Resilience-based intervention for youth: An initial investigation of school social work program in Kuwait

Abstract

This article describes the preliminary investigation of the initial feasibility of the ‘Fostering Youth Resilience Project’, a universal school-based program delivered by school social workers to 54 high school students in Kuwait. Results reported significant positive change and high satisfaction with the program. The study provided initial evidence support to the applicability of the program for youth in a non-Western culture. Future research needs to evaluate the effect of the program in larger groups, using controlled trials and longer term follow ups. Discussion of limitations and practical implications for the social work profession are presented.

Keywords

Evidence-based practice Kuwait resilience school social work universal school-based programs youth

Introduction

Youth face many challenges in today’s fast changing society and continuously must overcome increasing levels of adversity to achieve success. It is established that adolescence is a stage of great change in young persons’ life; during which their brains and bodies change, and so do their responsibilities and social roles (Huang et al., 2019). The breadth of these personal and social changes can result in high levels of stress for many youths. The 2014 annual survey of the American Psychological Association (APA, 2014) found that teens reported experiencing a greater amount of stress than did any other age group. Therefore, for many social scientists and researchers, the focus has been placed on how young people struggle in the process of establishing themselves and building their social identities in a fundamentally changing world (Furlong and Cartmel, 2007). Difficulties in coping with emotional and social demands during development toward adulthood can have a negative impact on youth’s ability to succeed in life. Experiencing high levels of stress with low psychosocial capabilities to deal with them has significant long-term implications, whose consequences may persist into adulthood. Those consequences include everything from physical and psychological health problems, to poor academic and social performance, and an inclination toward harmful lifestyle choices such as substance abuse, suicidal behaviors, eating disorders, behavioral misconducts, and violence (Said et al., 2013).

In the United States, 72 percent of all deaths among persons aged 10–24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide (Eaton et al., 2008). Results from the 2007 national Youth Risk Behavior Survey (YRBS) indicated that many high school students engaged in behaviors that increased their likelihood of death from these four causes. In Kuwait, one of the major issues of concern to the national strategy for youth development and empowerment was the escalating behavioral problems of high school students such as verbal and physical aggression toward teachers and other students, moral behavioral problems, damaging the property of others, stealing, smoking in school, drug and alcohol consumption, cheating, and truancy (Ministry of Education Annual Report of the Department of Social and Psychological Services, Kuwait Ministry of Education, 2017).

Adolescence is a sensitive period in which social, psychological, and mental health may be positively modifiable. Integrated school interventions focusing on adolescents offer the possibility of influence for a healthy development and decrease the risk of developing short and long-term implications. Recently, the field of adolescent health and wellbeing has witnessed a tremendous acceleration of interest in the concepts of resiliency, protective factors, and healthy adolescent development (Resnick, 2000). Departing from a mutual interest in successful outcomes, the idea of protecting young people from harm through a combination of risk reduction and the promotion of protective factors gained legitimacy across multiple fields of professions that work with and on behalf of young people including social work (Masten and Coatsworth, 1998; Resnick et al., 1997). More specifically, the focus of professionals shifted from interventions based on pathology toward strengths and empowerment because of a growing body of literature emphasizing the protective effects of resilience. Resilience is a dynamic mental process marked by the ability to engage in positive and adaptive behaviors that allow for successful emotional and social development in the face of adversity and stress (Rutter, 2012). Developing resilience skills leads to lasting beneficial effects on a range of educational, social, and behavioral outcomes, thus may prevent the development of psychosocial and behavioral problems in adolescents (Patel and Goodman, 2007). Previous work has shown the importance of training resilience of youth by leveraging on relevant activities they typically perform in formal and informal learning environments (Steinebach and Langer, 2019). Resilience interventions have been conducted among others in the United States, Europe, and South America (e.g. Angel, 2016; Kalisch et al., 2017; Macedo et al., 2014). Experience showed that these initiatives have supported positive mental health and reduced risky behavior, and at the same time raised academic attainment (Cassen et al., 2009). A strong evidence base exists for school-based resilience interventions (e.g. Hodder et al., 2017).

Despite the promising reports of its effectiveness and utility, no resilience-based intervention program has ever been introduced to adolescents in Kuwait within the school-settings, nor any other venue. Therefore, the purpose of the current study was to examine and report on the initial feasibility of the ‘Fostering Youth Resilience Project’ (FYRP), a newly developed program based on the resilience model and sponsored by the Kuwait UNDP (United Nations Development Program) Office, in improving cognitive and behavioral protective skills. The program is a universal school-based group intervention, delivered by school social workers and psychologists to a sample of high school students. The feasibility and the acceptability of the program are assessed.

Background

Kuwait is a small, wealthy nation with a small population whose main source of income is oil. It occupies the Northwestern center of the Arabian Gulf with a total area of 17,818 square kilometers. It is bounded to the East by the Arabian Gulf, to the South and Southwest by Saudi Arabia, and to the North and Northwest by Iraq. The country was established in 1756 and ruled by the Al-Sabah family, who moved into the region from Najd, and has ruled the country since then (Arnett, 2007). Kuwait is a constitutional sovereign state with a semi-democratic political system. It has a high-income economy backed by the world’s sixth largest oil reserves. Islam is the country’s official religion, yet the constitution protects the right of freedom of religion. Arabic is the main language spoken, and English is the second and widely spoken language that is included within the free public education system.

The total population of Kuwait as of July 2019 was 4.82 million, 3.40 million expatriates and about 1.42 million Kuwaiti citizens, according to the Public Authority for Civil Information (PACI). Youth aged 10–24 constitute about one-third of the total population (432,330, 30.2% of the total 1,431,814 of Kuwaitis) (Public Authority for Civil Information of Kuwait, 2019). In a so-called youth society like the case of Kuwait, the need for a strategy to increase the likelihood of the youth population being an integral part of the country’s sustainable development becomes crucial, and one way to do so is by fostering empowerment and resilience.

As previously mentioned, one of the major issues of concern related to youth in Kuwait was the escalating behavioral problems of high school students. A look at the recorded students’ behavioral cases dealt with by school social workers for the years of 2007 through 2016 (Table 1) revealed that the behavioral problems ranked first or second for both male and female students throughout the years (Annual Report of the Department of Social and Psychological Services-Kuwait Ministry of Education, 2011, 2017). In 2016–2017 academic year, there were 33,294 reported cases of students with behavioral problems in high schools, averaging 9.8 percent of the total number of 338,192 students, with problems ranging from gender identity disorders, to verbal and physical assaults on teachers and other students, to cases of alcohol and drug use, lack of discipline, vandalizing public properties, low academic achievement, lack of participation in activities, continuous or intermittent dropout, isolation and aggressiveness, emotional problems of low self-confidence, depression, and persistent tension (Annual Report of the Department of Social and Psychological Services-Kuwait Ministry of Education, 2017).

Table 1.

Number of student cases dealt with by school social workers from 2007–2008 to 2015–2016.

School year	Students	Economic problems	Health problems	Behavioral problems	Truancy	Academic problems
2007–2008	Males	69	1596	3521	1869	4131
2007–2008	Females	–	7	21	7	15
2009–2010	Males	55	1666	3493	1620	3451
2009–2010	Females	88	1857	3188	767	4223
2010–2011	Males	36	1595	3756	1794	3727
2010–2011	Females	107	1943	3417	540	3487
2015–2016	Males	47	1239	3620	1654	3940
2015–2016	Females	87	1692	3854	793	3750

Al-Husaini (2004) investigated the issue of interpersonal violence among adolescents in Kuwait and documented that roughly 40 percent of male and 34 percent of female school-attending adolescents were involved in physical fights at least once in 2000. Furthermore, a recent study investigating the individual and social correlates for being involved in a physical fight among a nationally representative sample of school-attending adolescents in Kuwait within a 12-month recall period found that within a total sample of 3637, 25.2 percent reported being involved in two or more physical fights (Shaikh et al., 2020). In addition, an official statistical report showed that the number of juvenile prosecution cases in 2018 amounted to 2316 cases committed by 3390 juveniles, with 2092 misdemeanors (90.3%) and 224 felonies (The Annual Juvenile Prosecution Report, 2018). It reported that the judicial rulings implemented comprised 1180 cases: 1065 probations (90%), 78 placements in the Social Welfare Institution (7%), and 37 sentences for imprisonment in the Social Correction Institution (3%).

These statistics indicate the need for intervention programs targeting students’ attitudes, skills, and ultimately behaviors, for better adjustment to daily life challenges for youth transitioning to adulthood, for greater chances of success both academically and personally, within school borders and beyond in society. To achieve these goals, officials realized the need for the educational systems to go beyond teaching academic knowledge, toward a more holistic approach focusing on the inclusion of social and life skills training.

In 2013, and with technical support from the UNDP, the ‘National Framework for Youth Engagement and Empowerment’ was initiated and endorsed by the Council of Ministers of the State of Kuwait. The framework aims to enhance the capacities, skills, and capabilities of young people through addressing their needs, promoting positive outcomes, and providing integrated, coordinated, targeted, and measurable initiatives necessary for the holistic development of all young people (Kuwait-UNDP, 2017). Accordingly, the FYRP was developed.

The Arab proverb ‘an ounce of prevention is worth a pound of cure’ rings particularly true in the fight against youth behavioral problems. Therefore, to better respond to these problems, officials are starting to recognize the need to focus on positive youth development as preventive measures, instead of traditional inefficient punitive responses as treatments. One often-neglected developmental construct in this rubric in Kuwait is resilience, which can help students successfully respond to the variety of challenges they face in productive ways as opposed to destructive manners, and be able to excel and fulfill their role in the country’s sustainable development efforts.

Resilience has been described as a characteristic that allows a person to make appropriate behavioral choices in the presence of multiple risk factors, and may explain why a person can resist substance abuse, mental health problems, and criminal behavior even though he or she may be exposed to significant stress and adversity (Choe et al., 2012). Therefore, resilience has gained attention in the literature for its ability to mitigate the relationship between negative and challenging life experiences and emotional and behavioral problems with its protective effect (Arslan, 2016; Masten, 2014; Wagnild and Collins, 2009). Researchers and practitioners are interested in resiliency because of its strong presence in individuals that exhibit adaptive functioning amid life circumstances that put them at risk of developing maladaptive psychopathologies (Wagnild and Collins, 2009). Instead of focusing on reducing risk factors, the resiliency theory is a strength-based conceptual framework of child and adolescent development (Fergus and Zimmerman, 2005; Masten, 2014) that strengthens and increases promotional factors that contribute to optimal physical, mental, and social development and academic achievement (Zimmerman, 2013). Previous research in this area suggests that high levels of resilience may prevent the development of mental health and behavioral problems in adolescents (Dray et al., 2014; Hjemdal et al., 2011), and a recent systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs provides evidence that focusing on resilience and coping skills has positive impacts on the students’ ability to manage daily stressors (Fenwick-Smith et al., 2018).

The earlier works on child and adolescent resiliency from the 1970s and the 1980s focused mainly on youth at risk for a variety of adverse outcomes such as young people living in poverty, familial conflicts, and parents with mental illness or addiction. Yet, the primary interest was in the identification of variables that enabled many of at-risk adolescents not merely to survive but thrive under conditions of seeming adversity (Resnick, 2000). Hence, questions for research and practice focused on the identification of protective, nurturing factors that buffered young people from involvement in behaviors and outcomes damaging to themselves and others (Rutter, 1979).

In Kuwait, despite the fact that the mainstream definition of conditions for at-risk youth does not apply in the small, wealthy, social welfare state, adolescents still face other types of challenges. The Kuwaiti society has undergone rapid development and had a unique experience of modernity; its young people are facing different circumstances from those of young people in Western contexts. Thus, their experiences and challenges in relation to transition to adulthood will appear differently from those described in other youth studies, and studying such differences has the potential to add new knowledge to the global youth literature. More specifically, due to the quick and sudden change to modernity in this small and mostly tribal society after the discovery of oil in the late 1930s, young people face confusion in ways of understanding and exercising free choice and speech, designing their own realities, and choosing to individualize their lives. The presence of many characteristics of traditional society like the strong influence of negative family traditions, patriarchal gender roles, and religious teachings persisting in contemporary life are likely to continue to be sources of tension in youths’ lives (Alnaser, 2018). The change in the population structure after the economic affluence was not accompanied by a change in values and traditions for the new conditions of urbanization (Al-Ghabra, 1995). There was incompatibility between the behavioral types from one part and the concepts of modern development and dominance of sect, family, and tribe over social relationships from the other part. This led to difficulties in achieving personal and societal development in the shadow of tribal and sectarian loyalties (Al-Tarrah, 1998). The theoretical starting point of the process of social and cultural change indicates that if change happened materially, it happened more rapidly than in immaterial ways. For example, throughout the years, considerable material changes took place in terms of wedding rituals and ceremonies for Kuwaiti young adults, yet the values and ‘unwritten rules’ relating to marriage and marital choice, such as family pressure for marrying a blood relative versus a stranger, did not change quite as rapidly, which creates confusion and stress for the new generations so that many of them felt forced to live a double life. Therefore, if we look at the behavioral and emotional problems of Kuwaiti youths described earlier through the lenses of the resilience theoretical perspective related to life stressors and challenging choices, it is safe to expect success in dealing with them similar to the success of resilience-based interventions reported in the literature with similar populations from diverse cultures (e.g. Bahramnejad et al., 2020; Brooks, 2006; Dray et al., 2017; Fergus and Zimmerman, 2005; Gillham et al., 2008).

Prevention programs, whether ‘universal’, serving all youth and families and aiming to maximize wellbeing regardless of mental health status; ‘selective’ for at-risk youth; or ‘indicated’ for youth with early signs of mental illness, are being strengthened by a conscious attempt to enhance resilience (Manjula et al., 2014). Research on resilience resulted in changing interventions’ goals, assessments, and strategies, by shifting the focus from risks and problems, to assets and resources. Thus, resilience-based interventions are needed as they enable social workers to get back to the basics of adopting a holistic and empowering approach in serving their clients.

Universal school-based prevention programs provide students and school staff with information about problem behaviors, change how youth think and feel about them, and enhance interpersonal and emotional skills such as communication and problem-solving, empathy, and conflict management (Hahn et al., 2007). These approaches are considered ‘universal’ because they are typically delivered to all students in a particular grade or school. Focus may vary among prevention programs according to the ages of the target student population, and programs may focus on either general behaviors or specific ones such as bullying or dating violence, for example (Hahn et al., 2007; Hinduja and Patchin, 2017).

A systematic review of 53 studies (Zaza et al., 2005) found that universal school-based violence prevention programs were associated with reductions in violent behavior at all grade levels. Median relative reductions were 29 percent for high school students, 7 percent for middle school students, 18 percent for elementary school students, and 32 percent for pre-kindergarten and kindergarten students. The review also found that the programs appeared to be effective in reducing violent behavior among students in all school environments, regardless of socioeconomic status, race and ethnicity, or crime rate. Whereas specific programs have been associated with reductions in delinquency and alcohol and substance abuse, improvements in mental health problems, and improvements in academic performance (e.g. Bastounis et al., 2016).

Another systematic review of literature that studied the implementation and evaluation of universal, resilience-focused mental health promotion programs based in primary schools used six primary databases: PsycINFO; Web of Science; PubMed; Medline; Embase and The Cochrane Library. The authors concluded that the review provides evidence that mental health promotion programs focusing on resilience and coping skills have positive impacts on the students’ ability to manage daily stressors (Fenwick-Smith et al., 2018).

Benefit-cost analyses conducted by the Washington State Institute for Public Policy (WSIPP) on three evidence-based school violence prevention programs, namely, Life Skills Training, the Good Behavior Game, and Promoting Alternative Thinking Strategies (PATHS), found that they were all associated with positive benefit-to-cost ratios (Washington State Institute for Public Policy, 2015).

In general, among many researchers who have administered and evaluated violence and behavioral problem prevention curricula and programs in schools (e.g. Taylor et al., 2013), there is a consensus that the students who benefit the most from these efforts are those who are most involved. They suggest that

a comprehensive approach including didactic curricula combined with conflict resolution training and the implementation of an ongoing peer mediation program may be an optimal approach to positively altering attitudes and behaviors . . . such a comprehensive approach is most likely to have the greatest impact in terms of strengthening the protective mechanisms which promote enhanced coping and competence underlying resilience. (Van Slyck et al., 1996: 155)

Therefore, the current FYRP curriculum built on the bases of a balanced content of lectures and training activities in peer groups.

Methodology

Sample and participants

The FYR as a universal program is intended to target all students with or without problem behaviors. Therefore, from the population of all public high schools in the six residential governates in Kuwait (n = 123 schools), 12 schools (6 boys and 6 girls) were chosen by the Ministry of Education based on the list of schools in each governate using a simple random sampling procedure to take part in the program. Then, small non-probability samples of students were drawn from each of the 12 chosen schools as participants.

The inclusion criteria of the study participants were (a) students from the 10th–12th grades, (b) 15 years and older, (c) no prior mental or psychological diagnoses, and (d) a signed parental approval to participate in the program sessions and data collection. The participants were recruited via referrals by the school social workers who posted announcements about the program on school boards asking for interested volunteers who meet the selection criteria to come forward. A total of 53 students formed the study’s sample. The average age for participants was about 16 years old (M = 16.34), almost 50/50 distribution of gender (27 males, 26 females), about half of them from 11th grade (52.8%), and all with no prior known diagnosis of mental or psychological disorders.

There were slight differences in the participating students’ demographics in the pre-intervention and the post-intervention samples due to changes that occurred after some students dropped out before the completion of the program, and others joined in. A description of all pre- and post-intervention groups by gender, age, and school grade is displayed in Table 2.

Table 2.

Samples, demographic characteristics (N = 54).

Demographic characteristics	Pre-sample % (n)	Post-sample % (n)
Gender
Male	50.9 (27)	63.0 (34)
Female	49.1 (26)	37.0 (20)
Total	100.0 (53)	100.0 (54)
Age (M = 16.34)
15	17.0 (9)	13.0 (7)
16	47.2 (25)	59.3 (32)
17	24.5 (13)	16.7 (9)
18 and older	11.3 (6)	11.2 (6)
Grade
10	30.2 (16)	25.9 (14)
11	52.8 (28)	61.1 (33)
12	17.0 (9)	13.0 (7)

Intervention and integrity

FYR: The program

The FYR program was designed to build resilience, promote adaptive coping skills, and teach effective problem-solving. The focus of the program is the promotion of optimistic thinking to help youth cope with the daily challenges and problems encountered during school years. The skills taught in the program can be applied to many contexts of life, including relationships with peers and family members as well as achievement in academic subjects and more. The FYR is a manualized intervention comprising of nine 60-minute group sessions led by either a school social worker or a psychologist. The curriculum teaches cognitive behavioral and social problem-solving skills. Participating students were encouraged to identify and challenge negative beliefs, use evidence to make more accurate appraisals of situations and events, and to use effective coping mechanisms when faced with stressful challenges. In addition, students learn techniques for assertiveness, negotiation, decision-making, and relaxation. The program was developed after an extensive literature review of the existing resilience-based interventions in schools, followed by defining the theoretical framework of the program by the project committee comprised of the researcher as the project expert, the UNDP Deputy Resident Representative, the program analyst, and the project senior social worker, ensuring that skills important during the adolescence period were included, redundancy was avoided, and applicability of the model was feasible to be implemented in schools.

The program in general is built on the basics of the well-known US Penn Resiliency Program (PRP) model that trains teachers and children from 8 to 13 years in the use of cognitive skills that aid development of a resilient approach to adversity (Hall et al., 2003). These same skills, which focus on thinking processes, have been taught to adults in the workforce, college students, and adolescents with positive results. Because of the beneficial effect of the resiliency skills training programs and the research to back it up, these programs are being adopted by educational institutions and businesses around the world to increase social problem-solving and productivity and reduce the risk of depression (Reivich and Shatté, 2002). According to researchers at the University of Pennsylvania, thinking processes directly affect seven critical abilities associated with resilience including emotional regulation, impulse control, causal analysis, empathy, maintaining realistic optimism, self-efficacy, and reaching out to others (Reivich and Shatté, 2002). The FYRP focuses on the same seven abilities of resilience and translates them into the training curriculum for specific skills related to each ability as suggested by the literature. For example, emotional regulation was represented in the program with teaching the ABC model of stress understanding and reduction, impulse control with the skills of coping with stress and anger management, causal analysis with critical thinking and self-empowerment, empathy with establishing positive relations and friendships, realistic optimism with personal goal setting, self-efficacy with decision-making, self-esteem, and self-respect, and finally reaching out with creating and keeping support groups. Thus, the FYRP follows a similar approach to the PRP, with minor modifications to some approaches and activities of sessions for cultural sensitivity to make some details more suitable for the special nature of the Kuwaiti society. For instance, the program was delivered in single-gender group sessions led by social workers of the same sex to conform with the separate genders school system of the country, and the unacceptability of the idea of shared activities of teenage boys and girls by cultural norms. In addition, the use of examples and scenarios was customized to fit with the Kuwaiti traditions, such as the inclusion of members of the extended family in building support groups and compassion activities. The content of each session of the program is presented briefly in Table 3.

Table 3.

Summary of the (FYRP) sessions.

Session 1 – Introduction: Presenting an overview of the program, discussing its goals and objectives, and setting ground rules. This session also included some icebreaker and team building activities, and the application of the pre-intervention measures.
Session 2 – The ABC Model of Stress Reduction: Identifying the role that our thoughts, beliefs, and self-talk play in triggering the fight/flight response after challenging events occur.
Session 3 – Personal Goal Setting: Teaching students how to set and reach SMART goals in everyday life, and the idea of linking their goals to the possible future.
Session 4 – Critical Thinking and Decision-Making: Focusing on the STEPS model applied to planned decision-making in relation to goal achieving, using role-plays on realistic examples.
Session 5 – Self-Esteem and Self-Respect: Applying the Glasser’s Model of dealing with Self-esteem; how to Know, Love, and Respect your SELF.
Session 6 – Coping with Stress and Empowerment: Explaining what stress is and identifying its different sources, and ways to handle, manage, and reduce stress. In addition, defining the true meaning of personal power and ways to build it, and positive and healthy ways to express it.
Session 7 – Positive Relationships and Support Groups: Focusing on peer relations, acceptance, and pressure, when and how to say NO, and how to create and keep a social support system to turn to.
Session 8 – Negotiation, Conflict Resolution & Anger Management: Concentrating on handling anger in appropriate ways through personal anger management plan. In addition, practicing the STEPS to negotiate a problem in a peaceful way, both individually and by working together with others.
Session 9 – Conclusion: Reflecting on the sessions, completing the Program Evaluation Sheet, Completing the After measures, and celebrating the completion of the program (Graduation Ceremony at the UN House, Kuwait City).

ABC: the cognitive connection between Adversity (A), Beliefs (B), and Consequences (C); FYRP: Fostering Youth Resiliency Project; SMART: Specific, Measurable, Achievable, Realistic, and Timely; STEPS: Stop, Think, Evaluate, Perform, Self-praise.

Objectives of the FYRP

Upon completion of the nine-session program, the participating students are expected to be able to:

Promote resilience and mental flexibility in dealing with stressful situations in daily life;

Solve the problems they face by making the appropriate decisions based on critical and positive thinking;

Understand and positively deal with feelings of anger, frustration, and anxiety that provoke violent and unacceptable behaviors;

Establish, develop, and maintain positive interpersonal relationships with peers and social support groups.

Intervention integrity

To ensure proper delivery of the intervention, the researcher conducted a ‘training for trainers’ intenseive workshop. Training sessions in the workshop were skills-focused, while ensuring that the relation between activities and resilience theory was clear. Besides training on the delivery of the FYR intervention, attention was given to ongoing evaluation of strengths and areas of improvements of the program. Furthermore, the training sessions included discussions of how to handle difficult students such as the importance of consistency, clear rules, and responsiveness. The training of trainers was carried out over 5 days, in a 3-hour session a day. All training sessions for the school social workers and psychologists took place at the United Nations House headquarters in Kuwait City.

To help unify the components of the training program, we developed a ‘Resilience Program Manual for Trainers’, describing the steps of teaching each of the social skills, including unified examples, videos, sketches, scenarios for role-playing, and brainstorming questions. Each member of the social workers and psychologists sample received the Manual and all videos used in the training on a flash memory stick as a reference to their training sessions with the student samples afterward, in addition to all materials needed for the program activities (e.g. notepads, coloring pens, robes, whiteboards), courtesy of the Kuwait UNDP.

Implementation of the FYR program

The FYRP was implemented in 12, 6 boys and 6 girls, public high schools, to a total of 54 students. The program was delivered in small groups (3–5 students) to allow enough time for the students to learn, build, and practice the different social skills of the program. All students committed in writing to attend all sessions, carry out the tasks and assignments given to them, and to cooperate with other peer team members. The training took place a week after the trainers’ workshop concluded, and training sessions for students were administered in schools for most samples, except two schools that chose to have the training at the UN House.

Study design, hypotheses, and procedures

The current pre-posttest pilot study sought to explore the preliminary evaluation of the immediate feasibility of the FYR program and its effects on participating students’ resilience skills and protective factors associated with them. This study design only looks at one group of individuals who received the intervention. The commonly used pre-posttest design, although not ideal, allows to make inferences on the effect of the intervention by looking at the difference in the pretest and posttest results of the study measures (Nestel et al., 2019).

The feasibility and acceptability of the initial application of the FYRP on target groups of high school students were assessed using quantitative and qualitative methods. For the quantitative approach, self-reported questionnaires measuring resilience factor skills were administered. Whereas the use of qualitative methodology aimed at getting youth to express their experience with the whole process of implementation. The focus was on reporting their level of satisfaction and acceptability, as well as the self-perceived benefits, using a short satisfaction survey incorporating both quantitative and qualitative questions of participants’ opinions about the program. In our investigation, we first hypothesized that the training program would significantly improve resilience-related skills covered by the curriculum (goal setting, critical thinking, self-esteem and respect, coping with pressure, positive relationships, anger management, and negotiation and conflict resolution skills) for students upon the completion of the training compared to baseline measures. Second, the participants would score high acceptability and satisfaction with the program; and third, that male and female students would report similar change in post-intervention measures with no significant difference based on gender.

To date, few studies have examined the effects of school-based prevention programs relevant to youth behaviors, and none using resilience-evidence based in Kuwait. The findings of this study will therefore be useful in addressing the gaps in the existing literature.

Ethical approval was granted by the project board at Kuwait UNDP. All survey participants (and their parents) were provided with a document outlining the purpose of the intervention, details regarding involvement as a participant, and ethical considerations, after which they signed a consent form prior to program participation and data collection.

Measures

The Resilience Skills Questionnaire (applied twice, pre- and post-intervention)

Developed based on the principal components of the FYR Program, the researcher constructed The Resilience Skills Questionnaire by first generating statements that describe all constructs of the program (e.g. personal goal setting, self-esteem, coping with stress) after careful review of related literature, then used the concept mapping procedure to reduce the number of items by sorting the most important statements, and using the item-sort tasks procedure (Howard and Melloy, 2016) to generate the final list of the questionnaire items. A group of five professionals (two senior social work field supervisors, a clinical psychology professor, and two social work faculty members) were given a detailed definition of the principal constructs of the study as well as several other theoretically similar constructs. Then, they were instructed to indicate which construct that they believe each item/statement best represents from a list of choices that included the principal constructs, other theoretically similar constructs, and an ‘any other construct’ option. After collecting the responses, the researcher calculated the number of times that each item was considered representative of the principal constructs, and items with sufficient number of assignments were considered representative and not others, using the cutoff values provided by Howard and Melloy (2016) that are based on traditional statistical significance testing. ‘Using this approach, the results of item-sort tasks have a sound statistical justification and have been shown to replicate EFA results’ (Howard and Melloy, 2016: 3).

The questionnaire starts with basic Demographics of participants (Gender, Age, and Grade) and consists of 29 items. In addition to the total score, the questionnaire also generates nine domain measures based on the item-sort tasks procedure results, which were personal goal setting skills (three items, for example, I can find alternative plans in difficult situations), critical thinking and decision-making skills (three items, for example, I can think of more than one solution to the same problem), self-esteem and self-respect (four items, for example, I’m satisfied with my current personality), coping with pressure skills (three items, for example, I get easily distracted when faced with pressure), positive relationship skills (three items, for example, It’s easy for me to make new friends), formation of support groups skills (three items, for example, I have an idol that I trust and listen to), negotiation and conflict resolution skills (four items, for example, I can express my opinion when I disagree with others), anger management skills (three items, for example, I can control myself when I’m angry), and cognitive and compassion skills (three items, for example, I interact with others when they express their feelings), plus the total score for resilience skills. The questionnaire adopts a Likert-type rating scale from 1 to 5 (1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Usually, and 5 = Always), with a higher score indicating greater skill competence. The questionnaire demonstrates good internal consistency (Cronbach’s alpha = 0.77 at pretest, and 0.76 at posttest), and test–retest reliability (r = 0.77–0.89).

Program evaluation scale (applied once at the end of the program)

Following the completion of the last session of the training program, participants completed a short scale designed to capture perception of the FYRP. The scale comprises four open-ended qualitative questions: (1) What was the activity that you preferred the most? (2) What were the things that you did not like about the program? (3) What was the most important thing that you learned from this program? and (4) If you had the chance, what would you change in the program to make it better? In addition, there was a set of six quantitative, multiple-choice items measured on a 5-point scale of 1 = Weak, 2 = Acceptable, 3 = Good, 4 = Very good, and 5 = Excellent. The items ask participants to evaluate the program based on usefulness, content, information gained, relation between program content and personal interest, if participant enjoyed the program, would he or she be willing to repeat it, and finally the appropriateness of the program timing.

All survey data were imported into the SPSS statistical package (version 23) to facilitate analysis. Analysis began with an examination of the dataset for missing data and yielded none. Descriptive statistics were used to produce summaries of the demographic data (Table 2), and multiple independent samples t-tests were conducted to compare the resilience skills measures in the pre- and post-intervention conditions in general, and for male and female students to examine the effect of gender on any change.

Results

Assessment of the FYRP efficacy

The assessment of the program was a three-fold process. The first was the qualitative assessment of the program by the school social workers and psychologists who were part of the trainers’ workshop. The second was the pre–post-intervention investigation. The third was the quantitative and qualitative short assessment of the acceptability and satisfaction scale completed by 37 students.

First, school social workers and psychologists assessed the program qualitatively during the review meetings with the researcher and the program assistant. We can summarize their notes as follows: (1) most of the feedback notes were positive and supportive, ‘we felt excited to be part of a new direction in dealing with students from a positive psychology view as opposed to the punitive approaches that make us look bad to students and distanced them from us’; (2) some trainers expressed the desire to use their own examples, videos, or activities to individualize the program and make it their own; (3) some suggested that this program would be greatly beneficial to be presented to parents and teachers as well to understand better ways of dealing with adolescents; (4) they applauded the realistic examples used in the training manual, the direct hands-on practice of scenarios, and the culturally relative aspects of the program to the Kuwaiti society; (5) some expressed the fact that the program is very rich and deals directly with students’ emotions, attitudes, thinking, and behaviors, and that ‘it helps students to express their feelings and opinions in a safe environment’. The only concern they had was the difficult application of the program in an ongoing manner because of time constraints due to busy study schedules of students within school hours and suggested that the intervention be applied as an after-school activity.

Second, multiple independent samples t-tests were conducted to compare the resilience skills measures in the pre- and post-intervention conditions. The means and standard deviations of all the variables are reported in Table 4.

Table 4.

Means and standard deviations of pre-intervention and post-intervention measures.

	Pre-group			Post-group
Subscale	M	SD	n	M	SD	n	t	p
Goal setting	11.38	2.37	53	13.11	2.13	54	−3.977	.000**
C-thinking & D-making	10.68	2.42	53	12.44	2.11	54	−4.015	.000**
Self-esteem & self-respect	15.49	3.10	53	17.15	2.44	54	−3.075	.003**
Coping with pressure	10.70	2.11	53	11.00	1.81	54	.018	.43
Positive relationships	12.23	2.02	53	12.17	2.07	54	−2.673	.88
Social support	11.15	2.76	53	12.28	2.00	54	−2.419	.017*
Negotiation & conflict res.	14.40	2.67	53	16.00	2.09	54	−3.462	.001**
Anger management	9.79	2.67	53	10.85	2.02	54	−.586	.021*
Cognitive and compassion	10.21	1.83	53	9.78	2.25	54	−1.531	.28
Total score for resilience social skills	106.02	12.06	53	114.78	10.31	54	−4.900	.000**

SD: standard deviation.

p < 0.05; **p < 0.01.

The results indicated an increase in the total and all subscale mean measures across the resilience skills between the pre- and the post-intervention scores in the hypothesized direction, suggesting that the program was successful in increasing the levels of social skills associated with resilience. Despite the fact that the increase appeared in all subscales, some increases were not strong enough to reach the level of significance. More specifically, the increase in the post-intervention Total resilience skills score, goal setting, critical thinking and decision making, self-esteem and respect, and negotiation and conflict resolution were statistically significant at (p < 0.01), and the social support and anger management skills at (p < 0.05). However, the improvements in scores of coping with pressure, positive relationships, and compassion were not statistically significant. Meaning that the first hypothesis that the training program would significantly improve resilience and related skills for students upon the completion of the training compared to baseline measures was partially supported.

To examine the second hypothesis regarding the effect of Gender on the change between the pre- and post-intervention measures, the means and standard deviations at the two time points measures are presented in Table 5. An independent samples t-test was conducted to compare the post-intervention total resilience skills measures for male and female students. There was no significant difference in the scores for male students (M = 115.68, SD = 9.86) and female students (M = 113.25, SD = 11.11); t (52) = .83, p = 0.41. Hence, the findings support the hypothesis. A discussion of these results will follow.

Table 5.

Mean scores and standard deviations of total resilience scale repeated measures by gender and grade.

Group	Pre-resilience skills		Post-resilience skills		t	p
	(n = 53)		(n = 54)
	M	SD	M	SD
All participants	106.02	21.06	114.78	10.31	−4.90	.000**
Gender
Males	109.70	8.47	115.68	9.86	.83	.41
Females	102.19	14.06	113.25	11.11

SD: standard deviation. **p<0.01.

The third analysis was evaluating the program’s acceptability and satisfaction among students. Participants’ attendance and engagement, and their ratings on the short survey were used to assess intervention acceptability. The high participation and low dropout rate (11.3 %), despite the voluntary nature of the program, indicated that students were well engaged and committed to the program. Quantitatively, 37 male and female students completed a short six-item program evaluation scale, expressing their opinion about the program/intervention. Students perceived the program as useful and interesting. On the 1–5 rating scale with 5 indicating the highest possible response, the results reported high satisfaction rates in all aspects of the evaluation, from the overall usefulness of the program (M = 4.70, SD = 0.67), to the program content (M = 4.67, SD = 0.63), to the level of information gained from participating in the program (M = 4.67, SD = 0.79), to the joy the students felt by taking part in this program (M = 4.78, SD = 0.63), and finally, the appropriateness of the length of the program (M = 4.5, SD = 0.70).

Qualitatively, on a closer look at the students’ comments in response to the open-ended questions on the program evaluation sheet, several themes emerged. First, the majority of participants (92%) expressed the need to change the timing of the program implementation from the third quarter of the academic year to the first, when it is a ‘less crowded period of exams, assignments, and other study-related activities and projects’. Second, the physical activities part of the program sessions was the most liked and enjoyed, and viewed as greatly beneficial by all students. Third, some students (38%) stressed the need to change the implementation site, demanding that the program be presented in a ‘more pleasant environment’ instead of the classroom. Fourth, when asked to point out the most important skill learned, many students chose critical thinking (92%), problem-solving (88%), decision making (86%), and anger management (79%). Finally, many students (72%) suggested increasing the practical and physical activities content when they were asked about things they would wish to change in the program for future application.

Discussion

The purpose of the study was to investigate the feasibility of the FYRP, a new universal school-based group prevention program based on the resilience model piloted with high school students in Kuwait as a way to promote healthy attitudes and behaviors by positive reactions to stress and challenges. The findings, although short-term and preliminary, seem encouraging. Given the many implications for positive youth development (Brown et al., 2012), mental health (Dray et al., 2014), emotional wellbeing (Vahedi et al., 2016), and the need for ways to enhance resilience among different populations (Craig et al., 2014), study findings support the potential of the FYRP for youth within the Kuwaiti culture.

In general, the results indicated a statistically significant short-term increase in resilience skills and competencies from baseline to posttest among participants. Moreover, separate analyses by gender revealed no significant differences between the two groups. Interestingly, while there was statistically significant difference at pretest of the total resilience skills measures between males (M = 109.70, SD = 8.47), and females (M = 102.19, SD = 2.76), t (51) = 2.36, p = 0.022, there was no statistically significant difference at posttest. This result suggests that the intervention was effective in enhancing resilience skills among all participating youth regardless of their pre-intervention levels.

The effect of FYRP on coping with pressure, positive relations, and compassion was not statistically significant between the pre- and post-intervention measures. This may be related to the fact that the students participating in the program have high pre-intervention scores on these variables to start with, making it difficult to detect significant changes in them. The mean scores for these skills in the pre-intervention were 10.70, 12.23, and 10.21, respectively, out of a possible perfect score of 15. In addition, some skills need longer time and more hands-on practice to develop and project on youth behaviors and attitudes than a limited one or two sessions devoted to teaching them within the program. We may also need to review and enhance the way the program delivers the training for these skills in the future.

Furthermore, the current evaluation of the FYRP yielded high levels of youth satisfaction and acceptability. As we discussed earlier, this can predict greater success chances for the future application of the FYRP due to the appealing nature of the program content and activities involved. Successful implementation of any intervention or program depends on the acceptability of the intervention to both intervention deliverers (the school social workers and psychologist in this study) and recipients (the high school students) (Diepeveen et al., 2013; Stok et al., 2015). If an intervention is considered acceptable, participants are more likely to adhere to its recommendations and to benefit from improved outcomes, yet if the delivery of a particular intervention is considered to have low acceptability, the intervention may not be delivered as intended by intervention designers, which may have an impact on the overall effectiveness of the intervention (Proctor et al., 2009).

Delivering universal interventions in school-based settings is a critical component of services targeting youth and adolescents because they provide unique opportunity to intervene with them in their natural environments (Wagner and Macgowan, 2006). Furthermore, they eliminate the stigma associated with targeting specific groups such as violent adolescents by utilizing the whole class approach, creating a positive culture which supports the continued use of the newly acquired skills (Taub and Pearrow, 2005).

The current study has several limitations. First, the preliminary and immediate positive findings of the study are not enough evidence that the FYRP can produce effects on youth attitudes and behaviors over time because of the lack of multi-time points follow-up investigations. Second, as the study design was limited to a one group pretest posttest design with no control group, factors other than participation in the program may have contributed to the resulted outcomes. Third, there is also limited generalizability due to the small sample size. Fourth, the measurement of intervention outcomes was based solely on responses to self-administered surveys. This type of information is subjective and may be biased by the effects of social desirability despite anonymity (Cook, 2010). Finally, as students in the study volunteered to participate, they may not be representative of all high school students.

Nevertheless, the study addresses a notable gap in both research and evidence-based practice. It represents an important building block toward identifying a promising school, strengths-based intervention designed to tackle possible future violent and unacceptable behaviors of youth (Guo and Tsui, 2010). As empirically supported interventions are scarce in the Middle Eastern literature, as well as in practice settings, the findings represent a fruitful contribution to social work intervention research. Furthermore, encouraging school social workers to deliver evidence-based interventions can set them apart from non-professionals who practice social work from other disciplines. In Kuwait, due to the high demand for social workers in schools, and low graduating rates from the single program of social work in the country at Kuwait University, the government started to hire graduates from other ‘close’ academic fields such as sociology, anthropology, and education as social workers to fill this gap in need. This employment strategy affected the profession of social work’s integrity and service negatively. Therefore, by encouraging social workers to use professional evidence-based interventions in practice, demanding ongoing training for new and senior practitioners, and using theoretical models of practice, we can preserve the integrity, service quality, and ethical professionalism of social work. Furthermore, it is important that future research build on current findings to address the previously mentioned limitations. For example, studies that compare the proposed FYRP intervention with other intervention approaches, using greater size samples, and more diverse populations, with the inclusion of control groups using random assignment of participants to each, are important to determine efficacy. Furthermore, adding multi-time points follow-up investigations to the program application protocol can provide evidence of short-term versus long-term effects. Moreover, future studies may benefit from exploring indicators of resilient youth, such as assessing changes and relationships between important domains of youth development and functioning, including academic and professional achievement, health and mental health status, and productive versus destructive behaviors, and how they contribute to long-term effects of the FYRP.

To conclude, the process of creating clinical practice models of resilience seems very natural to the profession of social work because it represents a biopsychosocial model. Such a process considers a range of biological, psychological, and social factors, each with multidirectional influence contributing to adequate functioning over time (Larkin et al., 2014). Therefore, the current study of piloting the first resilience model in Kuwait is just the first step in a thousand mile road toward stronger models. Research findings indicate that without significantly changing the environment in which youth live, attempts to enhance resilience will meet with limited success (Armstrong et al., 2005). Therefore, we must widen the scope of research and intervention to include families, teachers, school administrative, and local communities to assure greater positive impact of youth prevention programs. Future research needs to continue the trend of evidence-based social work practice and interventions (Bellamy et al., 2006) to extend the praxis-based knowledge (Petersen and Olsson, 2015) of risk and resilience related to youth for greater impact.

Footnotes

Acknowledgements

Thanks to the Project Committee at the KU-UNDP (Kuwait–United Nations Development Program) Office for taking the initiative in supporting the development of the first resilience-based intervention in the country and for their moral and financial support throughout the process. Special thanks to the Project Assistant for participating in the development of the training manual, and in delivering the training workshop to school social workers and psychologists. Thanks to the participating youth for sharing their expertise and engaging fruitfully with our Project team.

Consent to participate

Informed consent was obtained from all individual participants included in the study and their parents prior to the intervention sessions and data collection.

Declaration of conflicting interests

As the lead consultant of the Project, the researcher received a onetime honorarium from the UNDP for developing the intervention program, training the trainers, and assessing its preliminary effectiveness.

Ethical approval

Approval was obtained from the project committee at the UNDP-Kuwait. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Funding

This work was supported by the United Nations Development Program (UNDP), Kuwait Office (Project No. 83838).

ORCID iD

Malak Al-Rasheed

Author biography

Malak Al-Rasheed is an associate professor of Social Work at Kuwait University, a former designated member of the Kuwait Supreme Advisory Council for Family Affairs, and the vice president of the Kuwaiti Social Work Association.

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