Family-based prevention of mental health problems in children affected by HIV and AIDS

Abstract

Objective The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda. Design Pre-post design, including 6-month follow-up. Methods The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child–caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N=39 children) with at least one HIV-positive caregiver and one child 7–17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI. Results Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P<0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P<.05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P<0.05). Conclusion The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.

Family‐based promotion of mental health in children affected byHIV: a pilot randomized controlled trial

“…In collaboration with Partners In Health/Inshuti Mu Buzima (PIH/IMB) and the Rwandan Ministry of Health (MOH), we tested the effectiveness of the Family Strengthening Intervention (FSI‐HIV) (Betancourt, Ng et al., ) in a pilot randomized controlled trial with families with at least one HIV‐positive primary caregiver of school‐aged children (7–17 years). We hypothesized that post‐intervention, families assigned to FSI‐HIV would report better caregiver‐child relationships and family protective constructs and as a result, children would have fewer mental health problems (symptoms of depression and conduct problems) and less functional impairment compared to control families receiving treatment as usual (TAU) via routine social work.…”

“…However, few interventions exist to explicitly prevent mental health problems in school‐aged children both directly and indirectly affected by HIV. We adapted an evidence‐based, home‐visiting preventive intervention (Beardslee, Wright, Gladstone, & Forbes, ; Betancourt, Ng et al., ) and examined its feasibility and effects on parent–child relationships and child mental health within HIV‐affected households in rural Rwanda (Betancourt et al., ). Rwanda's robust HIV services present an opportunity to link mental health services to routine care for HIV‐affected families.…”

A church-based intervention for families to promote mental health and prevent HIV among adolescents in rural Kenya: Results of a randomized trial.

“…Conversely, distance and mistrust in relationships, harsh discipline, and permissiveness are often associated with risky behavior and mental health problems (Mejia, Calam, & Sanders, 2012; Kabiru, Beguy, Undie, Zulu, & Ezeh, 2010; Kincaid, Jones, Sterrett, & McKee, 2012; Boudreault-Bouchard et al, 2013). Thus, promoting protective interactions and preventing those that increase risk is an important approach for addressing both mental health and HIV risk among young people (Sandler, Schoenfelder, Wolchik, & MacKinnon, 2011; Betancourt et al, 2014; Betancourt & Khan, 2008). …”

Addressing Health Disparities in the Mental Health of Refugee Children and Adolescents Through Community-Based Participatory Research: A Study in 2 Communities

“…27 These results are part of an ongoing program of work to develop mental health screening tools and intervention models to promote better mental health among diverse groups of refugee children and adolescents. Free list and KI data are informing the modification of an evidence-based family strengthening intervention that has been used previously with culturally diverse populations 30,31 to meet the unique needs of refugees. Adaptations may include the addition of psychoeducational materials on resettlement stressors as well as intervention components that address the relationship between the challenges of resettlement, positive parenting, and child mental health and resilience.…”