Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial / Theresa S. BETANCOURT in Journal of Child Psychology and Psychiatry, 58-8 (August 2017)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 58-8 (August 2017) . - p.922-930 Titre : Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial Type de document : texte imprimé Auteurs : Theresa S. BETANCOURT, Auteur ; Lauren C. NG, Auteur ; Catherine M. KIRK, Auteur ; Robert T. BRENNAN, Auteur ; William R. BEARDSLEE, Auteur ; Sara STULAC, Auteur ; Christine MUSHASHI, Auteur ; Estella NDUWIMANA, Auteur ; Sylvere MUKUNZI, Auteur ; Beatha NYIRANDAGIJIMANA, Auteur ; Godfrey KALISA, Auteur ; Cyamatare F. RWABUKWISI, Auteur ; Vincent SEZIBERA, Auteur Article en page(s) : p.922-930 Langues : Anglais (eng) Mots-clés : HIV  depression  Rwanda  adolescents Index. décimale : PER Périodiques Résumé : Background Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent–child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services. Methods Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7–17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. Trial Registration: NCT01509573, ‘Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573 term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1. Results At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = −.246; p = .009) and parent report (β = −.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting. Conclusions Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators. En ligne : http://dx.doi.org/10.1111/jcpp.12729 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=316 [article] Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial [texte imprimé] / Theresa S. BETANCOURT, Auteur ; Lauren C. NG, Auteur ; Catherine M. KIRK, Auteur ; Robert T. BRENNAN, Auteur ; William R. BEARDSLEE, Auteur ; Sara STULAC, Auteur ; Christine MUSHASHI, Auteur ; Estella NDUWIMANA, Auteur ; Sylvere MUKUNZI, Auteur ; Beatha NYIRANDAGIJIMANA, Auteur ; Godfrey KALISA, Auteur ; Cyamatare F. RWABUKWISI, Auteur ; Vincent SEZIBERA, Auteur . - p.922-930. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 58-8 (August 2017) . - p.922-930 Mots-clés : HIV  depression  Rwanda  adolescents Index. décimale : PER Périodiques Résumé : Background Children affected by HIV are at risk for poor mental health. We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent–child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services. Methods Eighty two families (N = 170 children, 48.24% female; N = 123 caregivers, 68.29% female) with at least one HIV-positive caregiver (n = 103, 83.74%) and school-aged child (ages 7–17) (HIV+ n = 21, 12.35%) were randomized to receive FSI-HIV or treatment-as-usual (TAU). Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up. Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points. Trial Registration: NCT01509573, ‘Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R).' https://clinicaltrials.gov/ct2/show/;NCT01509573 term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1. Results At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = −.246; p = .009) and parent report (β = −.174; p = .035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting. Conclusions Family-based prevention has promise for reducing depression symptoms in children affected by HIV. Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators. En ligne : http://dx.doi.org/10.1111/jcpp.12729 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=316

Intergenerational impacts of trauma and hardship through parenting / Sarah K.G. JENSEN in Journal of Child Psychology and Psychiatry, 62-8 (August 2021)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 62-8 (August 2021) . - p.989-999 Titre : Intergenerational impacts of trauma and hardship through parenting Type de document : texte imprimé Auteurs : Sarah K.G. JENSEN, Auteur ; Vincent SEZIBERA, Auteur ; Shauna M. MURRAY, Auteur ; Robert T. BRENNAN, Auteur ; Theresa S. BETANCOURT, Auteur Article en page(s) : p.989-999 Langues : Anglais (eng) Mots-clés : Emotional Regulation  Emotions  Humans  Mental Health  Parenting  Stress Disorders, Post-Traumatic  emotional dysregulation  internalising disorder  post-traumatic stress disorder  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Millions of people worldwide experience severe trauma in their lifetime. Trauma has immediate and long-term effects on emotional wellbeing. Moreover, the experiences of one generation may influence subsequent generations via social and biological pathways. Poor mental health and emotion dysregulation associated with trauma may affect parenting behaviours, which may have long-lasting effects on children's development. METHODS: We use longitudinal data from a unique sample of 732 caregivers of children aged 6-36 months living in extremely poor rural households in Rwanda to examine associations of caregiver lifetime trauma, recent daily hardships, mental health, and emotion dysregulation with parenting behaviours reflecting parental acceptance and rejection of their offspring. RESULTS: Cumulative trauma exposure (β = .234, p < .001) and recent daily hardships (β = .323, p < .001) are associated with higher levels of internalising symptoms. Trauma (β = .257, p < .001) and daily hardships (β = .323, p < 0.001) are also associated with post-traumatic stress disorder (PTSD) symptoms. Internalising symptoms predict more rejection (β = .177, p = .001), but show no association with acceptance. Caregiver PTSD symptoms predict more rejection (β = .277, p < .001) and less acceptance (β = -.190, p = .003). Both internalising symptoms (β = .557, p < .001) and PTSD symptoms (β = .606, p < .001) are strongly associated with poor emotion regulation. Indirect effects suggest that caregiver trauma and hardships affect parenting indirectly via elevated caregiver internalising symptoms and PTSD and that some of these effects are accounted for by emotion dysregulation. CONCLUSIONS: Caregiver internalising and PTSD symptoms are important mechanisms through which caregiver trauma and hardship affect parenting behaviours. Emotion dysregulation is a shared mechanism linking caregivers' mental health problems with parenting behaviours that reflect acceptance and rejection of the child. Emotion regulation is indicated as a key target for prevention of adverse effects of caregiver trauma on mental health and child wellbeing. En ligne : http://dx.doi.org/10.1111/jcpp.13359 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456 [article] Intergenerational impacts of trauma and hardship through parenting [texte imprimé] / Sarah K.G. JENSEN, Auteur ; Vincent SEZIBERA, Auteur ; Shauna M. MURRAY, Auteur ; Robert T. BRENNAN, Auteur ; Theresa S. BETANCOURT, Auteur . - p.989-999. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 62-8 (August 2021) . - p.989-999 Mots-clés : Emotional Regulation  Emotions  Humans  Mental Health  Parenting  Stress Disorders, Post-Traumatic  emotional dysregulation  internalising disorder  post-traumatic stress disorder  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Millions of people worldwide experience severe trauma in their lifetime. Trauma has immediate and long-term effects on emotional wellbeing. Moreover, the experiences of one generation may influence subsequent generations via social and biological pathways. Poor mental health and emotion dysregulation associated with trauma may affect parenting behaviours, which may have long-lasting effects on children's development. METHODS: We use longitudinal data from a unique sample of 732 caregivers of children aged 6-36 months living in extremely poor rural households in Rwanda to examine associations of caregiver lifetime trauma, recent daily hardships, mental health, and emotion dysregulation with parenting behaviours reflecting parental acceptance and rejection of their offspring. RESULTS: Cumulative trauma exposure (β = .234, p < .001) and recent daily hardships (β = .323, p < .001) are associated with higher levels of internalising symptoms. Trauma (β = .257, p < .001) and daily hardships (β = .323, p < 0.001) are also associated with post-traumatic stress disorder (PTSD) symptoms. Internalising symptoms predict more rejection (β = .177, p = .001), but show no association with acceptance. Caregiver PTSD symptoms predict more rejection (β = .277, p < .001) and less acceptance (β = -.190, p = .003). Both internalising symptoms (β = .557, p < .001) and PTSD symptoms (β = .606, p < .001) are strongly associated with poor emotion regulation. Indirect effects suggest that caregiver trauma and hardships affect parenting indirectly via elevated caregiver internalising symptoms and PTSD and that some of these effects are accounted for by emotion dysregulation. CONCLUSIONS: Caregiver internalising and PTSD symptoms are important mechanisms through which caregiver trauma and hardship affect parenting behaviours. Emotion dysregulation is a shared mechanism linking caregivers' mental health problems with parenting behaviours that reflect acceptance and rejection of the child. Emotion regulation is indicated as a key target for prevention of adverse effects of caregiver trauma on mental health and child wellbeing. En ligne : http://dx.doi.org/10.1111/jcpp.13359 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456

Scaling up home-visiting to promote early childhood development and prevent violence in Rwanda: a hybrid type-2 effectiveness-implementation trial / Candace J. BLACK in Journal of Child Psychology and Psychiatry, 66-10 (October 2025)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 66-10 (October 2025) . - p.1484-1499 Titre : Scaling up home-visiting to promote early childhood development and prevent violence in Rwanda: a hybrid type-2 effectiveness-implementation trial Type de document : texte imprimé Auteurs : Candace J. BLACK, Auteur ; Matias PLACENCIO-CASTRO, Auteur ; Gabriela PHEND, Auteur ; Jean Marie Vianney HAVUGIMANA, Auteur ; Grace UMULISA, Auteur ; Pacifique UWAMAHORO, Auteur ; Marie Gaudence NYIRAHABIMANA, Auteur ; Laura BOND, Auteur ; Kayla HERNANDEZ, Auteur ; Sarah K.G. JENSEN, Auteur ; Ursula KAJANI, Auteur ; Shauna M. MURRAY, Auteur ; Laura B. RAWLINGS, Auteur ; Vincent SEZIBERA, Auteur ; Theresa S. BETANCOURT, Auteur Article en page(s) : p.1484-1499 Langues : Anglais (eng) Mots-clés : Implementation science  implementation strategy  Hybrid Type-2 Trial  early child development  global health  violence prevention  father engagement  poverty  social protection  home-visiting Index. décimale : PER Périodiques Résumé : Background Children in impoverished families?especially those affected by violence?face risks to healthy development. In the years of strong economic recovery since the 1994 Genocide Against the Tutsi, the Rwandan Government has invested in early child development, social and child protection and violence prevention, but few strategies for scaling evidence-based interventions (EBIs) in these areas have been studied. Methods We present a Hybrid Type-2 Implementation-Effectiveness study of the PLAY Collaborative implementation strategy to engage government and other stakeholders in scaling Sugira Muryango (SM, ?Strong Family?) to families eligible for social protection in three rural districts. SM promotes nurturing care of children under three while reducing family violence. We assessed delivery quality (fidelity, competence) and perceptions of the PLAY Collaborative (e.g, feasibility, leadership, organisation, sustainability). An embedded trial of 538 households (778 caregivers, 555 children) tested SM effectiveness when delivered by child protection volunteers. Results Child protection volunteers delivered SM with high fidelity and competence that improved with time and routine supervision. The PLAY Collaborative was rated moderately to highly across implementation outcomes. The embedded trial revealed improvements in children's stimulation at home (d 0.20, 95% CI: 0.04 0.36) as caregivers involved them more in daily activities (d 0.37, 95% CI: 0.18 0.57) and provided more learning materials (d 0.37, 95% CI: 0.16 0.59). SM families increased stimulating care (e.g. singing, playing; d 0.26, 95% CI: 0.07 0.46); involved fathers more in caregiving (IRR 1.18, 95% CI: 1.03 1.37); reduced harsh discipline (OR 0.34, 95% CI: 0.14 0.82); and increased dietary diversity (d 0.25, 95% CI: 0.04 0.45). SM caregivers reported improved mental health (d 0.13, 95% CI: 0.26 to 0.01). SM households increased safe water storage (OR 3.14, 95% CI: 1.64 6.03) and water treatment (OR 3.56, 95% CI: 1.80 7.05) practices. Conclusions The PLAY Collaborative successfully overcame implementation barriers and maintained effectiveness across most outcomes while scaling delivery to N 8,745 families, highlighting the value of systematically investigating implementation strategies while scaling an EBI as integrated into existing social and child protection systems. En ligne : https://doi.org/10.1111/jcpp.14160 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=568 [article] Scaling up home-visiting to promote early childhood development and prevent violence in Rwanda: a hybrid type-2 effectiveness-implementation trial [texte imprimé] / Candace J. BLACK, Auteur ; Matias PLACENCIO-CASTRO, Auteur ; Gabriela PHEND, Auteur ; Jean Marie Vianney HAVUGIMANA, Auteur ; Grace UMULISA, Auteur ; Pacifique UWAMAHORO, Auteur ; Marie Gaudence NYIRAHABIMANA, Auteur ; Laura BOND, Auteur ; Kayla HERNANDEZ, Auteur ; Sarah K.G. JENSEN, Auteur ; Ursula KAJANI, Auteur ; Shauna M. MURRAY, Auteur ; Laura B. RAWLINGS, Auteur ; Vincent SEZIBERA, Auteur ; Theresa S. BETANCOURT, Auteur . - p.1484-1499. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 66-10 (October 2025) . - p.1484-1499 Mots-clés : Implementation science  implementation strategy  Hybrid Type-2 Trial  early child development  global health  violence prevention  father engagement  poverty  social protection  home-visiting Index. décimale : PER Périodiques Résumé : Background Children in impoverished families?especially those affected by violence?face risks to healthy development. In the years of strong economic recovery since the 1994 Genocide Against the Tutsi, the Rwandan Government has invested in early child development, social and child protection and violence prevention, but few strategies for scaling evidence-based interventions (EBIs) in these areas have been studied. Methods We present a Hybrid Type-2 Implementation-Effectiveness study of the PLAY Collaborative implementation strategy to engage government and other stakeholders in scaling Sugira Muryango (SM, ?Strong Family?) to families eligible for social protection in three rural districts. SM promotes nurturing care of children under three while reducing family violence. We assessed delivery quality (fidelity, competence) and perceptions of the PLAY Collaborative (e.g, feasibility, leadership, organisation, sustainability). An embedded trial of 538 households (778 caregivers, 555 children) tested SM effectiveness when delivered by child protection volunteers. Results Child protection volunteers delivered SM with high fidelity and competence that improved with time and routine supervision. The PLAY Collaborative was rated moderately to highly across implementation outcomes. The embedded trial revealed improvements in children's stimulation at home (d 0.20, 95% CI: 0.04 0.36) as caregivers involved them more in daily activities (d 0.37, 95% CI: 0.18 0.57) and provided more learning materials (d 0.37, 95% CI: 0.16 0.59). SM families increased stimulating care (e.g. singing, playing; d 0.26, 95% CI: 0.07 0.46); involved fathers more in caregiving (IRR 1.18, 95% CI: 1.03 1.37); reduced harsh discipline (OR 0.34, 95% CI: 0.14 0.82); and increased dietary diversity (d 0.25, 95% CI: 0.04 0.45). SM caregivers reported improved mental health (d 0.13, 95% CI: 0.26 to 0.01). SM households increased safe water storage (OR 3.14, 95% CI: 1.64 6.03) and water treatment (OR 3.56, 95% CI: 1.80 7.05) practices. Conclusions The PLAY Collaborative successfully overcame implementation barriers and maintained effectiveness across most outcomes while scaling delivery to N 8,745 families, highlighting the value of systematically investigating implementation strategies while scaling an EBI as integrated into existing social and child protection systems. En ligne : https://doi.org/10.1111/jcpp.14160 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=568

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