Table 1 Summary of the research question, outcomes of interest, and findings for interdisciplinary evaluation of program impacts in a humanitarian setting

Research question: What are the psychosocial, biological, and cognitive impacts of a brief, scalable intervention for war-affected youth?

Mental health, insecurity, and psychosocial stress: We used regionally and internationally relevant instruments such the Arab Youth Mental Health scale, Strength and Difficulties Questionnaire, Human Insecurity scale, Human Distress scale, and Perceived Stress Scale, in combination with a Trauma Events Checklist and Household Wealth Index. Youth who engaged in the Advancing Adolescents program reported fewer symptoms of psychosocial stress, insecurity, and mental health difficulties, relative to waitlisted controls in the randomized controlled trial [11]. We found small to moderate effect sizes across outcomes - equivalent or greater than intervention impacts reported for psychosocial interventions in this age-group in crisis settings [11]. We noted differential impacts for youth with high/low trauma exposures, and there were sustained effects over 11 months.

Traumatic stress and resilience: We used the Child Revised Impact of Events Scale, and developed the Arabic-language Child and Youth Resilience Measure [12]. We found no program impacts for these outcomes, but resilience scores did moderate changes in anxiety/depression for youth with high trauma exposure [11].

Biological stress: We used biomarkers such as hair cortisol secretion and immune function biomarkers to track chronic physiological stress. We found that average cortisol levels dropped by a third (38%) in response to the program; stress was down-regulated in youth with high cortisol levels and up-regulated in youth with blunted cortisol profiles, showing beneficial regularization over time [13, 14].

Cognitive function: We used Rapid Assessment Cognitive and Emotional Regulation [RACER] tests, developed for use with children in low- and middle-income countries, [15] to measure working memory and inhibitory control, both important for learning abilities. We found no program impacts on these executive function skills, but showed that deficits in working memory were associated with pervasive poverty, rather than trauma exposure [16].