Barriers and facilitators to integrating mental health and psychosocial support into economic inclusion programming for displaced families in ecuador

Dados Bibliográficos

ID24139926
AutoresDaniela Vergara (0009-0009-0654-2322, Columbia University), Arianna Moyano (Columbia University), Amaleah F Mirti (Columbia University), Amaleah Mirti, Annie G Bonz (0009-0008-7739-8084), Adriana Monar, Efrén Astudillo, Efrén Estudillo, Sara Vaca (0000-0003-3619-9907), Andrea Armijos, Jeremy C Kane (0000-0002-6598-3840, Columbia University), Franco Mascayano (0000-0002-3118-504X, New York State Psychiatric Institute), Yescárleth Rodríguez, Matthew Schojan (0009-0006-2451-3662), Kathleen J Sikkema (0000-0003-0371-5119, Columbia University), Ezra Susser (0000-0001-7665-4826, New York State Psychiatric Institute), Mike Wessells, Mike Wessels (Columbia University), M Claire Greene (0000-0002-4631-4764, Columbia University), Kathryn L Lovero (0000-0001-6067-8663, Columbia University, autor correspondente)
Ano2026
Data de publicação2026-08-28
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoConflict and Health (JOURNAL)
Identificadores do periódicoISSN: 1752-1505 • E-ISSN: 1752-1505
EditoraSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s13031-026-00832-y
PMID41756447
OpenAlexW7130649707
IdiomaEN
Referências citadas18

Background Displaced populations have increased rates of mental health problems, which have been shown to have a bidirectional relationship with economic insecurity. Despite growing calls globally to integrate mental health and psychosocial support (MHPSS) with economic inclusion (EI) programming, few models exist for practical implementation. We co-developed and piloted the Building the Future Toolkit (i.e., the Toolkit), an integrated MHPSS-EI intervention for displaced families in Ecuador, a country that hosts a large number of displaced persons. Here, we present participant and implementer perspectives on the barriers and facilitators to implementation of the Toolkit . Methods Fifty displaced families in Quito participated in a pilot trial of the Toolkit between October 2023 and May 2024. Following completion of the trial, we conducted six focus group discussions (n=31; 22 intervention participants, 9 staff) to explore determinants of implementation outcomes, guided by Proctor’s Implementation Outcomes Framework and the Consolidated Framework for Implementation Research 2.0. Data were analyzed thematically using a hybrid inductive-deductive approach. Results Both intervention participants and staff viewed the Toolkit as highly acceptable, appropriate, feasible, and usable, with strong potential for sustainability. Key facilitators included the holistic integration of mental health and livelihood skills, enhanced social network building among displaced families, the Toolkit’s standardized yet adaptable structure, and alignment with organizational values and existing activities. Barriers included competing economic demands, childcare responsibilities, transportation costs, limited participation of men and youth, and challenges related to donor reporting indicators. Contextual disruptions—such as Ecuador’s 2024 insecurity and energy crisis—posed additional challenges but also demonstrated the Toolkit’s adaptability in unstable environments. Conclusions The Building the Future Toolkit illustrates how integrated MHPSS-EI programming can be designed and implemented in humanitarian contexts through participatory methods. Our findings highlight the multilevel determinants supporting successful implementation and promoting sustainability. Future integrated program efforts should address structural participation barriers, develop strategies to target engagement of men and youth, and work with funding institutions to create indicators that recognize the interdependence of mental health and livelihoods.

Displaced person · Focus group · Inclusion (mineral) · Intervention (counseling) · Livelihood · Mental health · Psychological intervention · Psychosocial · Social support · Employment and Welfare Studies · Migration, Health and Trauma · Poverty, Education, and Child Welfare