@article{ref1,
title="Sustainability of effects and secondary long-term outcomes: one-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care",
journal="PLOS global public health",
year="2022",
author="Hecker, Tobias and Mkinga, Getrude and Hartmann, Eva and Nkuba, Mabula and Hermenau, Katharin",
volume="2",
number="5",
pages="e0000286-e0000286",
abstract="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. <br><br>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). <br><br>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). <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="2767-3375",
doi="10.1371/journal.pgph.0000286",
url="http://dx.doi.org/10.1371/journal.pgph.0000286"
}