We conducted a pilot feasibility and acceptability trial of the Family Strengthening Intervention for refugees (FSI-R) using a community-based participatory research (CBPR) approach. The FSI-R is a family home-visiting intervention, delivered by refugee community-based health workers, to promote youth mental health and improve family relationships. We hypothesized that those in the intervention would have better psychosocial outcomes and more positive family functioning post-intervention compared to care-as-usual (CAU) families. We hypothesized that FSI-R would be feasible to implement and accepted by the communities.
Methods: 40 Somali Bantu (n=102 children, 58.4% female; n=43 caregivers, 79.0% female) and 40 Bhutanese (n=53 children, 55.3% female; n=67 caregivers, 54.0% female) families with at least one child (7–17 years) were randomized to receive FSI-R or CAU. Refugee research assistants conducted psychosocial assessments at baseline and post-intervention. Multilevel modeling assessed effects of FSI-R on outcomes. Feasibility was measured from the retention rate and acceptability was measured from satisfaction surveys.
Results: The FSI-R was associated with improved individual- and family-level outcomes. Across both communities, children who received FSI-R reported reduced traumatic stress reactions and caregivers reported fewer symptoms of child depression compared to CAU families (β=-0.42; p=0.03; β=-0.34; p=0.001). Bhutanese children who received FSI-R reported reduced family arguing (β=-1.32; p=0.035) and showed fewer symptoms of depression and conduct problems by parent report (β= -9.20; p=0.038; β=-0.92; p=0.01) compared to CAU families. There were no significant differences by group on other measures of functional impairment, intergenerational congruence, or caregiver trauma symptoms. The retention rate of 82.5% indicates FSI-R was feasible and high reports of satisfaction with FSI-R (81.5%) indicates community acceptance.
Conclusion: Family-based prevention through a home-visiting intervention can be feasible and acceptable and has promise for promoting mental health and family functioning among resettled refugees.