Adolescent - Emotional Problem, Adolescent Problem Behavior, Child Abuse, Child Behavior, Child Mental Disorder, Domestic Violence, Family Conflict, Family Relations, Marital Conflict, Mental Health Issue, Parent-Child Relations, Parenting
Conditions
Brief summary
The purpose of this study is to evaluate a family counseling intervention, entitled Tuko Pamoja (Translation We are Together in Kiswahili). The intervention, delivered by lay counselors and through existing community social structures, is expected to improve family functioning and individual mental health among members. The sample includes families with a child or adolescent (ages 8-17) experiencing problems in family functioning.
Detailed description
The purpose of this study is to evaluate a family counseling intervention, entitled Tuko Pamoja (Translation We are Together in Kiswahili), using a pilot randomized control trial design. The intervention, delivered by lay counselors and through existing community social structures, focuses on improving family relationships and mental health with content derived from evidence-based practices; these include family systems and solution-focused family therapies and cognitive behavioral strategies. It is components based, with modules delivered based on need. The content and structure has been adapted in both content and implementation model based on formative research in this context. Primary hypotheses include achieving improvements in outcomes related to: 1. Family functioning, including elements such as communication, emotional closeness, structure and organization, and satisfaction for the overall family; this also includes indicators of functioning at dyadic levels (i.e., parent-child and couples functioning) 2. Mental health of both children and caregivers. The investigators also hypothesize feasibility and acceptability, including high fidelity and adequate clinical competency by the non-specialist counselors, based on a previous evaluation of the program. The study will follow a randomized controlled design with a target sample size of 60 families, including up to 2 caregivers per family (who hold primary responsibility for the child whether biological or non-biological) and a target child identified either through caregiver-report of the child about whom they are most concerned or randomly, if there is no child with particular concerns. Families will be recruited in two rounds of 30 families due to logistical limitations of enrolling all 60 at the same time.
Interventions
Tuko Pamoja, We are Together in Kiswahili; This intervention, delivered by lay counselors and through existing community social structures, focuses on improving family relationships and mental health with content derived from evidence-based practices; these include solution-focused family therapy and cognitive behavioral strategies. It is components based, with modules delivered based on need. Tuko Pamoja includes a smart phone component to support psychoeducation components and data collection. The content and structure has been adapted in both content and implementation model based on formative research in this context.
Sponsors
Moi University
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized Controlled Trial
Eligibility
Sex/Gender
ALL
Age
8 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Family with self-reported elevated distress (e.g., high levels of conflict) that also has a child/adolescent (ages 8-17) with caregiver-reported emotional or behavioral concerns
Exclusion criteria
* Families without reported distress and/or without reported adolescent distress. * Families with children older than 17 or younger than 8 years of age. * Families in which primary caregivers or children are living too far outside of the community to participate in treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Family Functioning (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 30 self-report items developed for the local context based on formative research (Family Togetherness Scale, FTS). Responses are endorsed on a 10-point scale and refer to the past month. One composite score is calculated (range: 0 - 30); higher scores represent more family distress. |
| Parent-Child Communication (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 20 self-report items from the Parent-Adolescent Communication Scale (PACS). Each include caregiver and child/adolescent report versions. Participants are asked to respond based on the past month. Children report on each caregiver separately. One composite score is calculated (range: 0 - 60); higher scores represent better parent-child communication. |
| Parent-Child Relationship Quality (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 20 self-report items from the Parent Adolescent Relationship Questionnaire (PARQ) Warmth Subscale. One composite score is calculated (range: 0 - 60); higher scores represent better parent-child relationship quality. |
| Harsh Parenting (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 15 self-report items from the Parent Adolescent Relationship Questionnaire (PARQ) Hostility/Aggression Subscale. One composite score is calculated (range: 0 - 45); higher scores represent more harsh parenting characteristics. |
| Couples Relationship Quality (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 13 self-report items from the Dyadic Adjustment Scale (DAS) Cohesion and Satisfaction subscales and 9 locally-developed items. One composite score is calculated (range: 22 - 132); higher scores represent better couples relationship quality. |
| Child Mental Health (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 20 self-report items from the Child Behavior Checklist (CBCL) and 6 locally-developed items. One composite score is calculated (range: 20 - 60); higher scores represent worse child mental health. |
| Child Mental Health (Child Report) | Baseline, 1 month, and 3 month post-intervention | 19 self-report items from the Youth Self-Report (YSR) and 7 locally-developed items. One composite score is calculated (range: 0 - 52); higher scores represent worse child mental health. |
| Caregiver Mental Health (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 9 self-report items from the Patient Health Questionnaire (PHQ-9), 14 self-report items from the General Health Questionnaire (GHQ), and 6 locally-developed items. One composite score is calculated (range: 0 - 87); higher scores represent worse caregiver mental health. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adult Well-being (Adult Report) | Baseline, 1 month, and 3 month post-intervention | 7 self-report items from the Short Warwick Edinburgh Well-being Scale. One composite score is calculated (range: 7 - 35); higher scores represent better adult well-being. |
| Physical Maltreatment (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 2 items from the Multiple Indicator Cluster Survey (MICS) and 2 items from the Discipline Interview. One composite score is calculated (range: 0 - 12); higher scores represent more physical maltreatment. |
| Caregiver Coping (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 28 self-report items from the Brief-COPE. One composite score is calculated (range: 28 - 112); higher scores represent better coping skills. |
| Couples Violence (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 3 locally-developed items. One composite score is calculated (range: 0 - 12); higher scores represent more couples violence. |
| Child Belongingness in Family (Child Report) | Baseline, 1 month, and 3 month post-intervention | 5 locally-developed items. One composite score is calculated (range: 0 - 10); higher scores represent more child belongingness in the family. |
| Child Hope (Child Report) | Baseline, 1 month, and 3 month post-intervention | 6 self-report items from the Children's Hope Scale. One composite score is calculated (range: 6 - 36); higher scores represent higher hope levels. |
| Child Prosocial Behavior (Caregiver and Child Report) | Baseline, 1 month, and 3 month post-intervention | 6 locally-developed items. One composite score is calculated (range: 0 - 12); higher scores represent more prosocial behaviors. |
| Caregiver Hope (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 12 self-report items from the Children's Hope Scale. One composite score is calculated (range: 6 - 48); higher scores represent higher hope levels. |
| Social Support (Caregiver Report) | Baseline, 1 month, and 3 month post-intervention | 28 self-report items from the Inventory of Socially Supportive Behaviors (ISSB), 12 self-report items from the Multidimensional Scale of Perceived Social Support (MSPSS), and 7 locally-developed items. One composite score is calculated (range: 29 - 147); higher scores represent more social support. |
| Child Well-being (Child Report) | Baseline, 1 month, and 3 month post-intervention | 7 self-report items from the Short Warwick Edinburgh Well-being Scale. One composite score is calculated (range: 7 - 35); higher scores represent better child well-being. |
Countries
Kenya
Outcome results
None listed