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.

### 研究背景
身处人道主义危机环境中的儿童罹患心理困扰或行为问题的风险显著更高，而照料者是其主要的保护性因素。尽管当前已存在多款家庭技能培训项目，但极少有针对低资源环境家庭开发或开展试点的同类项目。为此，我们设计了一款简短轻量化的培训项目，并在阿富汗开展了有效性评估试验。

### 研究方法
我们通过阿富汗境内的学校与药物治疗中心招募女性照料者及8-12岁儿童，将其纳入为期三周的家庭技能培训项目。我们在干预前、干预后2周及6周，从照料者处收集人口统计学数据、儿童情绪与行为问题情况、父母养育技能及家庭适应相关测评指标数据。本研究采用长处与困难问卷（Strengths and Difficulties Questionnaire, SDQ）以及养育与家庭适应量表（Parenting and Family Adjustment Scales, PAFAS）对干预效果进行评估。

### 研究结果
本研究共纳入72个家庭，总体随访保留率达93.1%。照料者的平均年龄为36.1岁，平均育有3.8名子女，其中91.7%的照料者曾经历过战争或武装冲突。72名儿童的长处与困难问卷总困难得分显著降低，从基线测评的17.8分降至干预后测评的12.9分，随访时进一步降至10.6分；该改善效果不存在性别差异，且主要体现在基线得分最高的儿童群体中。同样，养育与家庭适应量表得分在项目结束后也得到显著改善，基线得分最高的照料者改善效果最为显著。

### 研究结论
简短型家庭技能培训项目在资源有限的环境中具备可实施性，且可有效改善儿童心理健康状况、父母养育行为及家庭适应能力。这证实了此类项目的应用价值，以及其规模化推广的可行性。该干预效果仍需通过随机对照试验（Randomized Controlled Trial, RCT）及更长周期的随访进行验证。

本研究结果已提交至同行评议期刊待刊。