Strong Families: A new family skills training programme for challenged and humanitarian settings: a single-arm intervention tested in Afghanistan

Abstract

Background Children living in challenged humanitarian settings (rural/underserved areas, displaced, refugees, conflict/post conflict) are at greater risk of mental health difficulties or behavioural problems, with caregivers acting as their main protective factors. While many family skills programmes exist, very few were developed for, or piloted in, low resource settings (settings with limited infrastructure). We designed the brief and light Strong Families (SF) programme, consisting of 5 hours contact time over 3 weeks. We conducted a pilot study aiming to test the feasibility of implementation, and preliminary effectiveness of SF, in improving child behaviour and family functioning in Afghanistan. Methods We recruited female caregivers and children aged 8-12 years through schools and drug treatment centres and enrolled them in the SF programme. Demographic data, emotional and behavioural difficulties of children and parental skills and family adjustment measures were collected from caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), assessing children’s behavioural, emotional, and social issues, and PAFAS (Parenting and Family Adjustment Scales), measuring parenting practices and family functioning. Results We enrolled 72 families in the programme with a 93.1% retention rate (n=67) for data collection 6 weeks post intervention. Mean age of caregivers was 36.1 years, they had 3.8 children on average and 91.7% of them had experienced war/armed conflict in their past. The average total difficulty score of the SDQ (ranging from 0 to 40, with scores above 16 being indicative of high problems) of the 72 children reduced significantly, from 17.8 at pre-test to 12.9 at post-test and 10.6 at second follow-up, with no difference in gender and most noticeably amongst those with the highest scores at baseline. Likewise, PAFAS scores decreased significantly after the programme, again with caregivers with the highest scores at baseline improving most. Conclusions The implementation of a brief family skills programme was seemingly effective and feasible in a resource-limited setting and positively improved child mental health and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for validation through further impact assessment and outcome evaluation.

Assessing the Feasibility of Providing a Family Skills Intervention, “Strong Families”, for Refugee Families Residing in Reception Centers in Serbia

“…Our results suggest that the intervention led to parents' subjective report on reductions in child behavioral and emotional difficulties, supporting previous research that even very light touch interventions can bring about change to families in low resource challenging settings [24,30,37]. These outcomes correspond to research demonstrating the positive relationship between improving parenting and resultant positive outcomes for children, such as their improved emotional and behavioral regulation and socialization in conflict [8,38].…”

“…Despite being a light intervention, Strong Families indicated improvement on the child mental health indicators, as well as the parenting practices and parent and family adjustment skills. These results are consistent with a pilot study of the same intervention with 72 Afghan families residing in Afghanistan [24]. While the study by Haar and colleagues aimed to assess the feasibility of implementation in a setting of stress, this study intended to assess the potential replicability of the findings in a further challenging context (displacement and refugee transition), as well as differential implementation circumstances.…”

“…This study has been reviewed and approved by the UNODC Drug Prevention and Health Branch in the Headquarters (HQ) office of Vienna and the national UNODC project office in Serbia, as well as the MLEVSP and the selected CSO that supported the program. From the UNODC perspective, the objective was to further enrich the experience in feasibility, practicality and benefit of Strong Families that assessed and documented in Afghanistan [24] in a refugee setting. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.…”

“…The version of Strong Families used in this study was previously culturally adapted, translated and reviewed in Afghanistan and successfully piloted on Afghan families in three Afghan cities [24]. The program was translated to Serbian for the purpose of training and implementation in Serbia.…”

“…The program was designed to be brief, "light" (requiring an infrastructure that is easy to mobilize and train), evidence-informed, open source (to facilitate national ownership and scale-up) and cost-effective. Initial findings of its efficacy have indicated encouraging results in Afghanistan [24].…”