Parenting Skills Training for Caregivers of Behaviorally Disordered Children in Port-Au-Prince, Haiti

Purpose: Traumatized children often react with an increase in problem behaviors such as defiance, aggression, decreased school performance, and disobedience. Parents may find caring for these children difficult and may struggle with setting limits or providing positive reinforcement. This difficulty is compounded when families are displaced after a traumatic event. Two years after the January 2010 earthquake, with 400,000 of Port-au-Prince’s 2.2 million residents still living in Internally Displaced Persons (IDP) camps, the authors implemented a social work intervention aimed at improving the parenting skills of adults caring for children with behavioral challenges.

Methods: Using a randomized clinical trial design, we compared the impact of the intervention, which included five group sessions of parenting, self-care and coping skills, to a control group comprised of individuals who were waitlisted for the intervention. Lay mental health workers received 3 weeks of training by Haitian social work students before leading the 5 week intervention group. Each 3 hour group session included practical skills such as limit setting, using praise, and options for non-violent discipline, in addition to as caregiver-centered self-care skills.

180 children living in IDP camps and temporary housing were recruited through contact with schools between January-August 2012. Primary inclusion criteria were being a primary caregiver of a child aged 6-13 who developed behavioral problems after the earthquake and being currently displaced. Data was collected at baseline as well as at 3, 6, 9, and 12 weeks post-baseline.

Primary outcome variables were a reduction in problem behaviors as reported by the caregiver/the child’s teacher improved quality of life (measured using the Pearson’s Quality of Life Inventory). Secondary outcomes were satisfaction with the intervention, family functioning, and improved self-care skills of the caregiver. Data analyses included descriptive statistics as well as multivariate analyses of variance.

Results: Outcome data suggested significant improvements in quality of life, coping behaviors and perceived parenting skills of caregivers. F-values representing the outcome variables demonstrated significance at the .001 level. Child behavior problems as reported by both parents and teachers decreased in both frequency and severity overall though a small group of children with serious behavioral problems including fire-starting and violence towards animals experienced only modest improvement after the intervention. Those in the control group (n=75) experienced no statistically significant change during the 16 week wait-listing period. Family functioning, as measured by the McMaster Family Functioning Scale, improved dramatically for participants. Measure variables related to increased quality and quantity of communication were correlated with improved quality of life of the caregiver, decreased sibling aggression as reported by the caregiver, and improved academic performance as reported by the child’s teacher.

Implications: This data suggests that short-term skills based interventions targeting caregivers can improve the behavior of traumatized children despite a precarious living environment. Although disaster response in the developing world often focuses on practical needs for shelter and food, targeted social work interventions addressing the psychosocial needs of children and their families are also needed and are able to improve the quality of life for those who are still displaced.