Over the past ten years, the global population of forcibly displaced people has nearly doubled, reaching 123 million¹. While relationship between migration and mental health is a complex one, dependent on many factors such as events experienced prior to leaving, context of reception, or phase of migration, in metanalalytic research suggests that forced displacement, as opposed to voluntary migration, is a risk factor for mental health disorders like depression, anxiety, and post-traumatic stress disorders². Additionally, approximately three-quarters of displaced individuals relocate to low- and middle-income countries (LMICs)³, where health systems are typically overburdened and barriers to care are substantial⁴. This highlights the need for scalable early interventions that can support the mental health of forcibly displaced people in LMIC settings.

Task sharing has emerged as a credible and pragmatic strategy for scaling mental health care in low-resource settings⁵, such as LMIC⁶. Evidence from brief, lay-delivered psychological interventions^7,8 demonstrates clinically meaningful effects and feasibility in adversity-exposed populations. These approaches have shown promise even in highly vulnerable contexts, including among forcibly displaced people⁸, underscoring the potential of non-specialist delivery models to expand access to care where professional resources are scarce.

As one example of forcible displacement, since 2016, over 1.7 million Venezuelans have been forcibly displaced to Peru due to Venezuela’s humanitarian crisis, marked by extreme inflation, shortages of essential goods, and political violence⁹. Studies reveal significant mental health needs among these forcibly displaced people, where in transit 19% of forcibly displaced Venezuelans met criteria for depression and 23% for anxiety¹⁰. In Peru, forcibly displaced people face many legal, economic, and social barriers that hinder help-seeking, where they rely on shelters or community leaders for psychosocial support due to limited access to Peru’s formal healthcare system⁴. Although Peruvian law guarantees healthcare access to all migrants, including forcibly displaced Venezuelans, bureaucratic barriers such as the requirement for official documents limit access, exacerbated by deficiencies in Peru’s mental health infrastructure.

Against this backdrop, we developed COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence)¹¹ guided by the Hueristic Framework for Cultural Adaptation¹², the Ecological Validity Model¹³, the Taxonomy of Treatment Components¹⁴, and grounded in lived-experience. COMPASS was co-designed in partnership with forcibly displaced Venezuelans to directly address the acute shortage of mental health services in Peru. The program is open-source and delivered by trained lay providers, who are called guides, ensuring accessibility and scalability while maintaining fidelity to evidence-based practices. Its therapeutic content draws on a robust evidence base and incorporates core cognitive-behavioral components: behavioral activation¹⁵, cognitive restructuring¹⁶, problem-solving¹⁷, in-vivo¹⁸ and imaginal¹⁹ exposure, and emotion regulation²⁰. COMPASS is not tailored to a specific mental health diagnosis, but is rather a transdiagnostic treatment protocol²¹, which targets the underlying and common features across mental health disorders with the primary targets being features of anxiety, depression, and post-traumatic stress disorder (PTSD).

Importantly, these skills are contextualized within migration-specific adaptation strategies, integrating culturally salient coping mechanisms co-developed with forcibly displaced communities (e.g., pa’lante and perseverance). In qualitative research we conducted with forcibly displaced people and experts²², we identified several distinct challenges faced by this group in their integration journey. These challenges included experiences of migration grief stemming from loss, discrimination, and xenophobia, as well as difficulties in reconciling their former “Venezuelan” identity with a new “Peruvian” identity. Ultimately, the interviews highlighted an urgent need for culturally sensitive, open-source CBT interventions tailored for forcibly displaced Venezuelan people in Peru, emphasizing essential themes such as cultural relevance, language access, and community involvement, while also addressing barriers related to integration and acculturative stress to improve mental health support for this community. Thus, a novel migration adaptation module was developed in collaboration with forcibly displaced people and experts. This module is optional, administered at the end of the program, and allows participants to apply skills they have learned throughout the intervention thus far.

Transdiagnostic and multi-problem treatment protocols are well established as effective, flexible, and sustainable options for mental health treatment in diverse populations. For instance, the Common Elements Treatment Approach⁷ utilizes common elements to target depression, anxiety, PTSD, substance use and other problems via lay providers⁷. The Common Elements Treatment Approach has been used with promising results in various global settings including with Bhurmese migrants in Thailand²³ and in Somalian refugee camps²⁴. The Unified Protocol is another transdiagnostic treatment option which utilize elements of altering thoughts, preventing avoidance of emotions, and helping take actions that are helpful to target the overlapping underlying origin of major emotional disorders like depression, anxiety and other related disorders²⁵. The Unified Protocol has been modified for internally displaced people in Colombia to target depression, anxietym and PTSD as a result of armed conflict²⁶. Additionally, culturally adapted CBT²⁷ and culturally adapted CBT+ Problem management²⁸ culturally adapts CBT to the population and uses emotional exposure and emotion regulation skills found in stretching, psychoeducation, meditation in various populations, including Farci speaking refugees²⁸. However, COMPASS was designed over alternative existing treatment options because it uniquely combines open-source accessibility (i.e., eliminating licensing and training bottlenecks), migration-specific adaptation, utility with common mental health disorders (i.e., more skills and higher acuity of care than prevention or problem-solving options) and lay delivery. This design preserves the active therapeutic ingredients while enabling scale in resource-constrained environments.

A critical dimension of COMPASS is its emphasis on lived-experience involvement. Traditional implementation efforts often engage affected populations superficially²⁹, without genuine shared decision-making, which limits effectiveness and sustainability. In contrast, COMPASS is grounded in the principle of “nothing about us, without us³⁰,” ensuring that displaced and vulnerable populations are central to design and delivery³¹. This participatory approach enhances contextual relevance, fosters community ownership, and strengthens the likelihood of meaningful impact.

Thus, this study tests the preliminary effectiveness, and initial indicators of feasibility and acceptability of COMPASS via a pilot randomized control trial. This intervention addresses the mental health challenges faced by forcibly displaced Venezuelans living in Lima, Peru, focusing on common mental health disorders (CMDs) such as anxiety, depression, and PTSD. This study employs a waitlist control design to measure intervention effectiveness, hypothesizing reduced depression, anxiety, and PTSD symptoms in the intervention group over time. This study also seeks to expand knowledge on lay-provided mental health interventions for displaced populations in resource-scarce settings. If proven effective, this intervention could serve as a critical resource for community leaders, NGOs, and primary healthcare providers, addressing a pressing mental health gap.