Preventing maltreatment in institutional care: A cluster-randomized controlled trial in East Africa

Tobias Hecker, Getrude Mkinga, Anette Kirika, Mabula Nkuba, Justin Preston, Katharin Hermenau, Tobias Hecker, Getrude Mkinga, Anette Kirika, Mabula Nkuba, Justin Preston, Katharin Hermenau

Abstract

An increasing number of orphans in low- and middle-income countries are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. To prevent maltreatment, we tested the effectiveness and feasibility of the intervention Interaction Competencies with Children - for Caregivers (ICC-C). In a two-arm cluster-randomized controlled trial, 203 caregivers (65.5% female, Mage = 36.63 years, SDage = 12.26) and 356 children (46.1% female, Mage = 9.43 years, SDage = 1.93) from 24 orphanages in Dar es salaam (Tanzania) participated from August to October 2018 (Baseline) and March to April 2019 (Follow-Up). Orphanages were assigned to the intervention or waitlist-group. Caregivers in the intervention group received the ICC-C intervention to prevent maltreatment through focusing on non-violent caregiving strategies. The primary outcome was the change in self-reported maltreatment by caregivers (Conflict Tactics Scale). Trial registration: ClinicalTrials.gov, NCT03594617, 20 July 2018. Participation in the intervention resulted in a significant reduction in reported maltreatment (f2 = 0.153), a decrease of positive attitudes toward violent discipline (f2 = 0.248), and an increased level of childcare knowledge (f2 = 0.220) in the caregiver sample, each indicating a moderate effect. Caregivers' training participation did not predict reduced maltreatment reported by children. Aspects of feasibility, including motivation to participate, acceptability, and integration of the new strategies were evaluated positively. The study promises initial effectiveness and feasibility of efforts to improve the situation of children in institutional care settings in resource-poor countries by offering training to care providers.

Keywords: Caregiver training; Childcare quality; Maltreatment; Orphans; Residential childcare.

Conflict of interest statement

We declare that none of the authors have competing financial or non-financial interests. The study was funded by the Young Researchers’ Fund of Bielefeld University.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Participant flow chart. Modified from CONSORT 2010.
Fig. 2
Fig. 2
Primary and secondary outcomes: Change from baseline to follow-up in the primary outcome measure maltreatment by caregivers (caregivers’ report) as well as the secondary outcome measures positive attitude toward violence and childcare knowledge in each of the orphanages (separated by allocation to intervention and wait-list condition). Across all variables a clear picture emerges: the values in all orphanages in the intervention condition are mostly similar and support our hypotheses, whereas the values in the orphanages in the control conditions do not show a uniform pattern.

References

    1. Akmatov M.K. Child abuse in 28 developing and transitional countries — results from the Multiple Indicator Cluster Surveys. Int. J. Epidemiol. 2010;40(1):219–227. doi: 10.1093/ije/dyq168.
    1. Altschul I., Lee S.J., Gershoff E.T. Hugs, not hits: warmth and spanking as predictors of child social competence. J. Marriage Family. 2016;78(3):695–714. doi: 10.1111/jomf.12306.
    1. Antonowicz, L., 2010. Too often in silence: A report on school-based violence in West and Central Africa. UNICEF, Plan West Africa, Save the Children Sweden West Africa and ActionAid. .
    1. Bowen D.J., Kreuter M., Spring B., Cofta-Woerpel L., Linnan L., Weiner D., Bakken S., Kaplan C.P., Squiers L., Fabrizio C., Fernandez M. How we design feasibility studies. Am. J. Preventative Med. 2009;36(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Brislin R.W., Lonner W.J., Thorndike R.M. Wiley-Intersection Publication; New York, NY: 1973. Cross-Cultural Research Methods: Comparative Studies in Behavioral Science.
    1. Carr A., Duff H., Craddock F. A systematic review of reviews of the outcome of severe neglect in underresourced childcare institutions. Trauma, Violence, & Abuse. 2018;21(3):484–497. doi: 10.1177/1524838018777788.
    1. Crosnoe, R., Leventhal, T., Wirth, R. J., Pierce, K. M., Pianta, R. C., & NICHD Early Child Care Research Network., 2010. Family socioeconomic status and consistent environmental stimulation in early childhood. Child Development, 81(3), 972-987. .
    1. Dreikurs R., Cassel P., Dreikurs Ferguson E. Wiley; 2004. Discipline Without Tears: How to Reduce Conflict and Establish Cooperation in the Classroom (revised)
    1. Ferguson C.J. Spanking, corporal punishment and negative long-term outcomes: a meta-analytic review of longitudinal studies. Clin. Psychol. Rev. 2013;33(1):196–208. doi: 10.1016/j.cpr.2012.11.002.
    1. Fukkink R.G., Lont A. Does training matter? a meta-analysis and review of caregiver training studies. Early Childhood Res. Quarterly. 2007;22(3):294–311. doi: 10.1016/j.ecresq.2007.04.005.
    1. Gray C.L., Pence B.W., Ostermann J., Whetten R.A., O’Donnell K., Thielman N.M., Whetten K. Prevalence and incidence of traumatic experiences among orphans in institutional and family-based settings in 5 low- and middle-income countries: a longitudinal study. Global Health, Sci. Practice. 2015;3(3):395–404. doi: 10.9745/GHSP-D-15-00093.
    1. Hecker T., Mkinga G., Ssenyonga J., Hermenau K. In: Child Maltreatment in Long-Term Residential Centers: History, Research, and Current Implications. Rus A.V., Parris S.R., Stativa E., editors. Springer Press; 2017. Interaction Competencies with Children (ICC) – an approach for preventing violence, abuse and neglect in institutional care in Sub-Saharan Africa; pp. 357–378.
    1. Hermenau K., Eggert I., Landolt M.A., Hecker T. Neglect and perceived stigmatization impact psychological distress of orphans in Tanzania. Eur. J. Psychotraumatol. 2015;6(1):28617. doi: 10.3402/ejpt.v6.28617.
    1. Hermenau K., Goessmann K., Rygaard N.P., Landolt M.A., Hecker T. Fostering child development by improving care quality: a systematic review of the effectiveness of structural interventions and caregiver trainings in institutional care. Trauma, Violence, & Abuse. 2017;18(5):544–561. doi: 10.1177/1524838016641918.
    1. Hermenau K., Hecker T., Elbert T., Ruf-Leuschner M. Maltreatment and mental health in institutional care-comparing early and late institutionalized children in tanzania. Infant Mental Health J. 2014;35(2) doi: 10.1002/imhj.21440.
    1. Hermenau K., Kaltenbach E., Mkinga G., Hecker T. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers. Front. Psychol. 2015;6:937. doi: 10.3389/fpsyg.2015.00937.
    1. Holden G.W., Brown A.S., Baldwin A.S., Caderao K.C. Research findings can change attitudes about corporal punishment. Child Abuse Negl. 2014;38(5):902–908. doi: 10.1016/j.chiabu.2013.10.013.
    1. Holland G.W., Holden G.W. Changing orientations to corporal punishment: a randomized, control trial of the efficacy of a motivational approach to psychoeducation. Psychol. Violence. 2016;6(2):233–242. doi: 10.1037/a0039606.
    1. Huang F.L. Multilevel modeling myths. School Psychol. Quarterly. 2018;33(3):492–499. doi: 10.1037/spq0000272.
    1. Li X., Naar-King S., Barnett D., Stanton B., Fang X., Thurston C., Turston C. A developmental psychopathology framework of the psychosocial needs of children orphaned by HIV. J. Assoc. Nurses AIDS Care. 2008;19(2):147–157. doi: 10.1016/j.jana.2007.08.004.
    1. Makuu M.J. Situation analysis of orphans and vulnerable children in existing alternative care systems in Dar es Salaam, Tanzania. Social Work & Society. 2019;17(1)
    1. McCall R.B. The consequences of early institutionalization: can institutions be improved? – should they? Child Adolesc. Mental Health. 2013;18(4):193–201. doi: 10.1111/camh.12025.
    1. McCall R.B., Groark C.J. Research on institutionalized children: Implications for international child welfare practitioners and policymakers. Int. Perspectives Psychol: Res., Practice, Consult. 2015;4(2):142–159. doi: 10.1037/ipp0000033.
    1. McCambridge J., Witton J., Elbourne D.R. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J. Clin. Epidemiol. 2014;67(3):267–277. doi: 10.1016/j.jclinepi.2013.08.015.
    1. Michie S., Abraham C., Whittington C., McAteer J., Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi: 10.1037/a0016136.
    1. Nkuba, M., Hermenau, K., Goessmann, K., Hecker, T., 2018. Reducing violence by teachers using the preventive intervention Interaction Competencies with Children for Teachers (ICC-T): A cluster randomized controlled trial at secondary schools in Tanzania. PLOS ONE, 13(8), e0201362. . pone.0201362.
    1. Rygaard N.P. Designing the Fair Start Project – a free E-learning and organizational development program for orphanages and foster families in quality caregiving. Clin. Neuropsychol. 2010;7(6):181–187.
    1. Sherr L., Roberts K.J., Gandhi N. Child violence experiences in institutionalised/orphanage care. Psychol., Health Med. 2017;22(sup1):31–57. doi: 10.1080/13548506.2016.1271951.
    1. Straus M.A., Mattingly M.J. University of New Hampshire, Family Research Laboratory; 2007. A Short Form and Severity Level Types for the Parent-Child Conflict Tactics Scales.
    1. The American Academy of Pediatrics. (1999). Caring for your school-age child: Ages 5 to 12 (E. L. Schoor (ed.)). Bantam Books.
    1. Toth S.L., Cicchetti D. A developmental psychopathology perspective on child maltreatment. Child Maltreatment. 2013;18(3):135–139. doi: 10.1177/1077559513500380.
    1. van IJzendoorn M.H., Bakermans-Kranenburg M.J., Duschinsky R., Goldman P.S., Fox N.A., Gunnar M.R., Johnson D.E., Nelson C.A., Reijman S., Skinner G., Zeanah C.H., Sonuga-Barke E.J.S. Institutionalisation and deinstitutionalisation of children: a systematic and integrative review of evidence regarding effects on development. Lancet Psychiatry. 2020;0366(19) doi: 10.1016/S2215-0366(19)30399-2.
    1. Werner C.D., Linting M., Vermeer H.J., Van IJzendoorn M.H. Do intervention programs in childcare promote the quality of caregiver-child interactions? a meta-analysis of randomized controlled trials. Prev. Sci. 2016;17(2):259–273. doi: 10.1007/s11121-015-0602-7.
    1. Whetten K., Ostermann J., Whetten R., O'Donnell K., Thielman N. More than the loss of a parent: potentially traumatic events among orphaned and abandoned children. J. Trauma. Stress. 2011;24(2):174–182. doi: 10.1002/jts.20625.
    1. Wright A.C., Lamsal D., Ksetree M., Sharma A., Jaffe K. From maid to mother: Transforming facilities, staff training, and caregiver dignity in an institutional facility for young children in Nepal. Infant Mental Health J. 2014;35(2):132–143. doi: 10.1002/imhj.21429.
    1. Wright A.W., Richard S., Sosnowski D.W., Kliewer W. Predictors of better functioning among institutionalized youth: a systematic review. J. Child Fam. Stud. 2019;28(12):3245–3267. doi: 10.1007/s10826-019-01527-0.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir