Impact of a brief family skills training programme (Strong Families) on child mental health, resilience and parenting skills in Iran: A multisite non-randomised trial

Children living in humanitarian or challenged settings are at greater risk of vulnerabilities including mental health difficulties or behavioural problems, being aggravated through social inequalities or family instability. Primary caregivers play a crucial role in protecting children’s mental health, hence interventions that encourage safe and nurturing relationships can prevent a number of negative social outcomes. To evaluate the programme, we included a pilot feasibility trial with an embedded multisite non-randomised trial with two arms to assess effectiveness. We recruited 377 families through ten centres (schools, community centres, primary healthcare centres and NGO-led centres) in Tehran and Karaj, Iran and allocated them to either intervention group (n=255) or waitlist group (n=122). Intervention caregivers and children aged 8-12 years participated in the Strong Families (SF) programme, whereas waitlist/control families received services-as-usual. We prospectively collected data before, 2 and 6 weeks after the intervention assessing changes in parenting skills and family adjustment in caregivers through the PAFAS (Parenting and Family Adjustment Scales), children’s behaviour through the SDQ (Strengths and Difficulties Questionnaire), and children’s resilience capacities (Child and Youth Resilience Measure (CYRM-R)). Overall, 292 participants were included in the analysis, 199 in the intervention group and 93 in the control group with an overall follow-up of 71% at t3. Families in the intervention and control group did not differ with respect to demographic baseline characteristics. Overall, caregivers improved in the intervention group over time within the majority of the PAFAS subscales, particularly within the family adjustment scales, whereas there was no statistical difference in caregivers in the control group. In general, children from families originating from Afghanistan started off with higher scores in both, the intervention and control group, that remained higher compared to children from Iranian families. Overall, there was no effect in Iranian children in the control group over time, in any of the subscales, nor the total difficulty score. Children of Afghan origin improved significantly on the “caregiver resilience subscale” and the “overall resilience scale” in the intervention group, but not in the control group. The findings of our study confirm the impact of SF. Implementation was proven feasible in a different country setting, replicating the previously reported modality. Overall, families with more problems at start improved most, not only in the intervention, but also the control group. We therefore recommend further research exploring the “cross-fertilisation” effect of our programme