Predictors of caregiver support intervention outcomes for refugees in Jordan: a three-path mediational study

Document Type

Journal Article

Publication Date

12-7-2025

Journal

Child and adolescent psychiatry and mental health

Volume

19

Issue

1

DOI

10.1186/s13034-025-00995-1

Keywords

Common and specific factors; Low and middle income countries; Parenting; Predictors of outcome; Quality of care

Abstract

BACKGROUND: More evidence is needed for understanding how evidence-based psychological interventions work, especially when implemented by briefly trained non-professionals in low- and middle-income settings. The nine-session caregiver support intervention (CSI) is such an evidence-based intervention, aiming to improve parental wellbeing and parenting skills. Specifically, this study aims to assess if and how a set of quality of care indicators explain intervention outcomes amongst participants from refugee settlements in Jordan. METHODS: We conducted a three-path mediational model, wherein levels of facilitators' competency (using the ENhancing Assessment of Common Therapeutic factors tool [ENACT]), facilitators' fidelity of implementing CSI, caregivers' attendance, and caregivers' adoption of the key intervention skills and strategies (i.e. mechanisms of action) are predictive of intervention outcomes. Outcome measures include the Warwick-Edinburgh Mental Wellbeing Scale to assess caregiver wellbeing, Kessler Psychological Distress measure to assess caregivers' psychological distress symptoms, Brief Parenting Questionnaire to assess warm and responsive parenting and harsh parenting and Kid(dy)-KINDL for Parents to assess children's psychosocial wellbeing. RESULTS: The study, amongst caregivers (n = 588) and facilitators (n = 51), demonstrates that baseline to endline intervention improvements in parenting, caregiver wellbeing, and caregiver-reported child wellbeing are all (fully or partly) mediated by a pathway of higher levels of facilitator competencies leading to higher levels of participants' attendance. Higher attendance in turn leads to higher levels of adoption of key intervention strategies by participants. Higher adoption in turn leads to the bespoke positive outcomes (indirect effects: 0.50 [SE = 0.14]; 0.90 [SE = 0.26]; 0.92 [SE = 0.29], respectively). This pathway does not play out for caregiver distress as an outcome (-0.20 [SE = 0.13]). CONCLUSION: Both common factors (foundational therapeutic competencies among the service providers) and specific factors (active ingredients of the intervention) are relevant in predicting outcomes following CSI-albeit through different pathways. This study provides support for using competency assessments, attendance tracking, and monitoring participant's skill adoption as a framework for the evaluation and improvement of quality of care.

Department

Global Health

Link to Full Text

Share

COinS