Early adolescent skills for emotions (EASE) program trial for young adolescents studying in public schools of rural Pakistan

INTERVENTION: Intervention: The Early Adolescent Skills for Emotions (EASE) intervention program is a new, brief, group psychological intervention program (Dawson et al., 2019) based on Cognitive Behavioural Therapy (CBT) techniques that are empirically supported and formally recommended by the WHO (WHO, 2016). The intervention is comprised of 7 group sessions lasting 90 minutes for the young adolescents and is accompanied by 3 group sessions for their caregivers, each lasting approximately 90 minutes. The young adolescent sessions involve the following empirically supported components: psychoeducation, problem solving, stress management (slow breathing), behavioural activation, and relapse prevention. The caregiver sessions involve psychoeducation, active listening, quality time, praise, caregiver self‐care and relapse prevention. The adolescent sessions will be delivered on weekly basis, and the three caregiver sessions will be embedded across the seven‐week period. Wait‐list control: Evidence based health practices are not available in schools to manage the mental health problems of children. No structured programs are being implemented in school settings for adolescents experiencing the symptoms of anxiety and depression, studying in 8 and 9 grades. During the study, participants in both arms will be able to seek specialists (psychologist/psychiatrist) support from the child psychiatry department at the Institute of Psychiatry (IoP)‐the tertiary mental health care facility of the region. We will maintain the record of health care services sought by study participants in both study arms using Client Service Receipt Inventory (CSRI) at baseline and 3‐months follow‐up. 40 eligible schools, stratified b CONDITION: Adolescents experiencing symptoms of psychosocial distress. ; Mental and Behavioural Disorders PRIMARY OUTCOME: Symptoms of psychosocial distress in adolescents are measured using the self‐reported Paediatric Symptoms Checklist (PSC) at baseline, immediate post‐intervention, and 3‐months post‐intervention. INCLUSION CRITERIA: 1. Adolescents aged 13‐15 years 2. Living with parents/primary caregivers, attending high public schools in the study area. 3. Written parent/primary caregiver informed consent or witnessed consent (in case the parent/primary caregiver is unable to read and write, the informed consent will be obtained parent/primary caregiver in presence of a witness) and adolescent assent for participation in the study. 4. Screened positive on self‐reported PSC (cut‐ off score = 28). 5. Where there is more than one eligible child in a family unit, we will include the youngest eligible child. SECONDARY OUTCOME: ; Measured at baseline, immediate post‐intervention, and 3‐months post‐intervention:; 1. Internalzing symptoms measured using Revised Children Anxiety and Depression Scale; 2. Adolescent wellbeing measured by the Short Warwick Edinburgh Wellbeing Scale (SWEWS); 3. Adolescent quality of life measured by the Paediatric Quality of Life (PedsQL)‐child version; 4. Adolescent problem solving skills measured by Social Problem‐Solving Inventory‐Revised Short Form; 5. Adolescent somatic complaints measured by somatic symptoms checklist; 6. Adolescent perceived emotional support measured by Perceived Emotional/Personal Support Scale; 7. Adolescent symptoms of depression measured by Patient Health Questionnaire‐ Adolescent version (PHQ‐A); 8. Academic performance measured through teacher‐rated student academic achievement record form; 9. Child dropouts measured through school administration record; 10. Parent‐child relationship measured by Alabama parenting scale; 11. Parent’s wellbeing measured by PedsQL‐family impact module;