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

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

doi:10.1016/j.pmedr.2021.101593

Cited by 6 publications

(23 citation statements)

References 29 publications

(43 reference statements)

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“…An outstanding example in this context is the preventative intervention Interaction Competencies with Children (Hecker et al, 2017). Its effectiveness has been shown for teachers in school settings (Hermenau, Kaltebach, et al, 2015; Nkuba et al, 2018) and recently also for caregivers (Hecker et al, 2021). Interaction Competencies with Children focuses on fostering positive interactions with children by establishing a reliable, warm and sensitive relationship between the caregiver and the child, and additionally actively reduces maltreatment by changing personal attitudes towards violence and practicing alternative discipline methods.…”

Section: Discussionmentioning

confidence: 99%

“…Effective and theory-based interventions for caregivers focusing on the prevention of maltreatment in low resource settings are still very rare (Hermenau et al, 2017), but the few existing studies show a significant improvement in caregiving strategies and a significant decrease of maltreatment (Browne, 2017; Hecker et al, 2021). However, a huge gap in research remains concerning orphanage-context and caregiver-specific factors and their association with the maltreatment of institutionalized children.…”

Section: Introductionmentioning

confidence: 99%

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Caregiver-specific factors and orphanage-context factors contributing to maltreatment of children in institutional care: A multi-level analysis of 24 orphanages in Tanzania

Mkinga

Kirika

Nkuba

et al. 2022

Developmental Child Welfare

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Background: High rates of maltreatment and low caregiving quality in institutional care settings have been identified in various low-and middle-income countries. Many studies have focused on children living in institutions. Objective: This study investigates the prevalence of maltreatment, caregiver-specific, orphanage-context factors, and their relation to maltreatment of orphans from the caregivers’ perspective. Participants and setting: In this cross-sectional study, 227 caregivers (67% female) with a mean age of 36.84 years ( SD age = 12.89) of 24 childcare centres in Dar es Salaam, Tanzania participated. Methods: The primary outcome was the maltreatment of children assessed through structured interviews of caregivers. Further information on individual (like work-related stress) and structural variables (working conditions) was gathered. Results: Caregivers’ work under extreme and exhausting conditions, with very high caregiver-child ratios, low salaries, and almost no possibility to recover. Results also showed significant differences in the maltreatment level and structural and individual factors (e.g., payment and days of entitlement) between the orphanages. Caregiver’s positive attitudes towards violence ( ƒ2attitudes = 0.19) and difficulties in the relationship with children ( ƒ2relationship = 0.05) significantly predicted maltreatment with moderate and small effects. Conclusions: The overall poor working conditions highlight the urgent need to reduce the caregivers’ burden. In addition to this, addressing caregivers’ positive attitudes and improving their interaction competencies with children may be a starting point to prevent maltreatment of children. Further investigation of structural factors contributing to maltreatment is essential to develop recommendations for the improvement and re-organization of childcare institutions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Caregiver-specific factors and orphanage-context factors contributing to maltreatment of children in institutional care: A multi-level analysis of 24 orphanages in Tanzania

Mkinga

Kirika

Nkuba

et al. 2022

Developmental Child Welfare

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“…This parallel group cluster-randomized controlled trial involving all orphanages in Dar es Salaam city, Tanzania, was a continuation of the work by Hecker et al [23]. In total, 24 orphanages were randomly assigned to the intervention or to the waitlist condition.…”

Section: Study Design and Settingmentioning

confidence: 98%

“…Our primary aims were to replicate and further investigate the promising findings in the caregivers' sample [23]. We expected (a 1 ) a significant decrease in caregiver reported maltreatment and (b 1 ) positive attitudes towards violence as well as (c 1 ) a significant increase in childcare knowledge in the waitlist orphanages from first to second follow-up.…”

Section: Introductionmentioning

confidence: 97%

“…To address this shortcoming, the intervention Interaction Competencies with Children-for Caregivers (ICC-C) was developed [10]. The feasibility and effectiveness of ICC-C has already been tested in the context of a two-arm cluster randomized controlled trial in Tanzanian orphanages with positive initial findings [23]. The caregivers who participated in the intervention reported a decreased use of maltreatment, less positive attitudes towards violent discipline, and improved childcare knowledge after three months as compared to the caregivers working in the waitlist orphanages.…”

Section: Introductionmentioning

confidence: 99%

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Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care

Hecker

Mkinga²,

Hartmann³

et al. 2022

PLOS Glob Public Health

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Background Many orphans in East Africa are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. We report on the extension of a cluster-randomized controlled trial aiming to replicate and show sustainability of previous found effects and to discover long-term effects of the intervention Interaction Competencies with Children–for Caregivers (ICC-C) 12-months after the intervention’s conclusion. Methods Conducting a robust 2x3 analysis of variance, we investigated the changes over time in the waitlist orphanages (n = 75, 62.7% female, Mage = 37.63 years, SDage = 11.81), which participated in the intervention after first follow-up and in the initial intervention orphanages (n = 81, 61.7% female, Mage = 38.73 years, SDage = 11.94). Results The caregivers in the waitlist orphanages reported less reported levels of maltreatment (d = −0.09), fewer positive attitudes towards violent discipline (d = −0.44) and increased childcare knowledge (d = 1.26) three months after intervention, replicating our findings of the initial intervention condition. In addition, these effects were maintained in the intervention orphanages 12 months post intervention. Furthermore, we found long-term improvements in negative caregiver-child relationship (d = –0.83), caregivers’ stress level (d = −0.98) and their mental health problems (d = −0.61). Conclusions The replication and maintenance of the intervention effects and first hints to additional long-term effects substantiates the effectiveness of ICC-C. As long as alternative care cannot be provided for all children in need, brief caregiver trainings can make an important contribution to enlarge the opportunities for many children. Trial registration ClinicalTrials.gov, NCT03594617. Registered on 20 July 2018.

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Improving Parent-Child Interaction and Reducing Parental Violent Discipline – a Multi-Informant Multi-Method Pilot Feasibility Study of a School-Based Intervention

Kabelege,

Kirika,

Nkuba

et al. 2024

J Fam Viol

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Purpose Globally, many children are exposed to violent discipline in multiple settings. Interventions to prevent violent discipline are therefore highly needed. In the present study, the feasibility of the intervention Interaction Competencies with Children – for Parents (ICC-P), an additional module of a school-based intervention for teachers, was tested. The intervention aims to prevent violent discipline by changing attitudes towards such method and fostering supportive adult-child interaction through non-violent interaction skills. Methods In total, 164 parents (Mage= 39.55, range = 24 70, 72.3% female) from four public secondary schools in Tanzania participated in a four-day training conducted by six trainers (Mage= 44.67, range = 40–47, 50% female). Using a One-Group Pre-Post design, we measured the feasibility and preliminary effectiveness of the intervention qualitatively and quantitatively. Parents were assessed via self-administered questionnaires before and six weeks after the intervention. Trainers rated the implementation of every workshop session. Results Based on descriptive statistics and Classical Content Analysis, implementing trainers and participants rated ICC-P as feasible. Participants indicated a high need for such interventions and showed high acceptance. They were able to integrate core aspects of the intervention in their daily interactions with children. Using t-tests, ICC-P proved to be preliminarily effective; parents reported applying less violent discipline and holding more critical attitudes about such measures after the intervention. Conclusion ICC-P is feasible intervention that showed initial signs of effectiveness. We recommend combining the parents’ training module with the teachers’ module to prevent violence in multiple settings.

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

Cited by 6 publications

References 29 publications

Caregiver-specific factors and orphanage-context factors contributing to maltreatment of children in institutional care: A multi-level analysis of 24 orphanages in Tanzania

Caregiver-specific factors and orphanage-context factors contributing to maltreatment of children in institutional care: A multi-level analysis of 24 orphanages in Tanzania

Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care

Improving Parent-Child Interaction and Reducing Parental Violent Discipline – a Multi-Informant Multi-Method Pilot Feasibility Study of a School-Based Intervention

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