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Bosqui T, Mayya A, Farah S, Shaito Z, Jordans MJD, Pedersen G, Betancourt TS, Carr A, Donnelly M, Brown FL. Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review. Compr Psychiatry 2024; 132:152483. [PMID: 38631272 DOI: 10.1016/j.comppsych.2024.152483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/31/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential. METHOD This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0-24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes. MAIN FINDINGS We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs. PRELIMINARY CONCLUSIONS Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.
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Affiliation(s)
- Tania Bosqui
- Department of Psychology, American University of Beirut, Beirut, Lebanon; Trinity Centre for Global Health, Trinity College Dublin, Republic of Ireland.
| | - Anas Mayya
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Sally Farah
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Zahraa Shaito
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Mark J D Jordans
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gloria Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, the George Washington University School of Medicine and Health Sciences, Washington D.C., United States
| | | | - Alan Carr
- University College Dublin, Dublin, Republic of Ireland.
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
| | - Felicity L Brown
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
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Abujaber N, Ryan M, McBride KA, Tingsted Blum P, Engels M, Didenko A, Green H, Peres de Matos CS, Whitton S, Vallières F. Implementing supportive supervision in acute humanitarian emergencies: Lessons learned from Afghanistan and Ukraine. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002416. [PMID: 38630740 PMCID: PMC11023585 DOI: 10.1371/journal.pgph.0002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024]
Abstract
Mental Health and Psychosocial Support (MHPSS) practitioners working in humanitarian contexts are at significant risk of mental health conditions, ultimately hindering the quality and sustainability of their work. Supportive supervision has shown to be effective in improving the wellbeing of MHPSS staff and volunteers and enhancing the effectiveness of MHPSS service delivery. Despite these proven benefits, there is a lack of standardised guidelines to inform supportive supervision within humanitarian contexts. To address this gap, the Trinity Centre for Global Health and the International Federation of the Red Cross Red Crescent Societies' Reference Centre for Psychocosial Support co-developed the 'Integrated Model for Supervision' (IMS) Handbook and supporting tools and led IMS trainings with four humanitarian organisations in Ukraine, Afghanistan, Jordan, and Nigeria from June-August 2021. The subsequent acute humanitarian emergencies that occurred in Afghanistan and Ukraine provided the opportunity to (i) examine the implementation of the IMS in the acute stages of two humanitarian crises and (ii) identify the challenges and lessons learned from this process. This study employed a case study design using semi-structured qualitative interviews with five MHPSS personnel (female: 4; male: 1) who had received training in the IMS and were directly involved in the implementation of supportive supervision using IMS guidelines in either Ukraine or Afghanistan. Results showed that participants identified the key steps needed for the implementation of supportive supervision and reported two significant barriers to implementation including the stress of a humanitarian crisis leading to competing responsibilities and priorities, staff shortages and time constraints as well as the challenge of creating a new supervision structure when none had existed previously. Overall, participants felt that the IMS resulted in improved knowledge, confidence, perceived support, team cohesion, staff wellbeing and was a helpful blueprint to guide the implementation of supportive supervision in humanitarian contexts.
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Affiliation(s)
- Nadeen Abujaber
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Meg Ryan
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Kelly A. McBride
- Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Pia Tingsted Blum
- Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Michelle Engels
- Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Anna Didenko
- Rehabilitation and Support Department, Red Cross Society, Kyiv, Ukraine
| | - Hannah Green
- Mental Health and Psychosocial Services Department, Save the Children, Kyiv, Ukraine
| | - Catia Sofia Peres de Matos
- Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Shona Whitton
- Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark
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O’Sullivan E, Abujaber N, Ryan M, McBride KA, Tingsted Blum P, Vallières F. Gender considerations for supportive supervision in humanitarian contexts: A qualitative study. Glob Ment Health (Camb) 2023; 10:e50. [PMID: 37854397 PMCID: PMC10579646 DOI: 10.1017/gmh.2023.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 10/20/2023] Open
Abstract
Supportive supervision has been shown to improve mental health outcomes and job retention for mental health and psychosocial support (MHPSS) workers in humanitarian contexts. However, the impact of gender on supervision practices has been poorly evaluated and documented in international guidelines to date. To address this gap, qualitative interviews were conducted with 12 MHPSS staff working in diverse humanitarian contexts to identify key gender considerations in supportive supervision. Results show that gender in supervision is influenced by the context of MHPSS work; with culture, religion and gender roles identified as key elements. Participants discuss recruitment mechanisms, highlighting the unequal gender distribution and inequitable opportunities within MHPSS programming. The importance of addressing power dynamics impacted by gender and of ensuring the safety of women within supervision is also highlighted. Finally, participants discuss the gender differences across the various supervisory formats. Altogether, results indicate that gender has the potential to influence supportive supervision within MHPSS, and it is recommended that international guidelines account for nuances of gender in supportive supervision within humanitarian contexts.
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Affiliation(s)
| | - Nadeen Abujaber
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Meg Ryan
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Kelly A. McBride
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Pia Tingsted Blum
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
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Ryan M, Abujaber N, McBride KA, Tingsted Blum P, Engels M, Alshibi A, Greene H, Githaiga S, Didenko A, Vallières F. The acceptability, appropriateness, and feasibility of implementing supportive supervision within humanitarian contexts: A qualitative study. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Schwartz L, Nakonechna M, Campbell G, Brunner D, Stadler C, Schmid M, Fegert JM, Bürgin D. Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border. Eur J Psychotraumatol 2022; 13:2101759. [PMID: 36212118 PMCID: PMC9543048 DOI: 10.1080/20008198.2022.2101759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
UNLABELLED Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.
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Affiliation(s)
- Lyla Schwartz
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Peace of Mind Afghanistan Global (PoMA Global), Longmeadow, MA, USA
| | - Mariia Nakonechna
- Department of General and Applied Psychology, Nizhyn Gogol State University, Nizhyn, Ukraine.,Unitatem Foundation ("Poland Welcomes"), Jarosław, Poland
| | | | - Donja Brunner
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Christina Stadler
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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