Assessing and Preparing the Field for Testing a Parenting Intervention for War-Affected Families in Northern Uganda

Introduction: Intergenerational transmission of family violence, substance abuse, and harsh parenting are only a few of the related consequences of war and organized violence on family and community functioning. Our workgroup [Removed for Review] has worked in Northern Uganda for over a decade, primarily providing treatment for Posttraumatic Stress Disorder (PTSD). This is the setting of a brutal civil war between the rebel Lord’s Resistance Army led by Joseph Kony and the Ugandan government that lasted nearly two decades. In this paper, we report the efforts that took place during engagement, assessment, cultural adaptation and overall preparation for testing the feasibility of introducing an evidence-based parenting intervention.

Methods:  In 2010 a team composed of [authors] traveled to Northern Uganda to talk to groups of mothers and fathers. We conducted five focus groups (four female and one male) with a total of 43 parents representing 5 rural communities and documented parents’ perceptions of the impact of the war on daily life, parenting practices before and after the war, family and community strengths, current challenges, and parenting values and practices. Concurrently, we conducted 18 mother-child interviews in the rural villages that included standardized instruments of mental health and parenting, videotaped observations of six five-minute structured interaction tasks, and a brief qualitative interview. These multi-method interviews provided an in-depth picture of the type of issues parents and children aged 5-12 were struggling with and how they were going about problem solving and sharing difficult life events.

Results: Parents reported being overwhelmed by poverty, displacement, loss of multiple family members, lack of opportunity to secure employment or recover pre-war lifestyles, frequent responsibility for orphaned children in their extended family, and ongoing worries that Kony will return. Parents provided specific information about domains they needed support with and pleaded for outside support in managing family stressors associated with substance use and domestic violence. The macro-level coding of the mother-child interactions showed a difficult portrait. On the one hand, we saw mothers’ sincerest attempts at connecting, problem-solving and being responsive to their children. On the other hand, mothers revealed an overwhelming lack of ability or skill in seeing and meeting children developmentally. We saw harsh and blaming interactions with low signs of problem solving resolution or ability to listen to children’s positive or negative sharing of events. Affect codes mostly depicted distressed, aversive, sad, or distracted behaviors for both mothers and children.

Conclusions: Results from this early assessment study provided clear support for proceeding to further adaptation of the parenting intervention (based on Parent Management Training-Oregon Model) and testing its feasibility in Northern Uganda.