Enhancing Teaching Recovery Techniques (TRT) with Parenting Skills: RCT of TRT + Parenting with Trauma-Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID-19

Abstract

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.

Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review

“…27,31 Gender distribution was almost equal in two studies, 31,34 boys predominated (57.8% and 54.9%) in two studies 27,32 and girls predominated (59.7%) in one study. 33 The study by El-Khani et al 35 did not report age and gender. This does not include all LMICs in the Middle East (Iran, Iraq, Jordan, Lebanon, Palestine, Syria, Yemen and Turkey 7,12 ), and therefore results cannot be generalised to all Middle Eastern locations.…”

“…Four of the included studies took place in Palestine with Palestinian children and adolescents in three different locations (Gaza, Nablus and West Bank), 31–34 one took place in Jordan 27 and involved Syrian refugees and Jordanian adolescents, and one took place in Lebanon 35 and included Syrian refugees. Included participants in all studies were children and adolescents aged between 9 and 18 years, with average ages around 11 years in two of the studies in Palestine, 32,34 13 years in the third study in Palestine, 33 and 14 years in the fourth study in Palestine and the study in Jordan.…”

Impact of a Brief Family Skills Training Programme (“Strong Families”) on Parenting Skills, Child Psychosocial Functioning, and Resilience in Iran: A Multisite Controlled Trial

“…In the past, it was already found difficult to reach caregivers, in humanitarian contexts, with evidence-based family skills programmes [ 89 , 90 , 91 ], despite their significant needs. As part of our secondary objective, we compared the effect of the Strong Families programme on different ethnicities, namely in families from Iran and those who have migrated from Afghanistan to Iran in the past.…”

Bridging the Gap between the Pressing Need for Family Skills Programmes in Humanitarian Settings and Implementation

“…While there is substantial evidence of the effectiveness of parenting and family skills interventions in high-income and stable contexts, interventions that have been tested in low and middle-income countries, and likewise in the contexts of refugee and displacement, are far fewer [ 2 ]. However, there are four recent exceptions of studies indicating the effectiveness of parenting and family skills interventions in refugee and displacement contexts in reducing child maltreatment through utilising nonphysical consequences to non-desirable behaviour and more positive parenting approaches, as well as improving parental and child mental health, such as reduced rates of depression [ 9 , 22 , 23 , 24 ]. For children living under extreme stress, the need for strong, healthy and nurturing caregiver relationships may assume even greater importance [ 25 ] when other extended support systems in their lives, such as community and extended family, may be compromised.…”