Combining Mental Health and Parenting Interventions to Improve Child Wellbeing Among Refugee Families in Tanzania

Caregiver-reported child emotional and behavioral functioning (Pediatric Symptom Checklist-17, PSC-17)

Emotional and behavioral functioning of children aged 7-10 years will be assessed using the Pediatric Symptom Checklist-17 (PSC-17), a 17-item caregiver-report screening tool for psychosocial problems (total score range 0-34; higher scores indicate greater difficulties). Each child's PSC-17 will be completed independently by both primary caregivers. The primary outcome metric is the mean (average) of the two caregiver-reported PSC-17 total scores for each child at 12 months post-intervention. PSC-17 subscales (internalizing, externalizing, attention) will be examined in secondary/exploratory analyses.

Self-reported child emotional and behavioral functioning (Youth-adapted Pediatric Symptom Checklist-17, Y-PSC-17)

Mental health problems in children will be assessed using a youth self-report version of the Pediatric Symptom Checklist-17 (PSC-17), adapted for child administration with newly developed pictorial response aids. The measure includes 17 items rated on a 3-point scale (Never, Sometimes, Often; scored 0-2) and summed to a total score (0-34), with higher scores indicating greater emotional/behavioral difficulties. Subscale scores for internalizing, externalizing, and attention problems will also be derived and examined separately.

Child health-related quality of life (KINDL-R)

Children's health-related quality of life will be assessed using the revised KINDL questionnaire (KINDL-R), which measures well-being across six domains: physical, emotional, self-esteem, family, friends, and school. Both the 24-item child self-report (Kid-KINDL-R) and parent proxy versions will be used. Items are rated on a 5-point Likert scale, with higher scores indicating better quality of life.

Psychological distress (Kessler Psychological Distress Scale, K6)

General psychological distress among caregivers will be assessed using the 6-item Kessler Psychological Distress Scale (K6). Items capture symptoms of anxiety and depression experienced during the past month. Each item is scored from 0 ("none of the time") to 4 ("all of the time"), with higher scores reflecting greater distress.

Depression (Patient Health Questionnaire-9, PHQ-9)

Caregiver depression symptoms will be measured using the 9-item Patient Health Questionnaire (PHQ-9). Items assess frequency of depressive symptoms during the past two weeks on a 4-point scale (0-3), with higher scores indicating greater severity of depression.

Emotion recognition task (facial and vocal expressions)

Children's ability to identify and interpret emotions will be measured using an emotion recognition task consisting of approximately 50 short video clips depicting facial and vocal expressions across nine emotions. Participants indicate the emotion and rate confidence in their judgment. Accuracy scores will be calculated, with higher scores reflecting better emotion recognition ability.

Executive functioning (Dimensional Change Card Sort, DCCS)

Children's cognitive flexibility and inhibitory control will be assessed using the Dimensional Change Card Sort (DCCS) task. Participants sort cards according to changing rules (e.g., by color or shape), measuring their ability to shift attention between tasks. Higher accuracy and faster reaction times indicate better executive functioning.

Theory of mind (false-belief tasks)

Children's theory of mind will be assessed using two standard false-belief tasks (surprise content and surprise outcome). These tasks evaluate the ability to understand that others may hold beliefs different from one's own. The proportion of correct responses indicates higher levels of theory of mind development.

Social preferences (incentivized experimental games)

Social preferences will be measured through an incentivized experimental dictator game slightly adapted from Benenson et al. (2007). The children are instructed to first select six stickers from a larger set of ten and then make a one-shot allocation decision, choosing how many stickers to keep for themselves and how many to give to an anonymous child living in the same village. The allocation is made privately by placing tokens into separate opaque bags for "keep" and "give," while the enumerator turns away. Children may give zero, some, or all tokens. This task is designed to capture basic prosocial sharing behavior in a developmentally appropriate manner.