Nurturing families: A feasibility randomised controlled trial of a whole-family intervention with vulnerable families in Jordan

Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised...

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Published in:	Global mental health Vol. 11; p. e51
Main Authors:	Brown, Felicity L., Yousef, Hind, Bleile, Alexandra C.E., Mansour, Hadeel, Barrett, Anna, Ghatasheh, Maha, Puffer, Eve S., Mansour, Zeinab, Hayef, Karam, Kurdi, Samer, Ali, Qaasim, Tol, Wietse A., El-Khani, Aala, Calam, Rachel, Abu Hassan, Hana, Jordans, Mark J.D.
Format:	Journal Article
Language:	English
Published:	Cambridge, UK Cambridge University Press 2024
Subjects:	Acceptability Assessors Caregivers Child & adolescent mental health Clinical assessment Community-based care Families & family life Family conflict family interventions Family relations Feasibility Feedback Fidelity Humanitarianism Hypotheses Intervention Interventions Jordan Measures mental health Military intervention Parents & parenting Perceptions pilot randomised controlled trial Property Psychological distress Quality of Care Quantitative psychology refugee Refugees Relocation Retention Special Issue: Community-based PSS interventions for displaced populations Teaching and Learning Training non-mental health professionals Trends Well being Iraq family interventions Jordan pilot randomised controlled trial mental health refugee
ISSN:	2054-4251, 2054-4251
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Abstract	Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.
AbstractList	Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness. Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness. Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.
ArticleNumber	e51
Author	Brown, Felicity L. Ghatasheh, Maha Kurdi, Samer Yousef, Hind Bleile, Alexandra C.E. Abu Hassan, Hana Barrett, Anna Ali, Qaasim El-Khani, Aala Calam, Rachel Jordans, Mark J.D. Tol, Wietse A. Hayef, Karam Mansour, Hadeel Puffer, Eve S. Mansour, Zeinab
AuthorAffiliation	4 Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University , Durham , NC , USA 9 Division of Psychology and Mental Health, The University of Manchester , Manchester , UK 11 Imperial College NHS Trust , London , UK 10 University of California San Diego , San Diego , CA , USA 5 Collateral Repair Project, Amman , Jordan 6 Section of Global Health, University of Copenhagen , Copenhagen , Denmark 3 Amsterdam Institute of Social Science Research, University of Amsterdam , Amsterdam , The Netherlands 2 Research and Development Department, War Child Alliance , Amman , Jordan 1 Research and Development Department, War Child Alliance , Amsterdam , The Netherlands 8 Arq International , Diemen , The Netherlands 7 Athena Research Institute, VU University Amsterdam , Amsterdam , The Netherlands
AuthorAffiliation_xml	– name: 4 Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University , Durham , NC , USA – name: 11 Imperial College NHS Trust , London , UK – name: 1 Research and Development Department, War Child Alliance , Amsterdam , The Netherlands – name: 9 Division of Psychology and Mental Health, The University of Manchester , Manchester , UK – name: 2 Research and Development Department, War Child Alliance , Amman , Jordan – name: 5 Collateral Repair Project, Amman , Jordan – name: 7 Athena Research Institute, VU University Amsterdam , Amsterdam , The Netherlands – name: 10 University of California San Diego , San Diego , CA , USA – name: 3 Amsterdam Institute of Social Science Research, University of Amsterdam , Amsterdam , The Netherlands – name: 6 Section of Global Health, University of Copenhagen , Copenhagen , Denmark – name: 8 Arq International , Diemen , The Netherlands
Author_xml	– sequence: 1 givenname: Felicity L. orcidid: 0000-0001-6800-1657 surname: Brown fullname: Brown, Felicity L. email: felicitylbrown@gmail.com organization: Research and Development Department, War Child Alliance, Amsterdam, The Netherlands – sequence: 2 givenname: Hind surname: Yousef fullname: Yousef, Hind organization: Research and Development Department, War Child Alliance, Amman, Jordan – sequence: 3 givenname: Alexandra C.E. surname: Bleile fullname: Bleile, Alexandra C.E. organization: Research and Development Department, War Child Alliance, Amsterdam, The Netherlands – sequence: 4 givenname: Hadeel surname: Mansour fullname: Mansour, Hadeel organization: Research and Development Department, War Child Alliance, Amman, Jordan – sequence: 5 givenname: Anna surname: Barrett fullname: Barrett, Anna organization: Research and Development Department, War Child Alliance, Amsterdam, The Netherlands – sequence: 6 givenname: Maha surname: Ghatasheh fullname: Ghatasheh, Maha organization: Research and Development Department, War Child Alliance, Amman, Jordan – sequence: 7 givenname: Eve S. orcidid: 0000-0003-2281-821X surname: Puffer fullname: Puffer, Eve S. organization: Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, NC, USA – sequence: 8 givenname: Zeinab surname: Mansour fullname: Mansour, Zeinab organization: Research and Development Department, War Child Alliance, Amman, Jordan – sequence: 9 givenname: Karam surname: Hayef fullname: Hayef, Karam organization: Collateral Repair Project, Amman, Jordan – sequence: 10 givenname: Samer surname: Kurdi fullname: Kurdi, Samer organization: Collateral Repair Project, Amman, Jordan – sequence: 11 givenname: Qaasim surname: Ali fullname: Ali, Qaasim organization: Collateral Repair Project, Amman, Jordan – sequence: 12 givenname: Wietse A. surname: Tol fullname: Tol, Wietse A. organization: Section of Global Health, University of Copenhagen, Copenhagen, Denmark – sequence: 13 givenname: Aala surname: El-Khani fullname: El-Khani, Aala organization: Division of Psychology and Mental Health, The University of Manchester, Manchester, UK – sequence: 14 givenname: Rachel surname: Calam fullname: Calam, Rachel organization: Division of Psychology and Mental Health, The University of Manchester, Manchester, UK – sequence: 15 givenname: Hana surname: Abu Hassan fullname: Abu Hassan, Hana organization: 0 University of California San Diego, San Diego, CA, USA – sequence: 16 givenname: Mark J.D. orcidid: 0000-0001-5925-8039 surname: Jordans fullname: Jordans, Mark J.D. email: felicitylbrown@gmail.com organization: Research and Development Department, War Child Alliance, Amsterdam, The Netherlands
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Keywords	family interventions Jordan pilot randomised controlled trial mental health refugee
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SubjectTerms	Acceptability Assessors Caregivers Child & adolescent mental health Clinical assessment Community-based care Families & family life Family conflict family interventions Family relations Feasibility Feedback Fidelity Humanitarianism Hypotheses Intervention Interventions Jordan Measures mental health Military intervention Parents & parenting Perceptions pilot randomised controlled trial Property Psychological distress Quality of Care Quantitative psychology refugee Refugees Relocation Retention Special Issue: Community-based PSS interventions for displaced populations Teaching and Learning Training non-mental health professionals Trends Well being
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Title	Nurturing families: A feasibility randomised controlled trial of a whole-family intervention with vulnerable families in Jordan
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