title: The impact of a family skills training intervention among Burmese migrant families in Thailand: A randomized controlled trial.
abstract: OBJECTIVE
  To conduct a randomized controlled trial assessing the impact of a family-based intervention delivered to Burmese migrant families displaced in Thailand on parenting and family functioning.
  
  
  METHODS
  Participants included 479 Burmese migrant families from 20 communities in Thailand. Families, including 513 caregivers and 479 children aged 7 to 15 years, were randomized to treatment and waitlist control groups. The treatment group received a 12-session family-based intervention delivered to groups of families by lay facilitators. Adapted standardized and locally derived measures were administered before and after the intervention to assess parent-child relationship quality, discipline practices, and family functioning.
  
  
  RESULTS
  Compared with controls, intervention families demonstrated improved quality of parent-child interactions on scales of parental warmth and affection (Effect size (ES) = 0.25 caregivers; 0.26 children, both p < 0.05) and negative relationship quality (ES = -0.37, p < 0.001 caregivers; -0.22 children, p < 0.05). Both children and caregivers also reported an effect on relationship quality based on a locally derived measure (ES = 0.40 caregivers, p < .001; 0.43 children, p < .05). Family functioning was improved, including family cohesion (ES = 0.46 caregivers; 0.36 children; both p < 0.001) and decreased negative interactions (ES = -0.30 caregivers, p < 0.01; -0.24 children, p < 0.05). Family communication also improved according to children only (ES = 0.29, p < 0.01). Caregivers, but not children, reported decreased harsh discipline (ES = -0.39, p < 0.001), and no effects were observed on use of positive discipline strategies. Treatment attendance was high, with participants attending a mean of 9.7 out of 12 sessions.
  
  
  CONCLUSIONS
  The intervention increased protective aspects of family well-being for migrant children and caregivers in a middle-income country. The strongest effects were on parent-child relationship quality and family functioning, while results were mixed on changes in discipline practices. Results suggest that a behavioral family-based approach implemented by lay providers in community settings is a promising intervention approach for strengthening families in highly stressed contexts.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01668992.
authors.affiliation: Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Eve S
authors.initials: ES
authors.lastname: Puffer
authors.affiliation: Research, Evaluation, and Learning Technical Unit, The International Rescue Committee, New York, New York, United States of America.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Annan
authors.affiliation: Centre for Evidence Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Sim
authors.affiliation: Labs of Cognitive Neuroscience, Department of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Carmel
authors.initials: C
authors.lastname: Salhi
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D044466:Asian People; D017028:Caregivers / Q000193:education; D002648:Child; D054242:Emigrants and Immigrants; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D002052:Myanmar / Q000208:ethnology; D017063:Outcome Assessment, Health Care; D010287:Parent-Child Relations; D016487:Parenting; D010290:Parents / Q000193:education*; D011795:Surveys and Questionnaires; D013785:Thailand; D014171:Transients and Migrants