# A family-systemic intervention for mental health with refugees in Jordan: Protocol of a randomised controlled trial of StrongerTogether

## TL;DR

This study tests a family-based mental health intervention for refugee families in Jordan to address psychosocial and economic stressors.

## Contribution

The first rigorous evaluation of a whole-family intervention targeting social determinants of mental health in humanitarian settings.

## Key findings

- The trial will assess improvements in family functioning, parenting practices, and caregiver mental health.
- It will evaluate direct effects on adolescent mental health among those with high baseline distress.
- Implementation tools for case detection and facilitator assessment will be tested alongside the intervention.

## Abstract

Forced displacement heightens mental health risks for children, including psychological, environmental and economic stressors, yet few interventions address whole-family needs within humanitarian contexts. Family-systemic approaches show promise, but evidence on interventions addressing social determinants of mental health remains limited. We will conduct a single-masked, two-arm randomised controlled trial with 550 families in East Amman, Jordan, to evaluate StrongerTogether, a modular whole-family intervention with a financial literacy component. Families experiencing multiple psychosocial challenges will be randomised 1:1 to receive the intervention or enhanced treatment as usual. The trial employs sequential dual outcomes testing, evaluating effectiveness through: (1) upstream improvements in at least one of three primary outcomes (family functioning, parenting practices and caregiver mental health) and (2) direct improvements in adolescent mental health among those with elevated baseline distress. We will also evaluate two implementation tools: ReachNow for family case detection and FamilyACT for facilitator competency assessment. A mixed-methods process evaluation will examine implementation, effectiveness and potential sustainability of core and optional modules. This will be the first rigorous evaluation of an integrated whole-family intervention addressing social and environmental determinants of mental health in humanitarian settings. Findings will inform evidence-based approaches to family mental health support and contribute validated tools for implementation at scale.