# Delivering a family‐based child mental health promotion program among two resettled refugee communities during the COVID‐19 pandemic: Lessons learned in a hybrid type II implementation‐effectiveness randomized controlled trial

## TL;DR

A mental health program for refugee families was successfully adapted during the pandemic, showing improved parental supervision in Bhutanese communities.

## Contribution

The study demonstrates how a hybrid trial design can support real-time adaptation and implementation of mental health interventions in dynamic, high-stress contexts.

## Key findings

- Bhutanese families receiving FSI-R showed greater improvements in parental supervision compared to usual care.
- Process evaluation highlighted that responsiveness to community needs supported successful implementation despite pandemic stressors.
- The Hybrid Type II design enabled real-time adaptation to policy shifts and community needs.

## Abstract

Resettled refugee families face elevated mental health risks, compounded by structural and cultural barriers. The Family Strengthening Intervention for Resettlement (FSIR), co‐developed with resettled refugee communities, aims to improve family functioning and child mental health. This study evaluated FSI‐R in Somali Bantu and Bhutanese communities in New England during COVID‐19 using a Hybrid Type II Implementation‐Effectiveness Trial guided by the EPIS framework.

Linear mixed modeling assessed changes in family functioning and child mental health. A process evaluation identified implementation barriers and informed adaptations. Activities were registered under Clinical Registry #NCT03796065.

Bhutanese families receiving FSI‐R showed greater improvements in parental supervision compared to usual care. Process evaluation highlighted that responsiveness to community needs supported successful implementation despite pandemic stressors. Somali Bantu interventionists reported stronger emotional connection with families during in‐person delivery.

Findings support the utility of hybrid trials in assessing both effectiveness and implementation of preventive interventions with resettling families. Despite contextual disruptions, attention to community needs and delivery flexibility enabled successful implementation. This study underscores the importance of context‐informed strategies to sustain core elements of evidence‐based interventions in dynamic settings.

Community‐based participatory research helped overcome barriers through collaborative, context‐informed implementation guided by the EPIS implementation science framework.FSI‐R improved parental supervision in Bhutanese families during a period of high stress due to the global COVID‐19 pandemic.The Hybrid Type II implementation‐effectiveness design supported real‐time adaptation to policy shifts and community needs.

Community‐based participatory research helped overcome barriers through collaborative, context‐informed implementation guided by the EPIS implementation science framework.

FSI‐R improved parental supervision in Bhutanese families during a period of high stress due to the global COVID‐19 pandemic.

The Hybrid Type II implementation‐effectiveness design supported real‐time adaptation to policy shifts and community needs.