugees, with close supervision from authorized healthcare professionals. The program follows a structured manual to ensure that the assistance provided is systematic and evidence-based. The goal is to strengthen refugees' ability to cope with mental health challenges, including trauma, loss, and stress, while receiving support from individuals with similar experiences. Over the next four years, the project will test and adapt PM+ to the specific needs found in Norway. The project is currently in its first year, focusing on adjusting the intervention, recruiting and training helpers from various cultural backgrounds, and establishing procedures for effective collaboration between research and practice. User involvement is central to all phases of the project, aiming to ensure that refugees themselves have a voice in the development of these services. The project aims both to improve the mental health of refugees and to increase the capacity of the Norwegian healthcare system. By integrating PM+ into standard healthcare and social services, it is hoped that the pressure on mental health care can be reduced, along with the associated societal costs. At the same time, the project seeks to break down barriers that often prevent refugees from seeking help through more traditional healthcare services, such as language barriers, cultural differences, and skepticism towards Western therapeutic methods. Another important goal of the project is to gather knowledge about how PM+ can contribute to increased well-being and job satisfaction among the refugees who serve as helpers. This will provide valuable insight into how motivation and identity can be maintained in the helper role, helping to ensure that the program can be operated sustainably over time. This aspect is crucial because many of the helpers have also experienced trauma and significant challenges on their journey to Norway, and their own mental health is just as important as that of the refugees they are helping. Research is an integral part of the project, and doctoral research is already well underway. Since March 2024, a PhD candidate has been working on evaluating how PM+ functions in a Norwegian context, both to improve the program and to assess its suitability for the target group. So far, around 30 refugees from various countries have started up or participated in PM+, with their mental health and coping abilities being measured before, during, and after the program. Interviews have also been conducted with the refugee helpers and their supervisors to gather insights into the implementation and effectiveness of the program. The results so far are currently being analyzed, and there is hope that PM+ could become an important part of Norway's long-term strategy for addressing the challenges related to the mental health of refugees., and there is hope that PM+ could become an important part of Norway’s long-term strategy for addressing the mental health challenges faced by refugees. The project also provides an opportunity to promote inter-municipal cooperation in the field of migration, as well as to increase the integration of research-based services into the healthcare system. In the long run, a successful implementation of PM+ will not only contribute to better healthcare services for refugees but also lead to a more sustainable use of resources within the Norwegian healthcare system. Additionally, it could help bridge the gap between refugees and Norwegian society by giving them an active role in helping their peers, thereby strengthening their own integration process.

På grunn av demografiske endringer og budsjettutfordringer er det behov for nye løsninger i dagens velferds-og omsorgstjenester. Forskning viser at flyktninger med psykososiale vansker kan få god hjelp av ufaglærte hjelpere med lik kulturell bakgrunn. Senter for Migrasjonshelse (SEMI) har erfart at rollen som ufaglært hjelper er givende for hjelperne, og treffer klientenes behov. Rollen kan imidlertid være belastende over tid. Hjelpere og ansatte ved SEMI har derfor opplevd et behov for å sikre at hjelperne får den nødvendige struktur og oppfølging de trenger. Gjennom intervensjonen Program Management+ (PM+) utviklet av Verdens helseorganisasjon brukes kompetansen til ufaglærte hjelpere med fluktbakgrunn til å hjelpe andre flyktninger under veiledning av faglærte veiledere. Program management plus (PM+) er en manualbasert seks ukers lav-terskel intervensjon som har som mål å øke klienters problemløsningsevne og autonomi og foregår over en avgrenset tidsperiode. SEMI gjennomførte, med assistanse fra UiB, i 2021-22 et pilotprosjekt for å tilpasse og implementere PM+ i norsk kontekst med fokus på den Østafrikanske flyktninggruppe, med støtte fra Inkluderings- og Mangfoldsdirektoratet (IMDi). Erfaring fra pilot prosjekt var positiv. Neste steg var å skalere til andre kommuner med annerledes organisering og det ble inngått samarbeid med Fredrikstad kommune. Gjennom forskningssamarbeid med UiB, tar prosjektet sikte på å undersøke gjennomførbarhet, nytte og gevinster av PM+ som en lavintensitets, skalerbar psykologisk intervensjon for ulike grupper av flyktninger i norsk kontekst. Ulike faggrupper og flyktninger i kommunene skal delta i prosjektet. Prosjektet skal registrere gjennomførbarhetsrate og effekter på klientenes psykososiale fungering ved bruk av standardiserte spørreskjema. Gjennom fokusgruppeintervjuer og individuelle intervjuer vil vi for hvert halvår over to år kartlegge hvilken effekt PM+ har på hjelpernes identitet, livsmestring og psykisk helse.

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Funding scheme:

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester