Project Summary
The Family Strengthening Intervention for Early Childhood Development and Violence Prevention (FSI-ECD+VP), also known in Rwanda as Sugira Muryango (SM) or Strengthen the Family, stems from early work with HIV affected families leading to the development of the Family Strengthening Intervention for Families/Children Affected by HIV/AIDS (R34MH084679) and has transformed to build parent capabilities, increase responsive parenting of both mothers and fathers, reduce family violence, support early childhood development, and strengthen family functioning.
This intervention, the FSI-ECD+VP, informed by the World Health Organization (WHO) Care for Child Development package, (a) builds parenting skills and improves knowledge of ECD to create a safe, stimulating, and nourishing environment for the growth of young children with a focus on nutrition, health, and hygiene promotion; (b) coaches parents of young children in 鈥渟erve and return鈥� interactions and playful parenting; (c) develops a 鈥渇amily narrative鈥� to build hope and highlight sources of resilience for addressing challenges and reducing the risk of violence; (d) strengthens problem-solving skills as well as the navigation of formal and informal community resources; and, (e) builds skills in parental emotion regulation and alternatives to harsh punishment.
The FSI-ECD+VP integrates these core components into 12 modules and two booster/follow-up sessions through a home-visiting model and active coaching. Currently, in Rwanda, the intervention has targeted families in extreme poverty with young children aged 0-36 months across three districts with plans to expand to additional districts.We have reached over 20,000 Rwandan families since 2018. In Rwanda, we have integrated the intervention within poverty reduction, social protection, and child protection initiatives with the Government of Rwanda鈥檚 existing structures. We are proudly collaborating with multiple funders and ministries in Rwanda to further strengthen our program to scale, including testing a continuous enrollment model and developing a digital dashboard to streamline the intervention effectiveness through an NIH-funded project to support scaling the intervention in collaboration with University of Rwanda, FXB-Rwanda, and digital partners to create this tool.
This project, titled, Testing an mHealth Digital Dashboard to improve Quality of Delivery of Evidence-based Interventions that Promote Family Mental Health and Functioning in Rwanda (R01MH136200) is investigating dashboard-supported delivery of the intervention in terms of its reach, efficiency, and cost effectiveness to enhance our understanding of the FSI-ECD+VP program in Rwanda. In addition to the RPCA research in Rwanda on the FSI-ECD+VP, the intervention has been adapted to multiple global cultural contexts including Sierra Leone and Colombia. The RPCA works with global partners to license our intervention with rigor to ensure the adaptability of our research in multiple contexts.
Approach
Combining parenting education with strategies to prevent violence and promote child development, tailored to the local context delivered by volunteer workers in line with government involvement.
Key Findings
- The 2018-2019 Cluster Randomized Trial (CRT) showed improved parent-child relationships, improved child鈥檚 health-related caregiving practices (e.g., fever and diarrhea care-seeking), and increased dietary diversity among participating families.聽
- Treatment families in the CRT showed improved hygiene behaviors (e.g., proper treatment of water), improved caregiver mental health, and reduced intimate partner violence (Betancourt et. al., 2020).聽
- A 12-month follow-up of the CRT found sustainment of many of these effects, including increased father engagement in caregiving practices, reduced harsh discipline of children, and reduced intimate partner violence.聽
- Improvements in children鈥檚 gross motor, communication, personal-social, and problem-solving early development (Jensen et. al., 2021) were observed 12 months post-intervention.
- Community-based volunteers participating in the study described how training and supervision experiences helped them feel prepared to deliver Sugira Muryango and provided examples of how competence enabled them to deliver Sugira Muryango effectively.
- Using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions, this trial intervention costs US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems.聽
- Through SM caregivers learned that strong relationships between partners and engagement of male caregivers in child care has positive impacts on children鈥檚 development.聽
- Techniques taught by community lay workers improved communication, promoted positive parent鈥揷hild interactions, and reduced intimate partner violence and violent discipline.聽
- Quantitative analyses also found that daily hardships predict violent discipline and intimate partner violence.