Implementing parenting programmes in humanitarian crises

On a chilly Thursday afternoon in late November 2017, Sandra Maignant, a technical advisor for the International Rescue Committee (IRC), visited a parenting class in the Nargazilia displacement camp in north-west Iraq. The tent where the class was being held was unheated and had flooded, causing Maignant to shiver as she watched the two-hour session. It struck her that none of the 18 Iraqi men attending even wore socks to protect against the damp cold. Yet when the class ended, all of the fathers stayed on to extol the programme to Maignant. Unable to offer the childhoods they had experienced, these parents were desperate for ways to protect their kids from the trauma of war and displacement.

It’s well known that parenting programmes can reduce violence against children and increase positive development. J. Barlow at al., ‘Individual and group-based parenting programmes for the treatment of physical child abuse and neglect’, Cochrane Database Syst Rev 19(3), 2006 (https://www.ncbi.nlm.nih.gov/pubmed/16856097); M. Chen and K. L. Chan, ‘Effects of parenting programs on child maltreatment prevention: a meta-analysis’, Trauma Violence Abuse 17(1), 2016 (https://www.ncbi.nlm.nih.gov/pubmed/25573846). Parents who participate learn to listen to their children, establish routines and use positive discipline techniques such as ‘time out’. Such programmes have mostly taken place in stable, wealthy countries. Only recently have humanitarian organisations begun adapting parenting programmes for caregivers in crisis areas such as the fathers in Nargazilia – who arguably need it the most.

Children growing up in humanitarian crises are likely to witness extreme violence and suffer unspeakable trauma. One father in Nargazilia told Maignant how televisions in nearby shops often showed images of dead bodies and beheadings that he now realised had stayed with his children. His children had begun shaking whenever they saw people in uniform. This ‘toxic stress’ can cause lifelong problems in physical and mental health. The UN Children’s Fund (UNICEF) has reported that toxic stress can eventually threaten the health and economic wellbeing of entire communities. UNICEF, Early moments matter, 2017 ( https://www.unicef.org/publications/files/UNICEF_Early_Moments_Matter_for_Every_Child.pdf). Adults can help children process trauma, but parents in crises may not know how to cope themselves, let alone support their kids. The stressors in parents’ lives can increase the risk of abuse in the home, leaving children even more vulnerable.

With this understanding in mind, the International Rescue Committee (IRC) has begun implementing parenting interventions such as the one in the Nargazilia camp. The 12-week programme, called Families Make the Difference (FMD), is offered in places as disparate as Nigeria and Jordan. The programme, which consists of ten sessons, was initially created for caregivers of children under five. Core lessons teach about brain development, empathy, positive communication, positive discipline, supportive guidance and routines. In areas of crisis or displacement the programme includes sessions on parental stress. The curriculum has also been adapted for caregivers of older children and adolescents.

The IRC has only fully evaluated FMD through randomised control trials (RCTs) in the relatively stable contexts of Burundi, Liberia and Thailand, but the results indicate that participants increased their use of positive parenting techinques, including spending time with their children; reduced the use of physical and emotional violence; and adopted more positive coping mechanisms. New research suggests that the programme can provide comfort and reduce violence within families in countries affected by conflict and displacement.

When I first contacted the IRC last September, FMD had been implemented in 17 countries in Africa, Asia, Europe and the Middle East. But the organisation had little evidence of how these interventions were performing – especially in camps or in the midst of armed conflict. RCTs are both costly and nearly impossible in countries facing crises. L. Richter and S. Naicker, A review of published literature on supporting and strengthening child-caregiver relationships (parenting) (Arlington, VA: USAID, 2013) (https://aidsfree.usaid.gov/sites/default/files/aidstarone_parenting_litreview_finalweb.pdf). While the IRC had conducted questionnaires with parents before and after their participation in FMD to monitor the programme’s impact, country offices had not been able to analyse the results of their local programmes, and no one had gathered the data at a global level.

My study S. Feintuch, A global evaluation of the International Rescue Committee’s Families Make the Difference parenting program, 2018 (https://www.hks.harvard.edu/sites/default/files/degree%20programs/MPP/files/Feintuch_PAE_Soft-Copy.pdf). brought me into contact with people like Maignant, who advises staff as they set up child protection programmes in the Middle East. She and her co-workers shared data gleaned from over 1,100 questionnaires from 77 interventions in seven countries, pilot programme evaluations and staff reports (including the three RCTs) from seven countries, and notes from focus groups with parents in Syria and Iraq. In addition, I interviewed staff in 12 countries and conducted focus groups with parents in Côte d’Ivoire.

The FMD model

FMD is a group-based intervention. Each week for three months, groups of about 20 parents meet for a couple of hours. A facilitator leads them through activities, including discussions about their own childhoods and role-plays designed to help them interact positively with their children, use non-violent discipline and provide supportive guidance. Although the curriculum is standardised, it can be adapted to fit situational needs. In crisis areas, for example, facilitators focus on teaching parents how to manage stress and improve their wellbeing. They also work with local teachers and social workers.

Implementing a parenting programme in a crisis

Implementing FMD in refugee camps, slums or informal settlements in the midst of armed conflict and forced displacement can be difficult. Interviews revealed the importance of seeking allies in the community, being flexible in the location and timing of sessions and developing buddy systems for participants to check in on and support each other. Interviews also highlighted the importance of trust, developed when the IRC has an established presence in the community, and when programme facilitators speak the same language, or are even programme graduates themselves.

Staff must also convince people whose futures are uncertain that parenting classes are worth their time. Ibrahiem Salloum, a senior child protection officer for the IRC, has been involved in setting up the Families Make the Difference intervention in Lebanon. In December 2013, when the IRC first introduced the programme in an informal tented settlement in the Bekaa Valley, only five parents signed up. Three years later, 700 parents of children under the age of five in Bekaa and 2,500 more in two neighbouring refugee settlements had completed the three-month programme with Salloum’s team.

‘When the programme started,’ Salloum reflected in an interview with me, ‘refugees used to say, “You guys really come and want to teach us how to parent our kids? Instead, why don’t you come and give us food to feed our children?” … So, parents were resistant, and the first year was really hard.’ Salloum and other staff told me that parents were reluctant to join the programme because of competing demands on their time, distrust of programme facilitators and scepticism that the programme could help them. But those who did participate found that the programme helped them process the guilt and anxiety they felt over the conditions that their children were growing up in, learn strategies to cope with their own stress and mitigate the effects of toxic stress on their children and develop friendships with others in similar situations. IRC staff found that the most effective way to attract participants was through building relationships with community leaders and other key stakeholders, who could convey the value of the programme to others. A couple of years later, the programme had a waiting list.

This pattern holds true elsewhere. Adrah is an Iraqi mother living in the Nargazilia camp with her husband and eight children. Every time her husband punished their oldest son severely, Adrah worried he would run away and join Islamic State. ‘My son had said, “If you treat me like this, I will go and join IS”.’ While FMD may not have solved all of Adrah’s problems, it has offered her strategies and a space to discuss her fears. Along with her children, she reported having benefited tremendously from the programme.

FMD’s outcomes in countries dealing with conflict and displacement

Such stories resonate – and are supported by quantitative data – in Iraq, Lebanon, Syria and Jordan. They show that FMD programmes have as big or bigger an impact in conflict-affected countries as they do in less toxic environments, reducing violence against children, improving relationships between parents and children and increasing parental wellbeing and the ability to cope.

The programme’s biggest impact was in reducing violent parental discipline. On average, in the month before they entered the programme 85% of participating parents used some form of harsh physical or psychological punishment on their children, such as spanking, slapping, beating, yelling and name-calling. In the month after they attended the programme, this dropped by half. Many parents seem willing to stop using violent discipline once they learn it’s harmful, and see that alternatives are more effective. ‘I thought my way of dealing with children was the best way,’ one father in the Nargazilia camp, who used to beat his children regularly, told Maignant. His view changed when his group watched a video about child development, which showed how the brains of abused three-year-olds differed visibly from those of nurtured children. ‘I was about to cry when I [realised] the impact of beating on the development of the brain of my children,’ he said. After that session, he stopped hitting his children. Role plays also taught him to empathise with his children. Now, he says, ‘I try to understand [my children]. I ask questions when they don’t want to eat or misbehave. I [use] empathy. There is a big change in my experience as a father and in my knowledge.’

As with parenting programmes elsewhere, FMD helps teach parents how to listen, empathise and help their children solve problems. Sessions teach the importance of positive parental time for healthy growth and development, how to respect children’s opnions and thoughts through empathetic communication and ways to help children with their education. In countries where data was collected, the percentage of parents who used positive parenting strategies increased from 78% to 96%.

Programmes also help parents, both through specific lessons on social and emotional needs and relaxation techniques, and by offering a space for reflection, support and community-building. Adrah, for example, uses deep breathing exercises to calm herself down when she feels suffocated in her cramped tent in Nargazilia: ‘At night, when all ten of us are trying to sleep in this one tent, sometimes I just close my eyes … to count from 20 down to one’. She said that the exercises stop her from getting angry and mistreating her children. The men in the Nargazilia group agreed that the relaxation session had been a favourite, but they also valued simply getting together. For the first time in a long time, the men agreed, someone listened to them. One father added, ‘In every session, we laugh and smile. This is the only place in the camp where we can’. After participating in FMD, fathers in the Nargazilia camp reported that they felt calmer, had a stronger support network in the community and saw improvements in their children’s wellbeing.

There still isn’t enough research to conclude that parenting programmes can work in every crisis context. Parents need to be in the same place for months to complete the training, and psychologically it’s tough to focus on parenting when you’re not sure where your next meal is coming from. Staff in several acute crises found it nearly impossible to retain participants, and feel that the programme should be shorter, but in many crises, especially where families are living for a prolonged period in camps, parenting programmes offer promise.

The IRC has made the parenting programme’s curriculum available online so that others can use it. It doesn’t need to be expensive: a 2014 study of the IRC’s programme in rural Liberia, for instance, showed that lay facilitators can successfully deliver the training. Such a model, where programme graduates are trained as facilitators, makes the programme relatively inexpensive, scalable and effective.

Sophie Feintuch is a Program Officer with the American Jewish World Service. She recently completed her Master’s in Public Policy at the Harvard Kennedy School, where she worked with the IRC to evaluate the FMD programme.