Strong Families: A new family skills training programme for challenged and humanitarian settings: a single-arm intervention tested in Afghanistan

Background Children living in challenged humanitarian settings 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 families living in low resource settings. We therefore designed a brief and light programme and conducted an effectiveness trial in Afghanistan. Methods We recruited female caregivers and children aged 8-12 years via schools and drug treatment centres in Afghanistan and enrolled them in a family skills programme over three weeks. Demographic data, emotional and behavioural difficulties of children and parental skills and family adjustment measures were collected from caregivers before, two and six weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire) and PAFAS (Parenting and Family Adjustment Scales). Results We enrolled 72 families in the programme and followed 93·1% up overall. 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 total difficulty score of the SDQ of the 72 children reduced significantly, from 17.8 at pre-test to 12.9 at post-test and 10.6 at follow-up, with no difference in gender and mostly in those with highest scores at baseline. Likewise, PAFAS scores improved significantly after the programme, again with caregivers with the highest scores at baseline improving most. Conclusions The implementation of a brief family skills programme was feasible in a resource-limited setting and had an impact on child mental health and parenting practices and family adjustment skills. This indicated the value of such programme and the feasibility to move it to scale. The effects need to be verified through an RCT and with longer follow-ups. The results are submitted for peer-reviewed publication