An Evaluation of a Family Counseling Intervention ("Tuko Pamoja") in Kenya: a Single Case Series Design

30 self-report items developed for the local context based on formative research. Responses are endorsed on a 10-point scale and refer to the past month. One composite score is calculated; higher scores reflect better family functioning. A subset of these are administered repeatedly pre- and post-intervention as part of the single case series design multiple assessments.

A direct observational measure in which families complete standardized video-recorded activities. Behaviors are then coded on multiple domains, including ones related to positive/negative interactions, quality of communication, and problem-solving ability. Primary analyses will be conducted with higher scores indicating better functioning.

Parent-Child Relationship: from standardized scales and locally developed items. Items selected and adapted from: (1) Parental Acceptance and Rejection Questionnaire, (2) Multiple Indicators Cluster Survey: Discipline Module, (3) Discipline Interview, (4) Parent-Adolescent Communication Scale. Each include caregiver and child/adolescent report versions. Caregiver report includes 66 items; Child report includes 60 items. Participants are asked to respond based on the past month. Children report on each caregiver separately.

For primary analyses, one composite score will be calculated. For follow-up analyses, subsets of items may be analyzed, including those related specifically to harsh treatment/abuse.

A subset of these are administered repeatedly pre- and post-intervention as part of the single case series design multiple assessments.

Locally-derived items and selected items adapted from standardized scales: Conflict Tactics Scale; Dyadic Adjustment Scale; additional locally-derived items. A total of 52 items are included, referring to both self and spouse behaviors. The majority of items are based on a frequency scale, referring to the past month; some items related to spousal maltreatment assess whether behaviors have ever occurred.

As a primary outcome, responses across these items will be combined into one score. Follow-up analyses may be conducted using subsets of items to assess relationship quality and harsh treatment separately.

A subset of these are administered repeatedly pre- and post-intervention as part of the single case series design multiple assessments.

Items locally developed and adapted from standardized measures, including the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL; for caregivers); locally-developed items assessed local terms reflecting symptoms, hope, prosocial behavior, risk behavior, and sense of belongingness. The majority of items reported on a 3-point scale (Not/Never True, Somewhat/Sometimes True, Very/Often True). Caregiver-report on child included 47 items; Child self-report included 56 items. A single composite score will be calculated, with potential follow-up analyses on subsets of items.

A subset of these are administered repeatedly pre- and post-intervention as part of the single case series design multiple assessments.

Locally-developed items and items adapted from subscales of standardized measures, including: Patient Health Questionnaire, General Health Questionnaire. Caregivers self-report on 29 total items. One composite score will be calculated, and potential follow-up analyses may examine subsets of items.

A subset of these are administered repeatedly pre- and post-intervention as part of the single case series design multiple assessments.

Each participant identifies the two highest priority problems related to their family that they would like the intervention to help with. Items assess how much each problem has bothered them in the past month. For repeated measures as part of the single case series design, these are also administered with participants reporting on the past 2-3 days.

Each participant identifies the highest priority problem related to themself that they would like the intervention to help with. An item assesses how much the problem has bothered them in the past month. For repeated measures as part of the single case series design, these are also administered with participants reporting on the past 2-3 days.

Each caregiver identifies the highest priority problem related to their child that they would like the intervention to help with. An item assesses how much the problem has bothered them in the past month. For repeated measures as part of the single case series design, these are also administered with participants reporting on the past 2-3 days.

This measure will assess feasibility, acceptability, and quality of delivery model.

Fidelity (Checklists, session transcript analysis) Lay counselor competency (session transcript ratings; Adapted ENACT), including counselor use of community practices (session transcript analysis)

A composite score will be calculated, and follow-up analyses may examine subsets of items dividing fidelity and competency scores.

This measure includes an inventory of locally-relevant household assets and a measure of consumption and spending. For repeated measures as part of the single case series design, these are also administered with participants reporting on the past 2-3 days.

AUDIT (Alcohol Use Disorders Identification Test) and locally-derived items; single items related to associated risk behaviors, such as other substance use, also included. Caregivers self-report on 37 items and spouse-report on 32 items. The majority of items are reported on a frequency Likert scale. Higher scores indicate higher severity.

For repeated measures as part of the single case series design, these are also administered with participants reporting on the past 2-3 days.

Sexually active (Yes/No); Sex past month; Condom use; Number partners; Locally-derived items on peer influence related to risky behaviors

One risk behavior composite will be calculated, and subsets or single items may be analyzed in follow-up analyses.

CRIES (Children's Revised Impact of Events Scale), self-reported experience of traumatic stress symptoms over the past week; 8 items (frequency scale). Higher scores indicate higher severity. (These items will be administered if a child endorses 1 or more experiences on the UCLA trauma exposure scale, self-reported experience of traumatic events; 16 items(yes/no)).

Survey items assessing frequency (6 items) and quality (6 items) of sex/HIV-related communication. Higher scores indicate better communication.

Locally-derived items on quality of relationships with both maternal and paternal extended family members, including positive and negative interactions, as well as any financial or logistical support received. Items are rated on a scale of 1-10. Caregivers report on 10 items; Children report on 6 items. Higher scores indicate better relationships.