Children who live through armed conflict and displacement are at increased risk of mental health difficulties, including posttraumatic stress (PTS). Parental support and monitoring are significant potentially modifiable factors amenable to preventive intervention. Children’s resilience can be increased by assisting parents and caregivers in supporting children. This study investigated the feasibility of delivering and evaluating an adapted version of the teaching recovery techniques (TRT) intervention, an established, evidence-based mental health recovery program for children, in a displacement setting resulting from the Syrian conflict. Three parent skills sessions were added to the original TRT intervention to form a brief, 5-week child plus parenting program (TRT + Parenting). Feasibility to recruit and train nonspecialist staff on the ground to screen families for eligibility, collect outcome data and deliver the intervention, and to recruit and retain families in the intervention and study were examined. Fourteen Syrian refugee families residing in a border town in Turkey took part in the study. Research staff and intervention facilitators were successfully appointed in the field, screened participants, and delivered the intervention, collecting outcome measures pre- and postdelivery. Supervision was provided via Skype and Whatsapp from the Unite Kingdom. All families completed the outcome measures, with very little missing data, and all of the intervention sessions, except for one family who moved to another location. This indicated that TRT + Parenting can be delivered feasibly and evaluated with displaced families in this humanitarian context. Preliminary outcome data showed promise that TRT + Parenting may have the potential to both reduce children’s PTS and increase caregivers’ parenting self-efficacy and use of effective strategies. Implications and future directions of the research are discussed.

Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving children’s future trajectory. We enhanced the well-established, evidenced-based child trauma recovery programme Teaching Recovery Techniques (TRT) intervention with parenting sessions, i.e., TRT + Parenting (TRT + P), which aims to improve parent mental health and their ability to support their children’s mental health. We describe the findings of a three-arm randomised controlled trial comparing enhanced TRT + P vs. TRT and waitlist. The primary aim was to test if children in the enhanced arm of the programme show improved child and caregiver mental health. We recruited 119 Syrian refugee children and one of their caregivers in Beqaa Valley in Lebanon. They were randomised to the TRT, TRT + P, or waitlist control group. Data were collected at baseline and 2 weeks and 12 weeks post intervention. Training of facilitators was via remote training from the United Kingdom. Results showed a highly consistent pattern, with children in the enhanced TRT + P group showing the greatest levels of improvement in behavioural and emotional difficulties compared to children in the TRT or waitlist control groups. Caregivers in the TRT + P group also reported significant reductions in depression, anxiety, and stress. Findings indicate that the addition of the evidence-based parenting skills components has the potential to enhance the effects of interventions designed to improve children’s mental health in contexts of trauma, conflict, and displacement. Implications for COVID-19 remote learning are also discussed.

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Background: Children living in challenged humanitarian settings (including those in rural/underserved areas, the displaced, refugees, in conflict/post conflict situations) 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, typical of humanitarian settings). We therefore designed a brief and light programme; the Strong Families (SF) programme, consisting of 5 h contact time over 3 weeks. We conducted a pilot study with the aim to test the feasibility of implementation, and a preliminary look at the effectiveness of SF, in improving child behaviour and family functioning in families living in Afghanistan. Methods: We recruited female caregivers and children aged 8-12 years through schools and drug treatment centres in Afghanistan 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 pretest 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.