Effects of an integrated parenting and mental health intervention on violence reduction and caregiver mental health among migrant and displaced families from Myanmar: a pragmatic randomized controlled trial.

BACKGROUND: Caregiver mental ill-health and violence against children are pervasive in conflict and displacement settings with adverse impacts on child mental health and well-being. Parenting interventions are effective at reducing violence against children but typically prioritize improving parenting knowledge and skills over preventing or treating caregiver mental health difficulties. We assessed the effects of Parenting for Resilience, a co-designed, non-specialist delivered intervention to simultaneously reduce violence against children and improve caregiver mental health among migrant and displaced caregivers from Myanmar. METHODS: We conducted a pragmatic parallel-group randomized controlled trial with 479 participants randomly allocated to Parenting for Resilience or treatment as usual consisting of information about local services. Primary outcomes were physical and psychological violence against children, caregiver psychological distress, and positive parenting assessed at baseline (T0), 1 month (T1), and 6 months (T2) post-intervention. Intention-to-treat analyses estimated intervention effects. The trial was prospectively registered at Thai Clinical Trials Registry (TCTR20240725001). RESULTS: Participants were recruited from July to September 2024. There were sustained reductions in physical (T1: IRR 0.62, 0.55-0.71; T2: IRR 0.48, 0.42-0.55) and psychological (T1: IRR 0.76, 0.71-0.81; T2: IRR 0.69, 0.64-0.75) violence against children and caregiver psychological distress (T1: β -1.94, -2.94 to -0.93; T2: β -1.26, -2.30 to -0.21) in the intervention group at both time points. Positive parenting increased at T1 only (β 1.64, 0.19-3.08). Caregiver post-traumatic stress symptoms, emotion regulation, psychological flexibility, well-being, parenting knowledge and beliefs, engagement in children's early learning, and family functioning also improved in the intervention group. We did not find effects on parental efficacy, social support, or children's emotional and behavioral difficulties. CONCLUSIONS: Effects on multiple caregiver and family outcomes indicate potential for an integrated model of caregiver mental health and parenting support to yield wide-ranging benefits in a low-resource displacement setting.