Improving Care and Preventing Maltreatment of Orphans
Condition: Maltreatment, Child
Study type: Interventional

Summary: 
      Sub-Saharan Africa, with more than 56 million orphans worldwide, is the most affected region
      in terms of orphans to be cared for (UNICEF, 2014). The recently developed preventative
      approach Interaction Competencies with Children - for Caregivers (ICC-C; Hecker, Mkinga,
      Ssenyonga, & Hermenau, 2017) trains the essential interaction skills in working with
      children. The focus here is on strengthening a warm, sensitive and reliable relationship
      between caregiver and child as well as on non-violent education strategies. In a first pilot
      study the feasibility of the approach icould be demonstrated (Hermenau, Kaltenbach, Mkinga, &
      Hecker, 2015).

      The study applies a two-arm cluster-randomized controlled design. The participating
      institutions will be randomly divided into intervention and control bodies. The follow-up
      examination should take place three months after the intervention. All caregivers in facility
      (N = approx. 150) and 25 randomly selected children (age: 6-12) per facility (N = 200) will
      be included in this study.
    

Detailed description: 
      Sub-Saharan Africa, with more than 56 million orphans worldwide, is the most affected region
      in terms of orphans to be cared for (UNICEF, 2014). The few studies investigating children in
      African orphanages mostly showed inadequate care (Espié et al., 2011; Hermenau et al., 2011;
      Levin & Haines, 2007; Wolff & Fesseha, 1998, 1999). In addition to the lack of trained and
      competent caregivers, children are also confronted with violence and abuse in the orphanages
      themselves (Hermenau et al., 2011; SOS Children's Villages International & University of
      Bedfordshire, 2014). Abuse and neglect in orphanages, in addition to traumatisation, abuse
      and neglect in the families of origin, pose a considerable risk for the healthy development
      and mental health of children (Hermenau, Goessmann, Rygaard, Landolt, & Hecker, 2017). In
      addition to meeting basic needs (e. g. eating, drinking, basic medical care, etc.), sensitive
      and non-violent education in orphanages is crucial for the emotional and physical development
      of children. However, the focus of previous intervention studies has been on promoting a
      sensitive and reliable relationship between caregiver and child. Violence and maltreatment,
      on the other hand, received little attention (Hermenau et al., 2017).

      The recently developed preventative approach Interaction Competencies with Children - for
      Caregivers (ICC-C; Hecker, Mkinga, Ssenyonga, & Hermenau, 2017) trains the essential
      interaction skills in working with children. The focus here is on strengthening a warm,
      sensitive and reliable relationship between caregiver and child as well as on non-violent
      education strategies. In a first pilot study the feasibility of the approach could be
      demonstrated (Hermenau, Kaltenbach, Mkinga, & Hecker, 2015).

      The study applies a two-arm cluster-randomized controlled design and includes 20 to 25
      orphanages. After an initial investigation, the participating institutions will be randomly
      divided into intervention and control bodies. The follow-up examination should take place
      three months after the intervention. In addition, feasibility data will be assessed in the
      intervention facilities only at the beginning and the end of the intervention. All caregivers
      in facility (N = approx. 150) and 10-15 randomly selected children (age: 6-12) per facility
      (N = 300) will be included in this study. Data of caregivers will be assessed with the help
      of self-administered questionnaires, whereas data of children will be assessed with
      structured interviews.

      There is a clear and pressing humanitarian need for science to address the issue of care
      quality and maltreatment prevention in institutional care settings in a practical manner.
      Perhaps surprisingly in view of this, so far no evidenced-based prevention measures adapted
      for the limited resources in low-income countries have been developed and scientifically
      evaluated. This research project can address this need, with a scientifically rigorous
      evaluation of a violence and maltreatment prevention program that fosters the active
      involvement of local personnel and that considers the limited resources of school settings in
      low-income countries. Through these efforts this study may help more orphans to grow-up in a
      supportive atmosphere, maintaining their psychological well-being and improving their
      performance. This preventative program aims to make a significant impact on the psychological
      well-being of orphans in Tanzania.
    

Intervention name(s): Interaction Competencies with Children - for Caregiver
Intervention type(s): Behavioral
Intervention description(s): Interaction Competencies with Children - for Caregiver (ICC-C) aims to reduce maltreatment and to improve care quality in institutional care facilities. Following the idea of a train-the-trainer approach, ICC-C is designed to be delivered by trained local facilitators. ICC-C is based on attachment, behavioral and social learning theories.
The key principles are its feasibility in low-resource contexts, participatory approach, and practical orientation. ICC-C includes sessions on (a) caregiver-child interaction, (b) maltreatment prevention, (c) effective non-violent caregiving strategies, and (d) identifying and supporting burdened children.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention