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

BACKGROUND: Family is one of the most influential social institutions and caregivers act as the main protective factors for children's mental health and resilience skills. Family skills programmes support caregivers to be better parents and strengthen positive age-specific and age-appropriate family functioning and interactions. We developed a universal, brief and light programme for implementation in low-resource settings, the Family UNited (FU) programme, and conducted a pilot study to show feasibility of implementation, replicability and effectiveness in improving family functioning, child behaviour and resilience. METHODS: We recruited caregivers with children aged 8-14 years through schools in East Java, Indonesia and Dhaka, Bangladesh to the FU programme. Demographic data, emotional and behavioural difficulties of children, child resilience and parental skills and family adjustment measures were collected from children and caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), PAFAS (Parenting and Family Adjustment Scales) and CYRM-R (Child and Youth Resilience Measure). RESULTS: We enrolled 29 families in Bangladesh and allocated 37 families to the intervention and 33 to the control group in Indonesia. Overall, there was no effect over time in the control group on any of the PAFAS subscales, whereas significant reductions in scores were found on six of the seven subscales in either country in the intervention group, most prominently in caregivers with higher scores at baseline. We found highly significant reductions in total SDQ scores in the intervention group in both countries, whereas there was no effect over time in the control group in Indonesia. Boys in the intervention group in Indonesia and in Bangladesh seemed to have benefitted significantly on the SDQ as well as the total resilience scale. Overall, on the CYRM-R, particularly children below the 33rd percentile at pre-test benefitted substantially from the programme. CONCLUSIONS: The implementation of a brief family skills programme was seemingly effective and feasible in resource-limited settings and positively improved child mental health, resilience 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: Clinical Trial Registration: ISRCTN99645405, retrospectively registered, 22 September, 2022.

Caring for Your Child during COVID-19-Utilizing a Light-Touch Parenting Resource during Lockdown in Indonesia.

To tackle the spread of COVID-19 globally, countries around the world have responded by implementing measures such as lockdowns, social distance maintenance, temporary school closures, and remote working and learning. COVID-19 social isolation has been found to increase stress, and potentially have long term harmful effects on both mental and physical health. Stress and compromised parenting often place children at risk of violence and abuse. In parallel, times of hardship might also provide an opportunity to build stronger relationships with our children. The United Nations Office on Drugs and Crime (UNODC) joined many other agencies and international organizations in recognizing the threat the pandemic might have on individual and family wellbeing, and has thus availed a number of light-touch parenting resources. One such tool is the 'Caring for your child in response to the COVID-19 lockdown' booklet, developed to enhance parenting skills, and to build family harmony as challenged by the COVID-19 context. This short communication reflects on a feasibility study that took place in Indonesia during the implementation of this booklet with 30 parents in five cities. Thematic analysis identified challenges in parenting during COVID-19, as well as reported positive experiences of engaging in the parenting resource. The findings are discussed with regard to the usefulness of light-touch parenting information, adding to the context of the feasibility and global scalability of reaching families. The implications pave the way to the engagement and implication of more intensive parenting information interventions in high-stress contexts. Despite the challenge, there is promising news for families globally, as agencies and policy-makers begin to recognize the importance of supporting families with the appropriate skills to navigate extreme stress contexts with effective strategies.

Fidelity Assessment of the Treatnet family (TF): A family-based intervention for adolescents with substance use disorders and their families.

INTRODUCTION: In transporting family-based interventions to community settings, establishing and maintaining fidelity to intervention is important. This exploratory study was implemented in the framework of a United Nations Office on Drugs and Crime (UNODC) global programme on Drug Dependence Treatment and Care. It is the first to examine an evidence-informed family-based intervention ("Treatnet Family"; TF) adherence for the treatment of adolescents with substance use disorders (SUD) among practitioners in community settings in Jakarta, Indonesia. METHOD: Twenty-three practitioners at five community-based counselling centres were trained in Treatnet Family and delivered it to 19 adolescents with SUD and their family members over a 6-week period. One of the five local Treatnet Family-trained supervisors randomly selected one session of the family-based intervention (TF) and observed the extent to which the practitioner's adhered to the TF manual. RESULTS: According to the supervisors' observation, all the practitioners used the Treatnet Family core skills such as positive reframing, positive relational reframing, perspective taking, relational questions, and going with resistance. There was a high level of agreement between practitioners' and supervisors' rating on the practitioners' use of specific therapeutic skills as measured using the Inventory of Therapy Techniques (ITT). CONCLUSION: Results suggest that Treatnet Family can be delivered with adherence by practitioners in community-based settings.

Acceptability and feasibility of using digital technology to train community practitioners to deliver a family-based intervention for adolescents with drug use disorders during the COVID-19 pandemic.

INTRODUCTION: By adhering to government preventative messages to stay-at-home and social distancing during the COVID-19 pandemic, training practitioners in person in implementing a family-based intervention (i.e., Treatnet Family) is not possible. The present study examined the feasibility and acceptability of using digital technology to remotely deliver Treatnet Family training to practitioners in community counselling services in Indonesia. METHOD: Fifteen practitioners, from the association of addiction counsellors in Indonesia, participated in the Treatnet Family workshop remotely. The training was delivered by four national Treatnet Family trainers remotely via a digital platform for five days with additional take-home assignments. RESULTS: All practitioners reported that Treatnet Family training have enhanced their skills in working with adolescents and their family. Most practitioners reported having confidence in conducting Treatnet Family and in applying core skills of family-based intervention. Participating in the workshop enabled practitioners to learn the core skills of the Treatnet Family at their own pace. However, some practitioners also stated few disadvantages in remote training, including having limited time for the discussion and feeling overwhelmed with the assignments. Some find it hard to attend such training from their home due to distractions. CONCLUSION: Digital technology is acceptable and feasible method for training community practitioners to deliver Treatnet Family to adolescents with SUDs and their families in Indonesia. These findings can inform the way to use digital technology to deliver core family-based skills to community practitioners in other low-resource settings.

An open trial investigation of Treatnet Family among adolescents with substance use problems.

INTRODUCTION: Studies that used evidence-based family therapies have demonstrated significant effects in reducing adolescent drug use and delinquent behaviours, and in reducing comorbid mental health problems. However, almost all these studies were conducted in high-income countries. The overall aim of the present study was to explore the effect of United Nations Office on Drugs and Crime's (UNODC) Treatnet Family (TF) in reducing substance consumption, drug-related activities, reducing mental health problems, and in improving family interaction among adolescents with substance-use problems. METHOD: Nineteen adolescents who had been referred to a community counselling clinic because of substance-use problems and their parents/family members participated in TF. They completed a set of questionnaires to measure substance use, family functioning, mental health problems, and life events at pre-, post-intervention as well as at a one month-follow-up assessment. RESULTS: TF had a positive significant impact in reducing alcohol use among adolescents with substance-use problems. The number of adolescents who smoked cigarettes and marijuana, and used amphetamines reduced across time. After participating in TF, the adolescents were involved with significantly fewer friends who consumed substances and participated in antisocial behaviours. Furthermore, parent/family member reported a significant decrease in mental health problems, and positive changes in adolescent's behaviours. CONCLUSION: The TF had a positive impact in reducing alcohol consumption and problems related to substance consumption among adolescents with substance-use problems when delivered by practitioners in routine community settings.