Evaluation of Early Adolescent Skills for Emotions (EASE) in Ethiopia: A Cluster Randomized Trial of a Youth Mental Health Intervention

Early Adolescent Skills for Emotions (EASE) is an intervention published by the World Health Organization (WHO) and United Nation's Children's Fund (UNICEF) that aims to help 10-15 year old youth who are affected by internalizing problems and live in communities that are exposed to adversity. Specifically, the intervention seeks to decrease psychological distress of participating youth. The intervention is comprised of ten 90-minute sessions. Seven sessions are delivered to the adolescents in small groups of no more than 12 participants, and three sessions are delivered to the caregivers of the adolescents. The curriculum for the sessions include topics such as the following for youth: 1) understanding their feelings, 2) calming their body, 3) changing their actions, 4) managing their problems. The curriculum includes the following topics for caregivers: 1) active listening skills, 2) identifying feelings (theirs and their child's), 3) quality time and giving praise, 4) self-care strategies. EASE uses a train-the-trainer model that provides direct instruction and coaching for adults called ‘Helpers’ who implement the intervention sessions with adolescent and caregiver participants. Helpers are trained over the course of several days prior to intervention implementation, and receive ongoing support during implementation. The EASE intervention is designed to be delivered by Helpers who do not have formal training in mental health. In this study, the intervention will be delivered in the context of Compassion International's child development program and will include youth who are already registered in Compassion's programming. Helpers will be recruited from Compassion program staff and volunteers who are based in the communities where the Compassion program is running.

2026-06-27

2026-09-04

The primary outcomes are psychological distress as measured by the Child and Adolescent Psychological Distress Scale (CAPDS-10).

Secondary outcomes include emotion regulation, ability to engage in goal-directed behavior, access to emotion regulation strategies, and emotional clarity. These will be measured using the following tools: the Difficulties in Emotion Regulation Questionnaire (DERS-18), the Strengths and Difficulties Questionnaire (SDQ), the Cognitive Emotion Regulation Questionnaire (CERQ).

The study will employ a cluster randomized controlled trial (cRCT) design, with the intervention (treatment) assigned at the site level. Sites are defined as the Compassion International Child Development Centers where the Compassion program is currently being implemented in Ethiopia. The study participants will be selected from youth who are already registered in the Compassion program at the respective site and who are between 10-15 years old as of May 1, 2026. Half of the sites included in the study will be randomly assigned to implement the EASE intervention in addition to the standard Compassion program, and half will serve as control sites that only implement the standard Compassion program. Outcomes will be measured at the individual youth level in a pre/post design.

Not available

Randomization of the clusters will be conducted via a computer, randomly assigning sites to one of two conditions, either treatment or control. Randomization will also be blocked by the site's experience with youth mental health interventions that were previously implemented.

The randomization unit will be the Compassion International site, which therefore will result in clustered randomization. Clusters will be comprised of about 25 youth participants. Individual youth will be selected within each site through a trained selection protocol as defined by EASE intervention guidance (see above).

Yes

70 Compassion International sites are included in the study.

1,750 total youth are to be included in the study.

35 clusters will be assigned to the treatment arm that will implement the EASE intervention in addition to the standard Compassion program for a total of 875 treatment youth. 35 clusters will be assigned to the control arm that will not implement the EASE intervention but will continue the standard Compassion program for a total of 875 control youth.

Accounting for an intraclass correlation coefficient (ICC) of 0.128 as calculated from similar internal Compassion data, the minimum detectable effect size for main outcomes of this study study given the sample size of 70 clusters and 25 youth per cluster is 0.25. This is calculated with an alpha of 0.1 and accounting for a potential 25% dropout rate.