(WITHDRAWN) Preliminary Findings from a Pilot Feasibility Trial of a Family-Focused Mental Health Intervention for Children Reintegrating from Orphanages in Post-Soviet Country

Background and Purpose: The countries of the former Soviet Union (fSU) and Eastern Europe have the highest number of children in institutional care worldwide--up to 1.3 million children. Due to years of family separation, deprivation, and maltreatment, children living in institutions are at an increased risk for emotional and behavioral problems that may lead to adult mental illness and risk of suicide. Despite on-going de-institutionalization reforms in the post-Soviet region, there are no culturally-adapted evidence-based programs to address the mental health needs of children from institutions reintegrating back in the society. Using a community-based participatory research framework, this study aimed to: 1) adapt a manualized family strengthening intervention for children reuniting with their families in Azerbaijan, 2) pilot-test the intervention with families and 3) assess the feasibility and acceptability of the adapted intervention.

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.