More good than harm? The case study of QADEROON, a mental health promotion program for Palestinian refugee youth in Beirut

QADEROON (‘We Are Capable') was a year-long social-skills building intervention for Palestinian youth (11-14 years) living in one of Beirut's refugee camps. The status of Palestinians in Lebanon is known to be the worst of Palestinian refugees in the region due to state imposed restrictions on employment, and limited rights. QADEROON was guided by an evidence-informed logic model, and modeled on interventions previously evaluated to be effective. The intervention objective was to improve mental health through changing intermediate outcomes such as improved communication skills, improved problem solving skills, improved relationship with parents and teachers, among others. The intervention package - developed, implemented, and evaluated in partnership with a community coalition - included activities for youth, their parents, and their teachers. The youth intervention - consisting of 45 sessions - was implemented August 2008 – May 2009 with approximately 150 youth. The process evaluation included tools to measure fidelity, dose delivered and received, reach, and satisfaction. A pretest posttest control group design tested impact on mental health as an outcome. Process evaluation results indicated that session objectives were commonly achieved and that session activities were frequently implemented as planned. Youth indicated high satisfaction with the sessions. Despite this positive feedback, preliminary analysis of intervention impact indicated no change in mental health, and a seeming trend towards worsened outcomes. Dialogue with community members and researchers suggest that changes in mental health may be difficult to achieve in contexts where structural conditions impinge harshly on daily life and future outlooks.