The bread wrapper study Evaluating a mechanism for dissemination and evaluation of psychological “first aid” for families affected by the conflict in Syria Aala El-Khani Kim Cartwright Rachel Calam School of Psychological Sciences The University of Manchester

The role of the family during displacement Primary caregiver- ‘protective shield’ or further complicate war stress? (Elbedour et al, 1993) Family cohesion is a significant predictor of refugee children’s mental health (Fazel et al 2012, Lancet) Family violence is a strong predictor of change in a child’s mental health; improved family life working to protect and increased conflict associated with intrafamilial violence THEY THEYB WILL BE GOING AND COMING

Using family skills approaches Family and parenting skills have a key role in improving children’s wellbeing now and in the future Prevention of emotional and behavioural difficulties, drug misuse, violence and crime Adapting to needs, cultures and contexts

Can this approach help displaced families?

Exploring refugee parenting needs 8 one to one Interviews with refugee parents 4 focus groups with parents 2 Interviews with professional aid workers Data collection was carried out inside refugee tents and refugee camp schools

Parenting challenges in refugee situations Environmental specific challenges Child specific challenges Parent specific challenges

How can we reach large numbers of families in such challenging contexts?

Caregiver leaflet Questionnaire What caregivers might be experiencing What children might be experiencing How caregivers can help themselves How caregivers can help their children Sample characteristics Demographics Usefulness ratings of leaflet Open comment section

Results 3000 bread wrappers distributed over 5 days 1784 returned 59.5% return rate! 400 comments left

Sample Characteristics Frequency Percentage Gender   Male 1307 73∙3 Female 452 26∙7 Missing 24 1∙3 Number of children 5 0∙3 1-4 1010 56∙6 5-8 714 40 9-12 32 1∙8 22 1∙2 Internally displaced Yes 1271 71∙3 No 492 27∙6 20 1∙1 Length of time in current location (for displaced families) <3 months 373 29∙3 3-6 months 404 31∙8 6-12 months 199 15∙7 >12 months 278 21∙9 17

Perceived overall usefulness of parenting leaflet

Content analysis Frequency of comments coded in themes (n=400)   Frequency Percentage Theme 1: Positive comments 289 68∙97 Theme 2: Modifications suggested 67 15∙99 Theme 3: Needs 36 8∙59 Theme 4: Faith 16 3∙82 Excluded 11 2∙63

Collaboration with an NGO

Key messages Using existing humanitarian aid chains can be a very effective mechanism to reach families There is a crucial need for family skills training and support for parents/caregivers who are affected by war and conflict Despite all the traumas of displacement, parents are motivated to be the best parents they can be We need to identify cost-effective ways of delivering such programs to these displaced families Aala.el-khani@postgrad.manchester.ac.uk