Preliminary Efficacy of My FRIENDS Youth with At-Risk Pakistani Adolescent Girls Living in Orphanage

Abstract

Background: Pakistan is a lower-and-middle-income country where the mental health burden is increasing day by day and the services are not enough to cater to the needs. Living in foster care settings is associated with an increased risk for different mental health conditions. It signifies the need to implement culturally sensitive intervention programs to decrease mental health burdens and improve the socio-emotional skills of these individuals. Objective: This study aimed to adapt the pictorial content of the MY FRIENDS Youth Program and assess the efficacy of the program on the at-risk population living in the orphanage of Pakistan. Method The efficacy of the Urdu version of My FRIENDS Youth program (N=38) was assessed by comparing the girls living in an orphanage setting (experimental group) with the girls living in a community setting (control group) by using a Quasi-experimental, non-equivalent control group design. The culturally adapted measures in the Urdu language were used to evaluate the level of participants’ anxiety, behavioral problems, fear, coping skills, social skills, self-esteem, and self-concept. A 3-month follow-up was also done in the experimental group. The social validity and fidelity of the program were also assessed. Results The results have shown positive changes with respect to the decrease in the scores of anxiety symptoms, behavioral problems, and fear while adaptive coping skills, self-esteem, and self-concept were also enhanced. A significant reduction in the overall scores of behavioral problems (F= 9.12, p< .01) along with emotional problems (F=4.95, p< .05) and overall externalizing (F=4.96, p< .05) and internalizing symptoms (F=7.93, p< .01) based on scores of primary outcome measures were found to be low in the experimental group. Moreover, a statistical improvement in pro-social behavior was significantly higher in the experimental group (F=19.64, p<.001) at post-intervention. The experimental group also had significantly lower scores on overall anxiety (F=12.18, p< .01), panic disorder (F= 8.69, p< .01), generalized anxiety (F= 6.90, p< .05), and school avoidance (F=21.45, p< .001) in comparison to the control group after controlling baseline scores. Furthermore, adaptive coping skills (F= 10.38, p<.01), self-esteem (F=10.15, p< .01) and self-concept (F=13.10, p< .01) were significantly higher while fear of failure and criticism (F= 15.27, p< .001), medical xvii fear (F=22.06, p< .001) and miscellaneous fear (F=13.81, p< .01) were found to be significantly lower in the experimental group as compared to the control group. To handle the missingness and asymmetry of data, Intent to Treat (ITT) was done using Linear Mixed Model (LMM). When the analysis was rerun using linear mixed modeling, the significance vanished for externalizing symptoms and school avoidance while remained statistically significant for overall anxiety (F=16.28, p< .001) and its components, overall behavioral problems (F=5.60, p< .05), internalizing symptoms (F=7.63, p< .01) along with emotional problems (F=6.88, p< .05) and prosocial behavior (F=3.97, p< .05) as assessed by primary outcome measures. Furthermore, the statistical significance on the scores of self-concept and self-esteem also vanished as assessed by secondary outcome measures while remained significant for the adaptive coping skills (F=5.21, p<.05), scores of fear (F=5.21, p< .05) and its subscales i.e. fear of failure and criticism (F=4.93, p< .05), medical fear (F=15.23, p< .001) and miscellaneous fear (F=5.76, p< .05). The results also revealed that the effect of the intervention was maintained at 3-month follow-up in the experimental group. The statistically significant improvements show the usefulness of the program for adolescent girls living in the orphanage of Pakistan. Conclusion The study provided preliminary evidence for the at-risk population in Pakistan. Participants reported the program as beneficial and enjoyable. The intervention provided an opportunity for promoting mental health among the orphanage girls.