The development of a caregiver intervention to address child mental health in settings of complex humanitarian emergency: a multi-phase, multi-method approach

Abstract

Background: Effective parenting can mediate the negative impact of complex humanitarian emergencies (CHEs) on child mental health, however many caregivers struggle to parent effectively in these settings. Parenting interventions have robust evidence in many settings, however research supporting their use in CHEs is limited. We describe the development of a caregiver group intervention delivered by non-specialist staff to support child mental health in CHEs. Methods: A multi-phase, multi-method approach was employed: Phase 1: semi-structured interviews, analysed inductively, with specialist mental health staff in CHEs on needs and challenges in providing mental healthcare to children and caregivers. Phase 2: initial intervention development informed by Phase 1 and evidence-based theoretical approaches and psychological therapies. Phase 3: expert review of draft intervention. Phase 4: semi-structured interviews, analysed inductively, with non-specialist staff in Papua New Guinea (PNG) to evaluate relevance, comprehensibility, and applicability of the intervention. Phase 5: cultural adaptation of the intervention prior to implementation in Northern Iraq. Different operational partners and research sites were employed at different phases of development to increase diversity of inputs and support the overall vision of an intervention that addressed common mental health difficulties and underlying factors to support children and caregivers across CHEs. Results: Mental health staff in CHEs identified a significant need for interventions to support parenting and address child mental health needs. A caregiver group intervention was developed consisting of six two-hour sessions, delivered weekly by non-specialist staff, and targeting parent knowledge and skills and parent stress. Expert consultation identified aspects of the intervention to emphasise or simplify, resulting in a refined intervention with ensured clinical quality. Non-specialist staff in PNG confirmed the intervention relevance to a vulnerable population in a humanitarian setting, and the manual was determined suitable for non-specialist facilitators. Mental health literacy, stigma and cultural views (masculinity, family privacy) were identified as challenges to address. A multi-stage method of cultural adaptation in Iraq ensured the clinical and cultural accuracy, relevance, and acceptability of the intervention. Initial adaptations to the language and metaphors used in the intervention resulted in high cultural appropriateness during pilot testing. Prioritising the recruitment and engagement of male caregivers is critical. Conclusions: A caregiver intervention to support child mental health in CHEs is available. It’s development using multi-method, co-design processes will ensure its relevance and acceptability to target populations. Further research to evaluate the effectiveness and long-term effectiveness of the intervention is warranted.