IntroductionFamilies living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda’s social protection system to promote ECD and reduce violence compared with usual care (UC).MethodsFamilies with children aged 6–36 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments.ResultsA total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI −0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth.ConclusionSocial protection programmes provide a means to deliver ECD intervention.Trial registration numberNCT02510313.
Objective: Peer support services for individuals with psychiatric conditions have burgeoned and now are proliferating within mental health systems nationally and internationally. More recently, variations of peer support have been developed, including those that focus on vocational outcomes. Methods: We conducted a randomized clinical trial in two mental health programs to test a newly developed model of vocationally oriented peer support. We recruited, randomly assigned, and followed 166 individuals for 12 months; 83 received Vocational Peer Support (the experimental condition, VPS) and 83 received peer support servicesas-usual. Peer support specialists (PSS) delivering VPS were trained and supervised. We examined vocational and educational outcomes as well as work hope, quality of life, and work readiness at baseline, 6-and 12-month postrandomization. We assessed the working alliance as well. Results: We found a groupby-time effect on domains of work readiness and modest differences in vocational activity. Secondary analyses revealed that VPS resulted in a stronger working alliance with the peer specialist, which mediated some aspects of a better quality of life and greater work hope. Conclusions and Implications for Practice: In the context of the peer relationship, peer specialists are often called upon to support individuals who are pursuing employment, often without adequate preparation or training. Our findings suggest that vocationally oriented peer support affects several aspects of readiness to pursue work-related goals and mediates some aspects of vocational hope and quality of life. VPS may assist individuals receiving peer support as they choose, get, and keep employment.
Impact and ImplicationsPeer support is burgeoning nationally but few initiatives are designed to test its role in promoting vocational outcomes. We developed an intervention that would extend the skills and knowledge of trained peer specialists to deliver support to individuals wishing to engage in a process of choosing, getting, or keeping employment. We conducted a randomized trial of Vocational Peer Support and found some evidence for its effectiveness.
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