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

Abstract

Caregivers have a key role in protecting children’s wellbeing, and, with appropriate skills, can prevent a multitude of negative social outcomes, particularly in challenged or humanitarian settings. Accordingly, the Strong Families programme was designed as a light touch family skills programme, with a focus of supporting caregiving during stressful situations. To evaluate the short-term impact of the Strong Families programme, we performed a time-convenience, randomized, controlled trial in Iran. A total of 292 families (63% from Iranian decent, 39% from Afghan decent, and 1% other), with children aged eight to twelve years, were recruited through ten centers in Iran and allocated to an intervention (n = 199) or waitlist/control group (n = 93). The two groups did not differ demographically at baseline. We assessed families prospectively, through three scales, PAFAS (parenting and family adjustment scales), SDQ (strengths and difficulties questionnaire), and CYRM-R (child and youth resilience measure). Caregivers in the intervention group improved (highly) statistically significantly on all but one PAFAS subscales (parental consistency, coercive parenting, positive encouragement, parental adjustment, family relationships, and parental teamwork), which was not noted in the waitlist group. On the SDQ, there were (highly) significant positive changes in scores in the intervention group on all sub-scales and the “total difficulty scale“, whereas the waitlist/control group also improved on three (prosocial, conduct problems, and hyperactivity) of the five SDQ subscales. Children originating from Afghanistan improved significantly on the overall resilience scale of the CYRM-R in the intervention group, but not in the waitlist/control group. Overall, all our stratified results of the different scales reflect an accentuated improvement in families with higher levels of problems at baseline. Our comparative results indicated a strong alignment of the strong families programme with its intended short-term impact, per its logical frame on parenting practices and family management skills, children behaviour, caregivers and children mental health, and capacity to cope with stress. We postulate that the potential nudging or diffusion of knowledge (cross-contamination between intervention and waitlist/control group) at the community level could explain improvements in the waitlist/control group on some indicators, however, further research on this is recommend.

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

“…In our programming efforts, we recognise that low-intensity brief interventions must produce outcomes equivalent to more intensive interventions for at least a proportion of participants [ 34 ], such that we have built a thorough evaluation arm alongside our global implementation activities. This has led to Strong Families effectiveness being recognised in a number of published articles, including with Afghan families in Afghanistan [ 35 ], with Afghan refugees in Serbia [ 36 ], and most recently in an RCT with families in Iran [ 37 ]. Strong Families success in supporting families has been recognised by the international community in several ways; it has been mentioned as a tool supporting community-based crime prevention resolution in a UNODC crime commission [ 38 ] as an example for programmes for interventions in humanitarian settings under the Helping Adolescents Thrive of WHO and UNICEF for prevention and promotion of Mental Health.…”

Family UNited: Piloting of a new universal UNODC family skills programme to improve child mental health, resilience and parenting skills in Indonesia and Bangladesh

“…In 2018, UNODC developed a family skills programme called 'Strong Families', which was tailored for challenged and humanitarian settings (selective level prevention). Building on the positive evidence emerging from Strong Families [25,26,12], UNODC now developed a new family skills programme called "Family UNited" [27]. Family UNited is a more comprehensive programme that is suitable for implementation in wider settings (universal level prevention) again targeting particularly families living in low-and middle-income countries.…”

“…Based on our previous experience with the same measures assessing the effects of the Strong Families programme over time [12,25,26], a sample size of 30 was calculated for each group, keeping the power at 80% and the 2-sided con dence interval at 95% [49].…”

“…One week before the start of the Family UNited programme (t1), a standardized Family Demographic Questionnaire (FDQ) was completed to collect baseline characteristics in Bangladesh. The FDQ had been previously used in other country contexts, such as Afghanistan [30], Uzbekistan, Zanzibar, Serbia, the Philippines, Iran [12] and the Dominican Republic, and only minor changes in some of the questions were made to re ect the Bangladeshi context. It was translated to Bangla by the DAM research team and a cultural working group and local advisory committee ensured and approved appropriateness.…”

Editorial Perspective: How can we help the children of Ukraine and others affected by military conflict?

“…At the third level, the UNODC Strong Families programme has been through an extensive process of development and adaptation within many countries. Strong Families was first developed in collaboration with agencies in Afghanistan, has been tested in a number of settings (Haar et al., 2021), and used in over 20 countries so far. The programme is very brief, made up of three sessions.…”