Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention
The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n = 479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n = 240) or a wait-list control condition (n = 239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) −0.22, p = 0.02; child report ES −0.11, p = 0.02) and child attention problems compared with controls (caregiver report ES −0.23, p = 0.03). There was no significant treatment effect on children’s internalizing problems (ES −0.06; p = 0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p < 0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children’s externalizing symptoms and protective psychosocial factors.
Trial Registration. Clinicaltrials.gov: https://clinicaltrials.gov/show/NCT01829815
KeywordsParenting Mental health Low and middle income countries Migrants Displacement Myanmar
- Achenbach, T. M., & Rescorla, L. A. (2001). Child behavior checklist. Youth self-report for ages 11–18 (YSR 11–18). In Manual for the ASEBA school-age forms and profiles. Research Center for Children, Youth, and Families in Burlington, VT.Google Scholar
- Bandura, A. (1977) Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215. doi:10.1037/0033-295X.84.2.191
- Barlow, J., McMillan, A. S., Kirkpatrick, S., Ghate, D., Barnes, J., & Smith, M. (2010). Health-led interventions in the early years to enhance infant and maternal mental health: A review of reviews. Child Adolescent Mental Health, 15, 178–185. doi:10.1111/j.1475-3588.2010.00570.x.CrossRefGoogle Scholar
- Betancourt, T., Scorza, P., Meyers-Ohki, S., Mushashi, C., Kayiteshonga, Y., Binagwaho, A., … Beardslee, W. R. (2012). Validating the center for epidemiological studies depression scale for children in Rwanda. Journal of the American Academy of Child and Adolescent Psychiatry, 51(12), 1284–1292. doi:10.1016/j.jaac.2012.09.003
- Betancourt, T., Ng, L. C., Kirk, C. M., Munyanah, M., Mushashi, C., Ingabire, C., … Sezibera, V. (2014). Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial. AIDS (London, England), 28(0 3), S359–S368. doi:10.1097/QAD.0000000000000336
- Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., … Starace, N. (2011). Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18, 154-172.Google Scholar
- Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Donnelly, M., Smith, S. M., & O’Neill, C. (2010). Behavioural/cognitive-behavioural group-based parenting interventions for children age 3–12 with early onset conduct problems. In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008225/abstract
- Gardner, F., Montgomery, P., & Knerr, W. (2015). Transporting evidence-based parenting programs for child problem behavior (age 3–10) between countries: Systematic review and meta-analysis. Journal of Clinical Child & Adolescent Psychology, 0, 1–14. doi:10.1080/15374416.2015.1015134
- Green, M., Jacobsen, K., & Pyne, S. (2008). Invisible in Thailand: Documenting the need for protection. Forced Migration Review, 30, 31–33.Google Scholar
- Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., … Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378, 1515–1525. doi:10.1016/S0140-6736(11)60827-1
- Kohrt, B. A., Jordans, M. J. D., Rai, S., Shrestha, P., Luitel, N. P., Ramaiya, M. K., … Patel, V. (2015). Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale. Behaviour Research and Therapy, 69, 11–21. doi:10.1016/j.brat.2015.03.009.
- Kumpfer, K. L., Alvarado, R., Tait, C., & Whiteside, H. O. (2007). The Strengthening Families Program: An evidence-based, multicultural family skills training program. In P. Tolan, J. Szapocznik, & S. Sambrano (Eds.), Preventing youth substance abuse: Science-based programs for children and adolescents (pp. 159–181). Washington, DC: APA.CrossRefGoogle Scholar
- Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., … Saxe, G. N. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 24–36. doi:10.1097/00004583-200401000-00012
- Manassis, K., Lee, T. C., Bennett, K., Zhao, X. Y., Mendlowitz, S., Duda, S., … Wood, J. J. (2014). Types of parental involvement in CBT with anxious youth: A preliminary meta-analysis. Journal of Consulting and Clinical Psychology, 82, 1163–1172. doi:10.1037/a0036969.
- Mullany, L. C., Richards, A. K., Lee, C. I., Suwanvanichkij, V., Maung, C., Mahn, M., … Lee, T. J. (2007). Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma. Journal of Epidemiology and Community Health, 61, 908–914. doi:10.1136/jech.2006.055087.
- Panter-Brick, C., Burgess, A., Eggerman, M., McAllister, F., Pruett, K., & Leckman, J. F. (2014). Practitioner review: Engaging fathers—recommendations for a game change in parenting interventions based on a systematic review of the global evidence. Journal of Child Psychology and Psychiatry, 55, 1187–1212. doi:10.1111/jcpp.12280.CrossRefPubMedPubMedCentralGoogle Scholar
- Pinyuchon, M. (2010, June). Effectiveness of implementing the Strengthening Families Program for Families of school children in Songkhla Province, Thailand. In Karol L. Kumpfer (Chair), Cultural Adaptations of Family-Based Interventions to Strengthen Families and Prevent Substance Abuse. Presented at NIDA International Conference, Scottsdale, AZ.Google Scholar
- Puffer, E., Green, E. P., Chase, R. M., Sim, A. L., Zayzay, J., Friis, E., … Boone, L. (2015). Parents make the difference: a randomized-controlled trial of a parenting intervention in Liberia. Global Mental Health, 2. doi:10.1017/gmh.2015.12
- Puffer, E., Green, E., Sikkema, K., Broverman, S., Ogwang-Odhiambo, R., & 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, 511–525. doi:10.1037/ccp0000076.
- Rubin, D. B. (2004). Multiple imputation for nonresponse in surveys. Hoboken, NJ: John Wiley & Sons.Google Scholar
- Ryzin, M. J. V., Kumpfer, K. L., Fosco, G. M., & Greenberg, M. T. (2015). Family-based prevention programs for children and adolescents: Theory, research, and large-scale dissemination. Psychology Press.Google Scholar
- Shonkoff, J. P., & Fisher, P. A. (2013). Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Development and Psychopathology, 25, 1635–1653. doi:10.1017/S0954579413000813
- Sim, A., Annan, J., Puffer, E., Salhi, C., & Betancourt, T. (2014a). Building Happy Families: Impact evaluation of a parenting and family skills intervention for migrant and displaced Burmese families in Thailand. International Rescue Committee.Google Scholar
- Sim, A., Puffer, E., Green, E., Chase, R., Zayzay, J., Garcia-Rolland, E., & Boone, L. (2014b). Parents Make the Difference Findings from a randomized impact evaluation of a parenting program in rural Liberia. International Rescue Committee.Google Scholar
- South, A. (2008). Ethnic politics in Burma: States of conflict. New York, NY: Routledge.Google Scholar
- StataCorp. (2011). Stata Statistical Software (Version 12). College Station, TX: StataCorp LP.Google Scholar
- Sumargi, A., Sofronoff, K., & Morawska, A. (2014). A randomized-controlled trial of the Triple P-Positive Parenting Program Seminar Series with Indonesian parents. Child Psychiatry & Human Development, 46, 749–761. doi:10.1007/s10578-014-0517-8
- Tol, W. A., Song, S., & Jordans, M. J. D. (2013). Annual Research Review: Resilience and mental health in children and adolescents living in areas of armed conflict—a systematic review of findings in low- and middle-income countries. Journal of Child Psychology and Psychiatry, 54, 445–460. doi:10.1111/jcpp.12053.CrossRefPubMedGoogle Scholar