Parent level support for child mental health in complex humanitarian emergencies: The basis for, development of, and pilot testing of a parent group counselling intervention.

Abstract

Background: Children in complex humanitarian emergencies (CHE) are exposed to extreme levels of adversity and stress. The experiences and circumstances of CHEs have a significant negative impact on child mental health, resulting in high levels of mental health disorders and psychosocial difficulties. Parents and primary caregivers can have difficulty responding to and managing the emotional and behavioural changes seen in their children, while at the same time struggling to cope with the impact of the CHE on their own health, wellbeing, and functioning. Evidence-based interventions to improve and protect child mental health and psychosocial wellbeing in CHEs are lacking. Little is known about how best to support the mental health of children and families in these settings. Methods: This research project consisted of five stages. In stage one, literature review was completed to understand the determinants of child mental health in CHEs, the existing interventions and evidence-base for these interventions, relevant guideline documents, and the theoretical frameworks relevant to understanding child mental health and parenting in settings of CHE. In stage two, qualitative interviews were conducted with Medecins Sans Frontieres (MSF) mental health staff to understand the needs and challenges experienced by parents and staff in addressing child mental health difficulties across CHEs. In stage three, an intervention was developed to address the needs and challenges as identified in the first two stages of the research project. The process of development considered the relevant psychological therapeutic approaches, defined the aims and structure of the intervention, and determined the framework to guide cultural adaptation of the intervention across contexts of CHE. In stage four, qualitative interviews were conducted with non-specialist health staff in Papua New Guinea that had extensive experience working with parents and children that had experienced extreme levels of violence, abuse, and psychological trauma. Staff views on (i) the potential usefulness, benefits, and challenges of the parent group intervention, and (ii) the suitability of implementing the parent group intervention in the PNG context were assessed. In the final stage, a pilot study was conducted in partnership with MSF to assess the feasibility and acceptability of implementing and evaluating the parent group intervention in Iraq. One group consisting of eight participants was implemented, alongside the completion of outcome measures. Results: A clear rationale and need for parent-level interventions to support child mental health in CHEs was identified. A parent group counselling intervention was developed for parents of 8-12 year olds that could be delivered by non-specialist health staff in settings of CHE to address child mental health needs. This intervention was perceived as useful, understandable, and relevant by a group of non-specialist health staff in PNG. These staff also highlighted a range of issues to consider and address when implementing the parent group intervention in different humanitarian settings. Pilot testing of the parent group intervention in Iraq found the intervention was feasible and acceptable, and that the research protocol for evaluating the intervention was also feasible and acceptable. Lastly, the pilot study provided preliminary support that the intervention holds potential benefit to child mental health and parent mental health. Conclusion: This research developed a parent group intervention that addressed the clear need for greater support for the mental health of children and families in CHEs. The intervention was well received by non-specialist health staff, and was found to be feasible and acceptable to implement and evaluate in a setting of CHE. The positive pilot results provide a strong basis for future research investigating the effectiveness of the parent group intervention in settings of CHE.