Feasibility of Implementing a Culturally Adapted Parenting Intervention for Karen Refugee Caretakers in the U.S.

Introduction: Increasing numbers of children are fleeing to the United States after exposure to war and conflict. Children exposed to war have high rates of negative health outcomes, including anxiety, depression, and post-traumatic stress disorder. Parenting interventions are an effective way to promote resilience in at-risk children, such as those in post-war settings. However, few evidence-based parenting programs have been adapted for trauma-affected resettled communities. The purpose of the current study was to test the feasibility of implementing a parenting intervention adapted for the cultural and trauma context of Karen refugees, a war-affected community.

Methods: Eleven Karen female caretakers (ages 21 to 48) participated in a nine-session manualized parenting group (two groups were held) based on the Parent Management Training-Oregon model(PMTO). Initial and ongoing adaptations were made based on focus groups, assessments, and consultation with community collaborators. Topics included PMTO’s core components (positive involvement, encouragement, and setting limits), family transmission of strengths and maladaptive coping, and psychoeducation on traumatic stress and comorbid symptoms. Pre-, post-, and 3-month follow-up assessments included standardized psychological and relational measures, parent-child observational interaction tasks, and ethnographic interviews. Findings for this presentation will focus on cultural adaptation and feasibility outcomes.

Results: Cultural adaptations were sorted into the eight categories of the Ecological Validity Model, including language, persons, metaphors, content, goals, methods, and context. Adaptations included the delivery of treatment in Karen through interpreters, use of visual manual and visual cues to account for literacy concerns, framing treatment content within cultural values and metaphors, addition of two sessions and case examples to address traumatic stress, and use of case examples to address acculturative stress. This adapted intervention showed several areas of promise with respect to the feasibility dimensions of acceptability (caretakers connected with model content and delivery style), usability (all caretakers attended at least six of the nine sessions and tried behavioral practices at home), and relative effectiveness (caretakers reported an increase in positive involvement and efforts towards decreasing the use of harsh discipline). Qualitative analysis of the interviews with caretaker also suggest that emotional regulation and positive interaction skills were particularly useful and led to new interactions, while these female caretakers still struggled to implement discipline strategies.

Conclusions: This culturally and contextually adapted PMTO model was considered suitable and attractive to the participants and had high retention. This study suggests that targeted adaptations can improve service delivery to resettled, post-conflict groups.