The purpose of this study is to evaluate a family counseling intervention, entitled "Tuko Pamoja" (Translation "We are Together" in Kiswahili). The intervention, delivered by lay counselors and through existing community social structures, is expected to improve family functioning and individual mental health among members. The sample includes families with a child or adolescent (ages 8-17) experiencing problems in family functioning.
The purpose of this study is to evaluate a family counseling intervention, entitled "Tuko Pamoja" (Translation "We are Together" in Kiswahili), using a pilot randomized control trial design. The intervention, delivered by lay counselors and through existing community social structures, focuses on improving family relationships and mental health with content derived from evidence-based practices; these include family systems and solution-focused family therapies and cognitive behavioral strategies. It is components based, with modules delivered based on need. The content and structure has been adapted in both content and implementation model based on formative research in this context. Primary hypotheses include achieving improvements in outcomes related to: 1. Family functioning, including elements such as communication, emotional closeness, structure and organization, and satisfaction for the overall family; this also includes indicators of functioning at dyadic levels (i.e., parent-child and couples functioning) 2. Mental health of both children and caregivers. The investigators also hypothesize feasibility and acceptability, including high fidelity and adequate clinical competency by the non-specialist counselors, based on a previous evaluation of the program. The study will follow a randomized controlled design with a target sample size of 60 families, including up to 2 caregivers per family (who hold primary responsibility for the child whether biological or non-biological) and a target child identified either through caregiver-report of the child about whom they are most concerned or randomly, if there is no child with particular concerns. Families will be recruited in two rounds of 30 families due to logistical limitations of enrolling all 60 at the same time.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
240
Tuko Pamoja, "We are Together" in Kiswahili; This intervention, delivered by lay counselors and through existing community social structures, focuses on improving family relationships and mental health with content derived from evidence-based practices; these include solution-focused family therapy and cognitive behavioral strategies. It is components based, with modules delivered based on need. Tuko Pamoja includes a smart phone component to support psychoeducation components and data collection. The content and structure has been adapted in both content and implementation model based on formative research in this context.
Moi University
Eldoret, Kenya
Family Functioning (Caregiver and Child Report)
30 self-report items developed for the local context based on formative research (Family Togetherness Scale, FTS). Responses are endorsed on a 10-point scale and refer to the past month. One composite score is calculated (range: 0 - 30); higher scores represent more family distress.
Time frame: Baseline, 1 month, and 3 month post-intervention
Parent-Child Communication (Caregiver and Child Report)
20 self-report items from the Parent-Adolescent Communication Scale (PACS). Each include caregiver and child/adolescent report versions. Participants are asked to respond based on the past month. Children report on each caregiver separately. One composite score is calculated (range: 0 - 60); higher scores represent better parent-child communication.
Time frame: Baseline, 1 month, and 3 month post-intervention
Parent-Child Relationship Quality (Caregiver and Child Report)
20 self-report items from the Parent Adolescent Relationship Questionnaire (PARQ) Warmth Subscale. One composite score is calculated (range: 0 - 60); higher scores represent better parent-child relationship quality.
Time frame: Baseline, 1 month, and 3 month post-intervention
Harsh Parenting (Caregiver and Child Report)
15 self-report items from the Parent Adolescent Relationship Questionnaire (PARQ) Hostility/Aggression Subscale. One composite score is calculated (range: 0 - 45); higher scores represent more harsh parenting characteristics.
Time frame: Baseline, 1 month, and 3 month post-intervention
Couples Relationship Quality (Caregiver Report)
13 self-report items from the Dyadic Adjustment Scale (DAS) Cohesion and Satisfaction subscales and 9 locally-developed items. One composite score is calculated (range: 22 - 132); higher scores represent better couples relationship quality.
Time frame: Baseline, 1 month, and 3 month post-intervention
Child Mental Health (Caregiver Report)
20 self-report items from the Child Behavior Checklist (CBCL) and 6 locally-developed items. One composite score is calculated (range: 20 - 60); higher scores represent worse child mental health.
Time frame: Baseline, 1 month, and 3 month post-intervention
Child Mental Health (Child Report)
19 self-report items from the Youth Self-Report (YSR) and 7 locally-developed items. One composite score is calculated (range: 0 - 52); higher scores represent worse child mental health.
Time frame: Baseline, 1 month, and 3 month post-intervention
Caregiver Mental Health (Caregiver Report)
9 self-report items from the Patient Health Questionnaire (PHQ-9), 14 self-report items from the General Health Questionnaire (GHQ), and 6 locally-developed items. One composite score is calculated (range: 0 - 87); higher scores represent worse caregiver mental health.
Time frame: Baseline, 1 month, and 3 month post-intervention
Physical Maltreatment (Caregiver and Child Report)
2 items from the Multiple Indicator Cluster Survey (MICS) and 2 items from the Discipline Interview. One composite score is calculated (range: 0 - 12); higher scores represent more physical maltreatment.
Time frame: Baseline, 1 month, and 3 month post-intervention
Couples Violence (Caregiver Report)
3 locally-developed items. One composite score is calculated (range: 0 - 12); higher scores represent more couples violence.
Time frame: Baseline, 1 month, and 3 month post-intervention
Child Belongingness in Family (Child Report)
5 locally-developed items. One composite score is calculated (range: 0 - 10); higher scores represent more child belongingness in the family.
Time frame: Baseline, 1 month, and 3 month post-intervention
Child Hope (Child Report)
6 self-report items from the Children's Hope Scale. One composite score is calculated (range: 6 - 36); higher scores represent higher hope levels.
Time frame: Baseline, 1 month, and 3 month post-intervention
Child Prosocial Behavior (Caregiver and Child Report)
6 locally-developed items. One composite score is calculated (range: 0 - 12); higher scores represent more prosocial behaviors.
Time frame: Baseline, 1 month, and 3 month post-intervention
Caregiver Hope (Caregiver Report)
12 self-report items from the Children's Hope Scale. One composite score is calculated (range: 6 - 48); higher scores represent higher hope levels.
Time frame: Baseline, 1 month, and 3 month post-intervention
Social Support (Caregiver Report)
28 self-report items from the Inventory of Socially Supportive Behaviors (ISSB), 12 self-report items from the Multidimensional Scale of Perceived Social Support (MSPSS), and 7 locally-developed items. One composite score is calculated (range: 29 - 147); higher scores represent more social support.
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Time frame: Baseline, 1 month, and 3 month post-intervention
Child Well-being (Child Report)
7 self-report items from the Short Warwick Edinburgh Well-being Scale. One composite score is calculated (range: 7 - 35); higher scores represent better child well-being.
Time frame: Baseline, 1 month, and 3 month post-intervention
Adult Well-being (Adult Report)
7 self-report items from the Short Warwick Edinburgh Well-being Scale. One composite score is calculated (range: 7 - 35); higher scores represent better adult well-being.
Time frame: Baseline, 1 month, and 3 month post-intervention
Caregiver Coping (Caregiver Report)
28 self-report items from the Brief-COPE. One composite score is calculated (range: 28 - 112); higher scores represent better coping skills.
Time frame: Baseline, 1 month, and 3 month post-intervention