Early Adolescent Skills for Emotions (EASE) was developed to meet the needs of young people with symptoms of internalizing problems, such as anxiety and depression. EASE has been designed for delivery in contexts where young people’s mental health is compounded by living in adversity, with limited access to specialist mental health services, including a limited availability of a specialist mental health workforce.
EASE aims to reduce symptoms of internalizing disorders through four core empirically‐supported strategies: psychoeducation, stress management, behavioural activation, and problem solving. These strategies were identified through a component analysis of the most commonly used strategies in effective psychological interventions for young people, and through expert consultation4.
The potential scalability of EASE is further enhanced through the provision of brief training for non-specialist providers (facilitators), which includes classroom training, supervised in-field training and competency and fidelity assessments. Facilitators also receive training in identifying and managing (by referral) child or adult protection concerns, including identifying risk for suicide or self-harm. Facilitators are then supervised weekly in groups, throughout the duration of delivering the intervention. To enhance local capacity building, a training of trainers model is utilised. Supervisors receive training in the supervision methods for EASE, monitoring fidelity and competency and in EASE delivery itself.
EASE is comprised of seven weekly 90-minute sessions for young adolescents, delivered in groups of approximately 8-12. An intervention manual is used to guide the facilitator and co-facilitator to deliver each session. To maximise engagement, the core strategies are shared through a combination of group teaching, discussion, activities, pictures and drawings, and through a story. Each session includes a welcome and review activity of the previous session’s content, followed by sharing or revising a core strategy, and ending with setting home practice to engage in between EASE sessions. The sessions are anchored by an illustrated storybook which depicts a character experiencing common difficulties faced by young people, as the character follows their way through the core EASE strategies. Young adolescents are also provided with an illustrated workbook for completing their home practice. For both children and caregivers, EASE has been designed to maximised accessibility in contexts where there is low literacy.
Caregivers of EASE-attending adolescents are invited to participate in three 90-minute caregiver group sessions, delivered to no more than 12 caregivers a group. The purpose of the caregiver sessions is to enhance existing strengths and promote adaptive parenting practices in order to improve the caregiver-child relationship and equip caregivers with skills to support their child living with distress. The caregiver sessions follow a similar approach to the young adolescent sessions – with session welcoming and review, imparting of the core content, and closing through setting home practice - using group teaching, pictures and discussion. Caregivers are kept informed about the EASE strategies which their children are receiving, without disclosing confidential or personal content about their child’s participation in the group (and vice versa).
The adolescent sessions are structured as follows:
- Understanding my Feelings (core strategy: psychoeducation, including emotion identification)
- Calming my Body (core strategy: stress management, including slow breathing)
- Changing my Actions – part 1, part 2 (core strategy: behavioural activation)
- Managing my Problems – part 1, part 2 (core strategy: problem-solving)
- Brighter futures (maintenance and relapse prevention)
The caregiver sessions are structured as follows:
- Understanding sadness, worry and stress (psychoeducation, active listening, quality time, stress management)
- Boosting confidence (praise, considering children’s strengths, reducing physical punishment)
- Caregiver self-care and brighter futures (caregiver stress management and basic self-care, maintenance and relapse prevention)