Reintegrating Children Living at Landfills in Burundi Into Society by Means of a Comprehensive Family Program Addressing Maltreatment and Mental Health Symptoms

Study Overview
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Brief Summary
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Children living at the landfills of Bujumbura are often exposed to maltreatment, including emotional neglect and physical abuse, and traumatic experiences. Furthermore, they grow up in severe poverty. Addressing trauma-related mental health issues and aggressive behaviour by Narrative Exposure Therapy (FORNET), familial communication by family visits, interaction difficulties of children by a group intervention, poverty by financial support and economic training for mothers, medical problems by medical assistance, legal conflicts by legal advice, and providing access to school, we aimed at reintegrating those children within the Burundian school system and improving familial relationships. The investigators want to provide evidence, that mental health interventions are an integral part of assisting children and families affected by poverty and violence.

Official Title
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Reintegrating Children Living at Landfills in Burundi Into Society by Means of a Comprehensive Family Program Addressing Maltreatment and Trauma-related Mental Health Symptoms

Conditions
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Posttraumatic Stress Disorder, Aggressive Behaviour, Parental Maltreatment, Days Spent at the Landfill

Intervention / Treatment
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* Behavioral: Comprehensive family intervention including individual sessions of FORNET


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Spending days at the landfills of Bujumbura Exclusion Criteria: Psychotic symptoms

Ages Eligible for Study
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Minimum Age: 7 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Children and adolescents in the intervention group received: A group intervention once a week for about 20 weeks, including psychoeducation on mental health and drug abuse, anger management, roles within families, developing plans for the future, communication skills, sex education. Access to schools and school material Family visits Their parents received training regarding agriculture and microcredit projects, and financial assistance FORNET if affected by trauma-related symptoms, and/or acting aggressive If needed medical assistance is provided If needed legal assistance is provided | Behavioral: Comprehensive family intervention including individual sessions of FORNET<br>* A group intervention once a week for about 20 weeks, including psychoeducation on mental health and drug abuse, anger management, roles within families, developing plans for the future, communication skills, sex education. Access to schools and school material Family visits Their parents received training regarding agriculture and microcredit projects, and financial assistance FORNET if affected by trauma-related symptoms, and/or acting aggressive If needed medical assistance /.) If needed, legal assistance<br>|
| No Intervention: Control group<br>The control group was invited to participate in three interviews getting small amounts of money ( 2,5 €) as decompensation of their time. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of load of traumatic symptoms measured via the University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index (scale administered by Clinicians) | 27 items assessing PTSD, 4 additional items assessing dissociation on a scale from 0 - 4. Due to scoring rules, total sum score ranges from 0 to 80; sub scale intrusion: 0 - 20; sub scale avoidance: 0 - 8; sub scale negative cognitions: 0 - 28; sub scale hyperarousal: 0 - 24; higher values indicate more severe PTSD symptoms; all items are summed up for the total score | baseline; 5 months follow-up; 9 months follow-up | 
| Change of number of aggressive acts measured via an adaption of the Domestic and Community Violence Checklist | 32 items; answer categories: yes or no; sum score ranges from 0 - 32 | baseline; 5 months follow-up; 9 months follow-up | 
| Change of experienced parental maltreatment measured via a shortened version of the Maltreatment and Abuse Chronology of Exposure (MACE) | total sum score ranges from 0 - 100; sum score of each sub scale ranges from 0 - 10 | baseline; 5 months follow-up; 9 months follow-up | 
| Change of number of days spent at the landfill | during the last 14 days; sum ranges from 0 - 14 | baseline; 5 months follow-up; 9 months follow-up |