Family Empowerment (FAME): A pilot implementation and evaluation.

The main study parameters are the difference in pre- versus post FAME family functioning and parental symptoms of depression/anxiety between the families living in asylum centres and families living in family locations.



SCORE-15

Family functioning will be measured using the Systemic Clinical Outcome and Routine Evaluation (SCORE-15; Stratton, Bland, Janes, & Lask, 2010). The SCORE-15 is a self-report questionnaire assessing changes in family relationships. The SCORE includes 19 questions, which take less than 10 minutes to complete. The questionnaire can be used to monitor and report indicators of progress in systemic therapy. It is an overall measure of family functioning as well as ‘sub-scale’ scores on the dimensions: strength and adaptability, overwhelmed by difficulties and disrupted communication. The validity as an index of therapeutic change is established. The questionnaire is acceptable and has strong consistency and reliability (Stratton et al., 2013).



PHQ-4

Parental symptoms of depression/anxiety are assessed using the Patient Health Questionnaire for Depression and Anxiety (PHQ-4; Kroenke, Spitzer, Williams, & Löwe, 2009), an ultra-brief screener for depression and anxiety. It can be either self-administered or administered by health care personnel. Reliability and validity of the PHQ-4 were supported by Löwe et al. (2010). Moreover, the authors offer normative data to compare scale scores with a general population reference group.

What is the difference between families living in asylum centers and those living in family locations?



PHQ-4 & SCORE-15, as described above.



EAS

Emotional Availability Scales (EAS) was developed by Biringen, Robinson and Emde (2000). Biringen, Derscheid, Vliegen, Closson, & Easterbrooks (2014) described emotional availability as "the capacity of a dyad to share an emotionally healthy relationship" (p. 114). As both child and caregiver can impact the caregiver-child relationship, EAS addresses both caregiver and child components. EAS measures four caregiver components: sensitivity, structuring, non-intrusiveness and non-hostility. The child components are the child's responsiveness to the caregiver and the child's involvement with the caregiver. A score on a Likert scale of 1-7 on each component will be used for data analysis. A score of 7 suggests that the participant displays optimal behaviors on that scale. A score of 4 indicates inconsistent behavior. Moreover, a score of 1 indicates that the participant displays non-optimal behavior. Studies focusing on the EAS suggest that it is universally applicable. Moreover, an association between EA-scales and parenting, child development and the parent-child relationship is demonstrated in various countries (Selin, 2014). Offers insight in the parent-child relationship in this two different groups.



Can the program be conducted in a naturalistic setting?



PIL

To measure whether the program can be executed as intended, a program integrity list (PIL) has been developed. The checklist is based on the four dimensions of program integrity:

- Adherence: specific components of the program (FAME), as described in the manual of FAME (Mooren, & Bala, 2016);

- Exposure: the extent to which family members were exposed to the program (e.g. presence list, duration of the program);

- Quality of delivery: therapeutic skills and competence;

- Participants responsiveness: reactions during the session (e.g. participation, enthusiasm).



An assessor will be present during all the sessions to fill in the program integrity list. The program integrity list will be filled in during the sessions and additional questions about participant responsiveness will be asked during the semi-structured interview. All assessors will be trained in using the program integrity list.

Evaluation of the program

Semi-structured interview

The semi-structured interview focuses on several subjects and has three main aims:

1) To evaluate the experience of participants/professionals involved in the project

2) To evaluate program outcomes: social support, coping strategies, the parent-child relationship

3) To evaluate program integrity

It lasts approximately 30/45 minutes per family member. If needed, an interpreter will be present. Open-ended questions will be posed to the family-members. Then, where possible, family members can score their answers on a 5-point Likert scale. For example: “Which component of the program was most helpful to you, and why?” (open-ended question) “How helpful was this component?” (scoring on a Likert-scale). The researcher will be trained in using the topic list of the semi-structured interview.

(YC)SRS, (YC)ORS

The (Young Child) Outcome Rating Scale ((YC)ORS) and (Young Child) Sessions Rating Scale ((YC)SRS) are self-report scales, offering insight in the process of participants. The ORS has four subscales: Individual, Relational, Social and General. The four subscales of the SRS are Relationship, Goals and topics, Approach and method, and Overall. They respectively measure distress of the participant after a session and how session is rated by the participants. This information can be used to understand the process during a program and how participants feel about sessions, thus offering insight in how a program can be improved. Both scales are visual and analogue.