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Randomized Controlled Trial
. 2023 Jan;64(1):71-82.
doi: 10.1111/jcpp.13668. Epub 2022 Jul 15.

Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention

Kenneth E Miller  1   2 , Alexandra Chen  3 , Gabriela V Koppenol-Gonzalez  2 , Ioannis Bakolis  4 , Maguy Arnous  5 , Fadila Tossyeh  5 , Ahmad El Hassan  5 , Ahmad Saleh  5 , Joy Saade  5 , Nayla Nahas  6 , Marianne Abboud  5 , Lya Jawad  5 , Mark J D Jordans  3   4   7
Affiliations
Randomized Controlled Trial

Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention

Kenneth E Miller et al. J Child Psychol Psychiatry. 2023 Jan.

Abstract

Background: Parenting interventions in humanitarian settings have prioritized the acquisition of parenting knowledge and skills, while overlooking the adverse effects of stress and distress on parenting-a key mediator of refugee children's mental health. We evaluated the effectiveness of the Caregiver Support Intervention (CSI), which emphasizes caregiver wellbeing together with training in positive parenting.

Methods: We conducted a two-arm randomized controlled trial of the CSI with Syrian refugees in Lebanon, with an intent-to-treat design, from September 2019-December 2020. A total of 480 caregivers from 240 families were randomized to the CSI or a waitlist control group (1:1). Retention from baseline to endline was 93%. Data on parenting and caregiver psychological wellbeing were collected at baseline, endline, and three-month follow-up. Prospective trial registration: ISRCTN22321773.

Results: We did not find a significant change on overall parenting skills at endline (primary outcome endpoint) (d = .11, p = .126) or at follow-up (Cohen's d = .15, p = .054). We did find a significant effect on overall parenting skills among participants receiving the full intervention-the sub-sample not interrupted by (COVID-19) (d = 0.25, p < .05). The CSI showed beneficial effects in the full sample at endline and follow-up on harsh parenting (d = -.17, p < .05; d = .19, p < .05), parenting knowledge (d = .63, p < .001; d = .50, p < .001), and caregiver distress (d = -.33, p < .001; d = .23, p < .01). We found no effects on parental warmth and responsiveness, psychosocial wellbeing, stress, or stress management. Changes in caregiver wellbeing partially mediated the impact of the CSI on harsh parenting, accounting for 37% of the reduction in harsh parenting.

Conclusions: The CSI reduced harsh parenting and caregiver distress, and demonstrated the value of addressing caregiver wellbeing as a pathway to strengthening parenting in adversity. These effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. Replication under less extreme conditions may more accurately demonstrate the intervention's full potential.

Keywords: Parenting; distress; refugees; stress; war.

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Figures

Figure 1
Figure 1
Conceptual model underlying the CSI*. *We recognize that there may be other pathways beyond those depicted in Figure 1 by which daily stressors may impact parenting directly, in addition to exerting effects via parental stress and wellbeing. Figure 1 depicts the conceptual model that guided the development of the CSI; it is not meant to be a comprehensive model capturing the diverse pathways by which external stressors may impact parenting [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
CONSORT flow diagram [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Mediating pathway of the effect of CSI intervention on harsh parenting via (A) distress, (B) psychosocial wellbeing, 95% confidence intervals in parentheses. Notes: c = total effect; c' = natural direct effect; (A) Indirect effect: −0.11 (−0.16, −0.05)*. *p < .05, **p < .01, ***p < .001. (B) Indirect effect: −0.03 (−0.07, −0.008)*. *p < .05, **p < .01 [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Bryant, R. , Edwards, B. , Creamer, M. , O'Donnell, M. , Forbes, D. , Felmingham, K. , … Hadzi‐Pavlovic, D. (2018). The effect of post‐traumatic stress disorder on refugees' parenting and their children's mental health: A cohort study. The Lancet Public Health, 3, e249–e258. - PubMed
    1. Chen, A. , Koppenol‐Gonzalez, G.V. , Bakolis, I. , Arnous, M. , Tossyeh, F. , Al‐Ogaily, D. , Jordans, M.J.D. , & Miller, K.E. (2022). Dimensions of Parenting Scale: a culturally grounded measure of parenting in adversity (Manuscript in preparation).
    1. Chen, A. , Tossyeh, F. , Arnous, M. , Saleh, A. , El Hassan, A. , Sade, J. , & Miller, K.E. (2020). Phone‐based data collection in a refugee community under COVID‐19 lockdown. The Lancet Psychiatry, 7. 10.1016/S2215-0366(20)30189-9 - DOI - PMC - PubMed
    1. Eltanamly, H. , Leijten, P. , Jak, S. , & Overbeek, G. (2019). Parenting in times of war: A meta‐analysis and qualitative synthesis of war exposure, parenting, and child adjustment. Trauma, Violence & Abuse, 22, 147–160. - PMC - PubMed
    1. Fung, K. (2015). Acceptance and commitment therapy: Western adoption of Buddhist tenets? Transcultural Psychiatry, 52, 561–576. - PubMed

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