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 (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 pre-test 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. CONCLUSIONS: The implementation of a brief family skills programme was seemingly effective and feasible in a resource-limited setting and positively improved child mental health and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for further validation through other methods of impact assessment and outcome evaluation. TRIAL REGISTRATION: ISRCTN76509384. Retrospectively registered on March 9, 2020.

The strong African American families-teen trial: rationale, design, engagement processes, and family-specific effects.

This study addresses two limitations in the literature on family-centered intervention programs for adolescents: ruling out nonspecific factors that may explain program effects and engaging parents into prevention programs. The Rural African American Families Health project is a randomized, attention-controlled trial evaluating the efficacy of the Strong African American Families-Teen (SAAF-T) program, a family-centered risk-reduction intervention for rural African American adolescents. Rural African American families (n = 502) with a 10th-grade student were assigned randomly to receive SAAF-T or a similarly structured, family-centered program that focused on health and nutrition. Families participated in audio computer-assisted self-interviews at baseline and 6-month follow-up. Program implementation procedures yielded a design with equivalent doses, five sessions of family-centered intervention programming for families in each condition. Of eligible families screened for participation, 76% attended four or five sessions of the program. Consistent with our primary hypotheses, SAAF-T youth, compared to attention-control youth, demonstrated higher levels of protective family management skills, a finding that cannot be attributed to nonspecific factors such as aggregating families in a structured, interactive setting.

Family-centered program deters substance use, conduct problems, and depressive symptoms in black adolescents.

OBJECTIVES: The present research addressed the following important question in pediatric medicine: Can participation in a new family-centered preventive intervention, the Strong African American Families-Teen (SAAF-T) program, deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents across 22 months? METHODS: Data were collected from 502 black families in rural Georgia, assigned randomly to SAAF-T or an attention control condition. The prevention condition consisted of 5 consecutive meetings at community facilities with separate, concurrent sessions for caregivers and adolescents followed by a caregiver-adolescent session in which families practiced skills they learned in the separate sessions. Adolescents self-reported conduct problem behaviors, substance use, substance use problems, and depressive symptoms at ages 16 years (pretest) and 17 years 10 months (long-term assessment). RESULTS: Adolescents who participated in SAAF-T evinced lower increases in conduct problem behavior, substance use, substance use problems, and depressive symptom frequencies than did adolescents in the attention control condition across the 22 months between pretest and long-term assessment. CONCLUSIONS: This is the first study to demonstrate efficacy in a prevention program designed to deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents. Because SAAF-T is a manualized, structured program, it can be easily disseminated to public health agencies, schools, churches, boys' and girls' clubs, and other community organizations.

The Strong African American Families Program: a cluster-randomized prevention trial of long-term effects and a mediational model.

The Strong African American Families Program, a universal preventive intervention to deter alcohol use among rural African American adolescents, was evaluated in a cluster-randomized prevention trial. This 7-week family skills training program is based on a contextual model in which intervention effects on youth protective factors lead to changes in alcohol use. African American 11-year-olds and their primary caregivers from 9 rural communities (N = 332 families) were randomly selected for study participation. Communities were randomized to prevention and control conditions. Intent-to-treat analyses indicated that fewer prevention than control adolescents initiated alcohol use; those who did evinced slower increases in use over time. Intervention-induced changes in youth protective factors mediated the effect of group assignment on long-term changes in use.

The strong African American families program: prevention of youths' high-risk behavior and a test of a model of change.

In this study, the efficacy of the Strong African American Families Program (SAAF) was tested. The trial, which included 332 families, indicated that families who participated in SAAF experienced increases over time in regulated, communicative parenting; increases in targeted parenting behaviors, according to youths' reports; and low rates of high-risk behavior initiation among youths. Changes in regulated, communicative parenting mediated the intervention's impact on youths' recognition of changes in parenting, which in turn was linked to changes in youths' high-risk behavior.

The Strong African American Families Program: translating research into prevention programming.

A randomized prevention trial contrasted families who took part in the Strong African American Families Program (SAAF), a preventive intervention for rural African American mothers and their 11-year-olds, with control families. SAAF is based on a contextual model positing that regulated, communicative parenting causes changes in factors protecting youths from early alcohol use and sexual activity. Parenting variables included involvement-vigilance, racial socialization, communication about sex, and clear expectations for alcohol use. Youth protective factors included negative attitudes about early alcohol use and sexual activity, negative images of drinking youths, resistance efficacy, a goal-directed future orientation, and acceptance of parental influence. Intervention-induced changes in parenting mediated the effect of intervention group influences on changes in protective factors over a 7-month period.