Methods: This feasibility study was conducted from 2018 to 2019. Families were eligible if they had a child aged 6-12 who was reuniting with their biological families as a part of national deinstitutionalization reform. Families (N = 20) were recruited from public residential institutions in three cities of Azerbaijan. The study used a mixed methods explanatory sequential design (a single group pre-posttest quantitative assessment with qualitative data collection at the end of the intervention).
Due to its focus on strengthening families and building social support between at-risk families, the team adapted the evidence-based intervention ‘SAFE Children.’ SAFE Children is designed to improve family functioning, strengthen child-parent relationships, and prevent emotional and behavioral problems among at-risk children. The intervention consisted of twelve weekly multiple-family group meetings led by trained facilitators. All interested family members were invited to join the sessions.
Measures: Process and implementation measures included acceptability (participant satisfaction, session attendance), feasibility (recruitment and attrition rates), and fidelity (using facilitator rating forms). Baseline and post-intervention data were collected from one participating child and one parent, assessing children’s mental health, parenting skills, quality of child-parent relationships, parental distress and social support using standardized measurement instruments.
Results: Participants attended an average of 75% of sessions; 50% of families attended all sessions. There was a statistically significant reduction on the total difficulty subscale of the Strengths and Difficulties Questionnaire from baseline (M = 21.14, SD = 6.09) to post-intervention (M =15.70, SD = 4.88), t = 4.69, p ≤ .01, also suggested by a large Cohen’s effect size value (d = 1.05). Further, large effect size values were noted in all parental distress symptoms on the Depression, Anxiety, and Stress Scale (DASS-21) from baseline to post-intervention (d = 1.18 for depression subscale, d = 0.91 anxiety, and d = 0.79 stress), indicating significant reductions in symptoms.
Conclusions and Implications: This pilot study demonstrated the feasibility, acceptability, and preliminary estimates of the efficacy of a family strengthening intervention model. Results support a critical need for targeting family-level protective factors to prevent mental health problems during the deinstitutionalization process. Findings have been used to inform a fully-powered randomized control trial funded by the National Institute of Child Health and Human Development.