Evaluating a Social-Emotional Training Program for Refugee Families and Service Providers: Pilot Study

BACKGROUND

Refugee children are often exposed to adversities that present a threat to their healthy development. Promoting refugee children's social-emotional capacities may be an opportune, strengths-based avenue to nurture their resilience, coping strategies, and mental health outcomes amid these risks. Furthermore, supporting caregivers' and service providers' capacities to provide strengths-based care may result in more sustainable, caring environments for refugee children. However, culturally adapted initiatives that aim to promote social-emotional capacities and mental health in refugee children, caregivers, and service providers are limited.

OBJECTIVE

In this pilot study, we aimed to assess the feasibility and efficacy of a brief, 3-week social-emotional training program for refugee caregivers of children aged between 2 and 12 years and service providers who support refugees. This study had 3 central objectives. First, we examined whether refugee caregivers' and service providers' knowledge of core social-emotional concepts increased from pre- to posttraining, whether these increases were maintained 2 months later, and whether caregivers and service providers reported a high use of training-based strategies after the training. Second, we assessed if refugee caregivers reported any improvements in their children's social-emotional capacities and mental health from pre- to posttraining and 2 months later. Finally, we evaluated whether caregivers and service providers experienced any improvements in their own mental health symptoms from pre- to posttraining and 2 months later.

METHODS

A total of 50 Middle Eastern refugee caregivers of children (n=26) aged between 2 and 12 years and service providers (n=24) were recruited using convenience sampling and participated in a 3-week training program. Training sessions were delivered via a web-based learning management system and involved a combination of asynchronous (video-based) and synchronous (web-based live group) sessions. The training was evaluated using an uncontrolled pre-, post-, and 2-month follow-up design. Caregivers and service providers reported their understanding of social-emotional concepts and mental health at pre-, post-, and 2 months after training and reported their use of training strategies after training. Caregivers reported their children's social-emotional capacities and mental health through a presurvey, a series of postsurveys (after each module session and 1 week after the training), and a 2-month follow-up survey. The participants also reported their demographic information.

RESULTS

Caregivers' and service providers' knowledge of social-emotional concepts increased significantly from pre- to posttraining, and the service providers' knowledge increase was sustained at the 2-month follow-up. Both caregivers and service providers reported high levels of strategy use. Furthermore, 2 markers of children's social-emotional development (ie, emotion regulation and sadness over wrongdoing) improved after training.

CONCLUSIONS

The findings highlight the potential of strengths-based, culturally adapted social-emotional initiatives to support refugee caregivers' and service providers' abilities to provide high-quality social-emotional care to refugee children.

Autonomic Arousal, Ethical Guilt, and Externalizing Behavior in Childhood: A Clinical Extension and Replication

Lower autonomic arousal is associated with higher externalizing behavior in childhood but the mechanisms explaining this link are still debated. One possibility is that lower autonomic arousal makes it difficult for children to anticipate or express social emotions, such as ethical guilt rooted in concern for others, thereby increasing their likelihood of externalizing behavior. However, evidence for this social-emotional hypothesis has been limited to community samples. The present study included ethnically diverse samples of 150 typically developing children (M_age = 8.01 years; 50% girls) and 62 children referred for clinically elevated externalizing behavior (M_age = 9.16 years; 16% girls; N = 212). Caregivers reported children's externalizing behavior. Children's respiratory sinus arrhythmia (RSA) was measured as an indicator of parasympathetic activity in response to hypothetical vignettes depicting externalizing behavior. Children's ethical guilt was coded from semi-structured interviews following each vignette. Greater RSA increases (indicating a low-arousal, rest-and-digest response) were associated with lower ethical guilt. Lower ethical guilt was associated with higher externalizing behavior. A significant indirect effect showed that RSA increases were associated with higher externalizing behavior through relative lapses in ethical guilt. Results were consistent across and within the community and clinical samples. Theoretical and practical implications for clinically elevated externalizing behavior are discussed.

Kindhearted: Ethical guilt and ethical heart rate reactivity codevelop with aggression across childhood

Largely cross-sectional evidence indicates that ethical guilt is a robust predictor of childhood aggression. However, the underlying mechanisms of ethical guilt-in part assessed as ethical heart rate (HR) reactivity in the present study-are less clear, and longitudinal associations between ethical guilt, its underlying mechanisms, and aggression have not been explored. The present study used a multicohort longitudinal design to assess these constructs across early and middle childhood. At the beginning of the study and 2 years later, cohorts of 4- and 8-year-olds (ns = 150; N = 300) reported their guilt in response to an ethical transgression (i.e., pushing) and a nonethical transgression (i.e., breaking a classroom rule), and their HR was measured while they imagined committing these acts. Caregivers reported their child's aggression at each time point via questionnaire. Latent difference score models indicated that, regardless of cohort, children who increased in their ability to prioritize ethical guilt over 2 years were more likely to decrease in aggression over the same period. Moreover, children whose HR reactivity became more sensitive to ethical transgressions over time showed corresponding declines in aggression over time. Overall, these findings highlight the potential protective roles of children's capacities to react affectively and autonomically to the gravity of ethical transgressions across early and middle childhood.

A process model linking physiological arousal and fear recognition to aggression via guilt in middle childhood

Aggression coincides with emotional underarousal in childhood, but we still lack an understanding of how underarousal contributes to aggression. With an ethnically diverse sample of 8-year-olds (N = 150), we tested whether physiological underarousal and lower fear recognition were indirectly associated with heightened aggression through dampened guilt feelings. Caregivers rated children's aggressive behavior. We assessed children's skin conductance (SC) and respiratory sinus arrhythmia (RSA) while they imagined transgressing norms and measured their fear recognition with a facial morph task. Children reported guilt or lack thereof after hypothetically transgressing. The interaction of decreasing SC and increasing RSA (i.e., physiological underarousal) and poor fear recognition were indirectly associated with higher aggression through their associations with lower guilt. Emotional underarousal may contribute to aggression by disrupting the normative development of guilt. We discuss strategies to improve social-emotional acuity and reduce aggression in children with blunted physiological arousal and fear recognition.