A Call for Theoretically Informed and Empirically Validated Military Family Interventions

Implementation of a Family Skills Programme in Internally Displaced People Camps in Kachin State, Myanmar

BACKGROUND/OBJECTIVES

Children that are forcibly displaced are more likely to experience mental health and behavioural challenges than non-displaced populations, including increased risk of anxiety, depression and post-traumatic stress disorder. Building appropriate parenting skills to strengthen the relationships between caregivers and their children in times of war is key to building resilience in children. There is a lack of research on the role of family skill interventions in internally displaced people (IDP). The aim of this study was to assess the potential change in parenting skills, child mental health, and resilience capacity in families living in IDP camps in Kachin State, Myanmar, after taking part in a brief family skill intervention, Strong Families.

METHODS

An open, multi-site pilot feasibility and acceptability trial was conducted with 100 families. Outcome data were collected prospectively, assessing changes in parenting skills and family adjustment in caregivers, children's behaviour, and children's resilience capacities. Families were assessed using three scales, Parenting and Family Adjustment Scales (PAFAS), the Strengths and Difficulties Questionnaire (SDQ), and the Child and Youth Resilience Measure (CYRM-R).

RESULTS

Despite being a light intervention, Strong Families produced improvements in the child mental health, parenting practices, and parent and family adjustment skills scales. Improvements were observed in scores particularly for caregivers and children with greater challenges at baseline.

CONCLUSIONS

The results positively value the importance and feasibility of family skill interventions being integrated into the routine care of IDP families. This advocates for the prioritisation of using such tools for supporting better family functioning and mental health in humanitarian contexts.

Feasibility and Acceptability of Formats in a Comparative Effectiveness Trial of a Preventive Parenting Program

Parenting can be challenging, and military parents face additional family stressors related to relocations and deployments. ADAPT4U is an evidence-based preventive parenting program specifically designed for military parents of school-aged children. This study examines the feasibility and acceptability of in-person group and telehealth versions of the program. We used quantitative and qualitative data in a concurrent embedded design. Quantitative data were analyzed using SPSS with regressions and ANOVAs. Qualitative data were thematically coded by multiple authors and then a consensus process was undertaken. Both conditions were highly satisfactory for participants, with in-person group rated slightly higher. Families were more likely to attend telehealth than group, both at all and for at least 50% of sessions. Telehealth participants rated more highly: helpfulness, the facilitator was understanding and responsive, and they would participate in a future parenting program based on their experience. Qualitative results reflected positive experiences both with the content and facilitators, and concerns or recommendations that often were directly addressed by the other format (e.g., suggestions by in-person group participants for a telehealth format). Consistent themes across formats included wanting children to be involved in the program and more follow-up after the end of the program. The ADAPT4U program is highly acceptable to participants, and providing multiple format options (in-person group and individual telehealth) will likely make it more feasible for parents to participate in a way that works best for them.

Parenting Interventions for Refugees and Forcibly Displaced Families: A Systematic Review

Globally, an estimated 79.5 million individuals have been displaced, nearly 40% of whom are children. Parenting interventions may have the potential to improve outcomes for displaced families. To investigate this, we conducted a systematic review to identify the types of caregiver or parenting interventions that have been evaluated among displaced families, to assess their efficacy across a range of contexts, and to describe their cultural and contextual adaptations. The review followed PRISMA guidelines. At stage one, all articles describing caregiver/parenting interventions for forcibly displaced families were included to provide a scoping review of the state of the literature. At stage two, only randomized controlled trials (RCTs) and quasi-experimental designs were included, allowing for quantitative analysis of program effects. A total of 30 articles (24 studies) were identified in stage one. 95.8% of these articles were published in the past 10 years. Of these, 14 articles (10 studies) used an RCT or quasi-experimental design to assess program efficacy or effectiveness. Relative to control groups, those assigned to caregiving programs showed significant, beneficial effects across the domains of parenting behaviors and attitudes, child psychosocial and developmental outcomes, and parent mental health. Cultural adaptations and recruitment and engagement strategies are described. The evidence base for caregiving programs for displaced families has expanded in recent years but remains limited. Caregiving/parenting programs show promise for reducing the negative effects of forced displacement on families, but future studies are needed to understand which programs show the greatest potential for scalability.

Fatherhood Matters: An Integrative Review of Fatherhood Intervention Research

Positive father involvement is critical to the healthy social, emotional, and academic outcomes of children at all stages of development. The purpose of this integrative review was to identify, categorize, and evaluate the potential impact of fatherhood interventions on father and child outcomes. A systematic search of four major research databases yielded 44 studies published between 1988 and 2018 that met study inclusion criteria. The most effective interventions were delivered in the community, with fathers convened in groups. Content focused on promoting positive parenting, co-parenting, and father/child relationships. Consequently, father involvement and child cognitive and socioemotional development were improved. Academic settings were underutilized in the fatherhood interventions in this review. We conclude that in order to optimize healthy child development, school officials must adopt a more inclusive stance toward the involvement of fathers in their children's education. Future randomized trials of fatherhood interventions delivered within school-based settings are warranted.