Program Profile: Happy Families (Thailand)

This was a parenting and family skills intervention for displaced Burmese migrant families in Thailand. The program is rated Promising. There was a statistically significant impact on child externalizing problems, family cohesion, family communication and positive parent-child interactions in the treatment group, compared with the control group. However, there was no statistically significant effect on child attention problems, or child internalizing problems.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

The Happy Families program was a parenting and family skills intervention designed for displaced Burmese migrant children and their caregivers in Thailand. Happy Families was intended for families with children between the ages of 8 and 12. The overall program goal of the Happy Families program was to improve parent–child and family relationships in both interaction behaviors (such as reducing harsh discipline) and relationship perceptions (such as the perception of care) [Puffer et al. 2017].

Program Components

Happy Families was a 12-week, group-based intervention. Caregivers and children participated in parallel group sessions once a week for 2.5 hours on either evenings or weekends to ensure the sessions were accessible. Caregiver sessions covered the topics of managing parent stress, rewarding good behavior, setting goals and objectives with children, family communication, problem solving, setting limits, behavior management, maintaining change, the effect of alcohol and drugs on families, and child development and appropriate expectations. Child sessions covered the topics of speaking and listening to others; rewarding good behavior; saying “no” to stay out of trouble; communication for families; communication to seek help; problem solving; recognizing feelings; dealing with criticism and anger; and the effect of alcohol, tobacco, and drugs.

Following the weekly session, caregivers and their children participated in joint activities in which the family practiced the skills they had learned. Each session began with a family meal and ended with a game to promote bonding and relationship building, and to allow opportunities for positive interactions.

The Happy Families program was a modified version of the Strengthening Families Program, which was originally developed for substance use prevention in families. The Strengthening Families Program was selected for modification because it also involved family functioning and skill-building sessions. Strengthening Families was adapted to incorporate cultural and religious concepts relevant to resilience and family functioning, to specifically target family-related problems faced by displaced Burmese migrant families. The most significant changes to the Strengthening Families Program were the addition of time spent on anger and stress management, incorporating the practice of meditation, and inclusion of traditional Burmese examples and stories related to the specific stress of displacement. Handouts were replaced with spoken explanation because of limited literacy, and the length of the program was reduced from 14 weeks to 12 weeks because of restrictions of participants’ time and movement (Puffer et al. 2017).

Key Personnel

Sites for the program were selected by the International Rescue Committee, and were based on the presence of Burmese migrant families, accessibility, and existing programming. Each site had a team of facilitators, including two facilitators for the caregiver sessions and two for the child sessions. These facilitators consisted of International Rescue Committee staff and community-based facilitators, who were recruited from local communities and participated in interviews and reference checks. International Rescue Committee staff attended a 5-day training course by the developer of the Strengthening Families Program, and then conducted training for local facilitators. International Rescue Committee staff monitored program sites by conducting visits every 2 to 3 weeks (Annan et al., 2017).

Study

Sim and colleagues (2013) conducted a randomized controlled trial to determine the impact that participation in the Happy Families program made on Burmese migrant families in Thailand. The study was conducted in urban and rural communities in Tak province, Thailand, on the western border with Burma (also known as Myanmar), between January 2011 and May 2013. Criteria for participation were being of Burmese origin and being the caregiver to a child between the ages of 8 and 12. Participants were recruited through a series of community meetings with local leaders, parents, and teachers. Families were randomly assigned to either the treatment group who received the intervention immediately following the baseline survey (n = 240) or the waitlist control group who received the intervention following the posttest (n = 239).

The majority of caregivers in the total sample were women (83 percent) and biological mothers to the children participating (69 percent). The remaining caregivers were biological fathers (15 percent), or grandparents, aunts, uncles, and older siblings (16 percent). Caregiver ages ranged from 16 to 80 years, with an average age of 40. Most caregivers were Burmese (68 percent), 19 percent were Karen, 8 percent were Muslim, and 5 percent identified as another ethnicity. Half of the caregiver participants had some primary school education, and 23 percent reported no formal education. Child participants were 51 percent girls and 49 percent boys. The average age of children was 10 years. Though the age range of eligibility was 8 to 12 years, 3 children self-reported as 7 years old and 32 children self-reported between the ages of 13 and 15. Most children (71 percent) lived with both biological parents and reported doing some form of work (paid or unpaid) in the previous week (76 percent). Approximately one fourth (27 percent) of the child participants were not in school. There were no statistically significant differences between the treatment and control group participants on baseline characteristics.

A difference-in-difference analysis was conducted to compare the treatment and control group participants in the outcomes of interest at the posttest, using an intent-to-treat approach. The posttest was conducted 1 month after the treatment group’s last session. Outcomes of interest included the levels of positive parent–child interaction, parenting consistency, and negative parenting behavior. These parenting practices were measured by the Parental Acceptance and Rejection Questionnaire. Both child and caregiver completed the questionnaire, but the CrimeSolutions review of this study focused on the differences between the treatment and control groups in child-reported measures. The authors did not conduct subgroup analyses.

Study

Annan and colleagues (2017) also conducted a difference-in-difference analysis using an intent-to-treat approach to examine the impact of the Happy Families program using the same sample described in Study 1 (Sim et al. 2013). The study was conducted in urban and rural communities in Tak province, Thailand, on the western border with Burma, between January 2011 and May 2013. Families were randomly assigned to either the treatment group who received the intervention immediately following the baseline survey (n = 240) or the waitlist control group who received the intervention following the posttest (n = 239). The sample eligibility criteria and demographics of participants at baseline were the same as in Study 1.

Outcomes of interest in this study included child psychosocial protective factors and child attention, internalizing, and externalizing problems. Child psychosocial protective factors were measured by a 14-item scale on children’s sources of support, positive social skills, positive emotional outlook, and negative self-esteem. Items such as “I can get help from family or other elders” and “I enjoy being with others” were rated on a three-point Likert scale. Child attention, internalizing problems, and externalizing problems were measured by the Achenbach Child Behavior Checklist (parent rated) and the Youth Self-Report (child rated). The CrimeSolutions review of this study concentrated on the differences between the treatment and control groups in child-reported measures. The Youth Self-Report consisted of 113 items to measure behavior and emotional problems on a three-point Likert scale. Outcomes were assessed at a posttest, which was completed 1 month after the treatment group’s last session. The authors did not conduct subgroup analyses.

Study

Puffer and colleagues (2017) also conducted a difference-in-difference analysis using an intent-to-treat approach to study the effects of the Happy Families program using the same sample described in Study 1 (Sim et al. 2013). The sample eligibility criteria, sample size, and demographics of participants at baseline were the same as Study 1.

Outcomes of interest included negative family interactions, family cohesion, family communication, overall relationship quality, and parent–child warmth and affection. Negative family interactions, family cohesion, and family communication were measured by the Burmese Family Functioning Scale, a 20-item scale that consisted of a four-point Likert scale for statements such as “expresses love through words or actions.” Overall relationship quality was measured by the Parent Behavior Inventory, a 12-item scale that consisted of a four-point Likert scale for measures such as praise and physical affection. Parent–child warmth and affection was measured by the Parental Acceptance–Rejection Questionnaire: Short Form, a 24-item scale that measures parental acceptance and rejection. Both child and caregiver completed the measures, but the CrimeSolutions review of this study focused on the differences between the treatment and control groups in child-reported measures. The authors did not conduct subgroup analyses.

These sources were used in the development of the program profile: