Abstract
In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample.
Similar content being viewed by others
References
Aron, A., Aron, E. N., & Smollan, D. (1992). Inclusion of Other in the Self Scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63(4), 596. https://doi.org/10.1037/0022-3514.63.4.596.
Barnes, H. L., & Olson, D. H. (1985). Parent-adolescent communication and the circumplex model. Child Development, 56(2), 438–447. https://doi.org/10.2307/1129732. JSTOR.
Barnett, M. L., Sanchez, L., Green, B. E., Rosas, Y., & Broder-Fingert, S. (2021). Future directions in Lay Health Worker involvement in Children’s Mental Health Services in the U.S. Journal of Clinical Child & Adolescent Psychology, 0(0), 1–13. https://doi.org/10.1080/15374416.2021.1969655.
Barnett, M. L., Puffer, E. S., Ng, L. C., & Jaguga, F. (2023). Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States. Cambridge Prisms: Global Mental Health, 10, e26. https://doi.org/10.1017/gmh.2023.19.
Best, A. L., Fletcher, F. E., Kadono, M., & Warren, R. C. (2021). Institutional distrust among African americans and Building trustworthiness in the COVID-19 response: Implications for ethical Public Health Practice. Journal of Health Care for the Poor and Underserved, 32(1), 90–98. https://doi.org/10.1353/hpu.2021.0010.
Bolton, P. (2019). 1 - Global mental health and psychotherapy: Importance of task-shifting and a systematic approach to adaptation. In D. J. Stein, J. K. Bass, & S. G. Hofmann (Eds.), Global Mental Health and Psychotherapy (pp. 11–24). Academic Press. https://doi.org/10.1016/B978-0-12-814932-4.00001-X.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa.
Cohodes, E. M., McCauley, S., Preece, D. A., Gross, J. J., & Gee, D. G. (2022). Parental assistance with emotion regulation moderates Link between COVID-19 stress and child Mental Health. Journal of Clinical Child & Adolescent Psychology, 1–18. https://doi.org/10.1080/15374416.2022.2140431.
Conger, R. D., & Donnellan, M. B. (2007). An interactionist perspective on the socioeconomic context of human development. Annual Review of Psychology, 58(1), 175–199. https://doi.org/10.1146/annurev.psych.58.110405.085551.
Coyne, L. W., McHugh, L., & Martinez, E. R. (2011). Acceptance and Commitment Therapy (ACT): Advances and applications with children, adolescents, and families. Child and Adolescent Psychiatric Clinics of North America, 20(2), 379–399. https://doi.org/10.1016/j.chc.2011.01.010.
Daks, J. S., Peltz, J. S., & Rogge, R. D. (2020). Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens. Journal of Contextual Behavioral Science, 18, 16–27. https://doi.org/10.1016/j.jcbs.2020.08.003.
Feinberg, M. E., Solmeyer, A. R., & McHale, S. M. (2012). The third rail of Family systems: Sibling relationships, Mental and Behavioral Health, and preventive intervention in Childhood and Adolescence. Clinical Child and Family Psychology Review, 15(1), 43–57. https://doi.org/10.1007/s10567-011-0104-5.
Giusto, A., Kaiser, B. N., Ayuku, D., & Puffer, E. S. (2019). A direct observational measure of Family Functioning for a low-resource setting: Adaptation and feasibility in a Kenyan sample. Behavior Therapy, 50(2), 459–473. https://doi.org/10.1016/j.beth.2018.08.004.
Giusto, A., Friis-Healy, E. A., Kaiser, B. N., Ayuku, D., Rono, W., & Puffer, E. S. (2022). Mechanisms of change for a family intervention in Kenya: An Integrated clinical and implementation mapping approach. Behaviour Research and Therapy, 159, 104219. https://doi.org/10.1016/j.brat.2022.104219.
Giusto, A., Jack, H. E., Magidson, J. F., Ayuku, D., Johnson, S. L., Lovero, K. L., Hankerson, S. H., Sweetland, A. C., Myers, B., dos Fortunato, P., Puffer, E. S., & Wainberg, M. L. (2023). Global is local: Leveraging Global Mental-Health methods to promote equity and address disparities in the United States. Clinical Psychological Science, 21677026221125716. https://doi.org/10.1177/21677026221125715.
Goldenberg, H., & Goldenberg, I. (2012). Family Therapy: An overview. Cengage Learning.
Goodman, R. (1997). The strengths and difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. Guilford Press.
Healy, E. A., Kaiser, B. N., & Puffer, E. S. (2018). Family-based Youth Mental Health interventions delivered by Non-specialist providers in low- and Middle-Income countries: A systematic review. Families Systems & Health: The Journal of Collaborative Family Healthcare, 36(2), 182–197. https://doi.org/10.1037/fsh0000334.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in Primary Care: Prevalence, impairment, Comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.
Kumpfer, K. L., Alvarado, R., Tait, C., & Whiteside, H. O. (2007). The Strengthening Families Program: An Evidence-Based, Multicultural Family Skills Training Program. In Preventing youth substance abuse: Science-based programs for children and adolescents (pp. 159–181). American Psychological Association. https://doi.org/10.1037/11488-007.
Lange, K. W. (2021). Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. Global Health Journal, 5(3), 120–127. https://doi.org/10.1016/j.glohj.2021.07.001.
Leijten, P., Gardner, F., Melendez-Torres, G. J., van Aar, J., Hutchings, J., Schulz, S., Knerr, W., & Overbeek, G. (2019). Meta-analyses: Key parenting Program Components for disruptive child behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 58(2), 180–190. https://doi.org/10.1016/j.jaac.2018.07.900.
Lumivero. (2017). NVivo (Version 12) [Computer software]. www.lumivero.com.
McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282.
Michaelson, V., Pilato, K. A., & Davison, C. M. (2021). Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family. PLOS ONE, 16(4), e0249707. https://doi.org/10.1371/journal.pone.0249707.
Morales, D. X., Morales, S. A., & Beltran, T. F. (2021). Racial/Ethnic disparities in Household Food Insecurity during the COVID-19 pandemic: A nationally Representative Study. Journal of Racial and Ethnic Health Disparities, 8(5), 1300–1314. https://doi.org/10.1007/s40615-020-00892-7.
Moreland-Russell, S., Jabbari, J., Ferris, D., & Roll, S. (2022). At Home and on the Brink: U.S. Parents’ Mental Health during COVID-19. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/ijerph19095586. Article 9.
Pedersen, G. A., Smallegange, E., Coetzee, A., Hartog, K., Turner, J., Jordans, M. J. D., & Brown, F. L. (2019). A systematic review of the evidence for family and parenting interventions in low- and middle-income countries: Child and youth mental health outcomes. Journal of Child and Family Studies, 28(8), 2036–2055. https://doi.org/10.1007/s10826-019-01399-4.
Pfender, E. (2020). Mental Health and COVID-19: Implications for the future of Telehealth. Journal of Patient Experience, 7(4), 433–435. https://doi.org/10.1177/2374373520948436.
Prime, H., Wade, M., & Browne, D. T. (2022). Pandemic-related disruption and positive adaptation: Profiles of family function at the onset of the pandemic. Adversity and Resilience Science, 3(4), 321–333. https://doi.org/10.1007/s42844-022-00077-7.
Prime, H., Wade, M., & Browne, D. T. (2020/07/13). Risk and resilience in family well-being during the COVID-19 pandemic. American Psychologist, 75(5), 631. https://doi.org/10.1037/amp0000660.
Puffer, E. S., Pian, J., Sikkema, K. J., Ogwang-Odhiambo, R. A., & Broverman, S.A. (2013). Developing a family-Based HIV prevention intervention in rural Kenya: Challenges in conducting community-Based participatory research. Journal of Empirical Research on Human Research Ethics, 8(2), 119–128. https://doi.org/10.1525/jer.2013.8.2.119.
Puffer, E. S., Friis-Healy, E. A., Giusto, A., Stafford, S., & Ayuku, D. (2019). Development and implementation of a family therapy intervention in Kenya: a community-embedded Lay Provider Model. Global Social Welfare. https://doi.org/10.1007/s40609-019-00151-6.
Puffer, E. S., Healy, F., Green, E., Giusto, E. P. M., Kaiser, A. N., Patel, B., P., & Ayuku, D. (2020). Family functioning and mental health changes following a family therapy intervention in Kenya: a pilot trial. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-020-01816-z.
Puffer, E. S., Johnson, S. L., Quick, K. N., Rieder, A. D., Mansoor, M., Proeschold-Bell, R. J., Jones, S., Moore-Lawrence, S., Rasmussen, J. D., Cucuzzella, C., & Burwell, F., Dowdy, Moore, L., Rosales, F., Sanyal, N., Ramachandran, A., Duerr, P., & Tice, E., L., Ayuku, D., & Boone, W. J. (2022). Family strengthening in the context of COVID-19: adapting a community-based intervention from Kenya to the United States. Prevention Science, https://doi.org/10.1007/s11121-022-01418-9.
Puffer, E. S., Green, E. P., Sikkema, K. J., & Broverman, S. A., Ogwang-Odhiambo, R. A., & Pian, J. (2016). A church-based intervention for families to promote mental health and prevent HIV among adolescents In rural Kenya: Results of a randomized trial. Journal of Consulting and Clinical Psychology, 84(6), 511–525. https://doi.org/10.1037/ccp0000076.
Raviola, G., Naslund, J. A., Smith, S. L., & Patel, V. (2019). Innovative models in Mental Health Delivery systems: Task sharing care with non-specialist providers to close the Mental Health Treatment Gap. Current Psychiatry Reports, 21(6), 44. https://doi.org/10.1007/s11920-019-1028-x.
R Core Team (2019). R: A language and environment for statistical computing [Computer software]. https://www.R-project.org.
Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330–366. https://doi.org/10.1037/0033-2909.128.2.330.
Samji, H., Wu, J., Ladak, A., Vossen, C., Stewart, E., Dove, N., Long, D., & Snell, G. (2022). Review: Mental health impacts of the COVID-19 pandemic on children and youth – a systematic review. Child and Adolescent Mental Health, 27(2), 173–189. https://doi.org/10.1111/camh.12501.
Sanders, M. R., Turner, K. M. T., & Markie-Dadds, C. (2002). The development and dissemination of the Triple P—Positive parenting program: A multilevel, evidence-based system of parenting and family support. Prevention Science, 3(3), 173–189. https://doi.org/10.1023/A:1019942516231.
Snyder, C. R., Sympson, S. C., Ybasco, F. C., Borders, T. F., Babyak, M. A., & Higgins, R. L. (1996). Development and validation of the State Hope Scale. Journal of Personality and Social Psychology, 70(2), 321–335. https://doi.org/10.1037//0022-3514.70.2.321.
Stein, G. L., Salcido, V., & Gomez Alvarado, C. (2023). Resilience in the Time of COVID-19: Familial processes, coping, and Mental Health in Latinx adolescents. Journal of Clinical Child & Adolescent Psychology, 1–15. https://doi.org/10.1080/15374416.2022.2158838.
Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of Change during Acceptance and Commitment Therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332–362. https://doi.org/10.1017/S1352465818000553.
Stracke, M., Heinzl, M., Müller, A. D., Gilbert, K., Thorup, A. A. E., Paul, J. L., & Christiansen, H. (2023). Mental Health is a Family Affair—systematic review and Meta-analysis on the associations between Mental Health problems in parents and children during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 20(5). https://doi.org/10.3390/ijerph20054485.
Tai, D. B. G., Shah, A., Doubeni, C. A., Sia, I. G., & Wieland, M. L. (2021). The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases, 72(4), 703–706. https://doi.org/10.1093/cid/ciaa815.
Thomeer, M. B., Moody, M. D., & Yahirun, J. (2023). Racial and Ethnic Disparities in Mental Health and Mental Health Care during the COVID-19 pandemic. Journal of Racial and Ethnic Health Disparities, 10(2), 961–976. https://doi.org/10.1007/s40615-022-01284-9.
Tutty, L. M. (1995). Theoretical and practical issues in selecting a measure of Family Functioning. Research on Social Work Practice, 5(1), 80–106. https://doi.org/10.1177/104973159500500107.
Walsh, F. (2016). Applying a Family Resilience Framework in Training, Practice, and Research: Mastering the art of the possible. Family Process, 55(4), 616–632. https://doi.org/10.1111/famp.12260.
Walsh, F. (2021). Family Resilience: A dynamic systemic Framework. Multisystemic resilience. Oxford University Press. https://doi.org/10.1093/oso/9780190095888.003.0015.
Watson, M. F., Bacigalupe, G., Daneshpour, M., Han, W. J., & Parra-Cardona, R. (2020). COVID-19 interconnectedness: Health Inequity, the Climate Crisis, and collective trauma. Family Process, 59(3), 832–846. https://doi.org/10.1111/famp.12572.
Willis, H. A., Gonzalez, J. C., Call, C. C., Quezada, D., Galán, C. A., & Scholars for Elevating Equity and Diversity (SEED). (2022). Culturally responsive telepsychology & mHealth interventions for racial-ethnic Minoritized Youth: Research gaps and future directions. Journal of Clinical Child & Adolescent Psychology, 51(6), 1053–1069. https://doi.org/10.1080/15374416.2022.2124516.
Acknowledgements
Coping Together Team (alphabetically)
Francelia Burwell1, Cameron Cucuzzella2, Latoria Dowdy1, Emmy Duerra2, Sierra Jones2, Florine Moore1, Shaneeka Moore-Lawrence1, Preetha Ramachandran2, Nancy Rosales1, Ameya Sanyal2, Logan Tice2
1 Together for Resilient Youth, Durham, NC, USA
2 Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC 27708, USA
Funding
This study was funded by Duke Bass Connections and the Duke Global Health Institute.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Johnson, S.L., Rieder, A.D., Rasmussen, J.M. et al. A Pilot Study of the Coping Together Virtual Family Intervention: Exploring Changes in Family Functioning and Individual Well-Being. Res Child Adolesc Psychopathol (2024). https://doi.org/10.1007/s10802-024-01183-z
Accepted:
Published:
DOI: https://doi.org/10.1007/s10802-024-01183-z