New phase begins for BCSSW's family intervention program in Rwanda

Created as a response to intergenerational violence, which in Rwanda is linked to trauma and loss stemming from the 1994 genocide, the intervention is linked to the social protection system serving families in extreme poverty. SM, developed in collaboration with both national and local Rwandan government, the University of Rwanda, and local nonprofit FXB Rwanda, is delivered by child protection volunteers—overseen by the Rwandan National Child Development Agency—who engage in active coaching to build the skill of male and female caregivers in interaction with their young children, encourage learning through play, and ensure a safe and healthy environment.

Studies have shown that families receiving the intervention demonstrated improvement in parent-child relations, play, father engagement, health and hygiene practices, caregiver mental health, as well as reduced intimate partner violence and less harsh discipline of children.

Sugira Muryango reflects RPCA’s mission of drawing from longitudinal and observational research on factors shaping risk and resilience in children who face multiple forms of adversity—including war, societal conflict, and poverty—and applying the research to develop and scale evidence-based interventions that support child health, development, and family functioning. RPCA has conducted or partnered on projects in more than 20 countries, including the United States, Sierra Leone, Colombia, Northern Uganda, Russia, and the Ethiopia-Eritrea border, as well as Rwanda.

Having seen encouraging results from SM, which so far has reached more than 10,000 of the most vulnerable households in Rwanda, RPCA and its collaborators now face the challenge of scaling up the intervention to aid more families. This step, say RPCA administrators, means developing and testing tools that the Rwandan government could use to ensure that SM continues to be delivered with quality.

A key element of SM that will be examined in the NIMH-funded study is a Digital Dashboard tool developed by the University of Rwanda and other partners to support scaling the intervention with quality. The Dashboard streamlines collection of data on the intervention, improves the visibility and searchability of implementation data, facilitates caregiver mental health and social services and follow-up, and serves as a training platform for interventionists. The NIMH grant will enable researchers to test whether the digital tool improves quality of program delivery as well as outcomes for families reached by the program.

“We are deeply honored to advance to this next stage in our long-term collaboration with the University of Rwanda and Rwandan National Child Development Agency to explore innovations for scaling home visiting to promote early childhood development and prevent violence,” said Salem Professor in Global Practice and RPCA Director Theresa Betancourt, the project leader and a principal investigator. “The results of this research will have implications for efforts to scale evidence home visiting in this and many settings in the U.S. and abroad.”

Other principal investigators include BCSSW Associate Professor Praveen Kumar; Melissa McTernan, research statistics manager for BC Information Technology Services; Vincent Sezibera, director of the University of Rwanda Centre for Mental Health; and Chris Desmond, a University of KwaZulu-Natal economist specializing in health and social policy research.

SM is based on the Family Strengthening Intervention developed with support from a prior NIMH grant to serve families and children affected by HIV/AIDS. Among the core components of FSI are: building parenting skills and improving knowledge of child development to create a safe, stimulating, and nourishing environment for children with a focus on nutrition, health, and hygiene promotion; developing a “family narrative” to build hope and highlight sources of resilience for addressing challenges; and fostering skills in parental emotion regulation and alternatives to harsh punishment to reduce risks of family violence.

Vital to the success of SM are the interventionists, said RPCA Associate Director for Research Joshua Bogus. “These are not ‘professionals.’ Most have only a high school education. But they are identified by the community as people who are respected and listened to, and who can show empathy and understanding. Their mandate is to protect children and families, and they work with supervisors from the local government ensuring there is oversight of the program.

“What we have to do is ascertain the impact of the Dashboard-supported delivery of the intervention by comparing it with the standard delivery,” said Bogus. “Without the Dashboard, interventionists are using a paper manual, which they have to carry around for reference on family visits. Then they have to make a report to their supervisors, who enter the data, which government officials then have to examine.

“So, we want to see if this tool improves outcomes by ensuring a higher quality of care through greater fidelity to the intervention model, which should result in more competence and self-efficacy in using the model. If that is the case, then we can expect there will be improved family outcomes and a favorable return on investment in this program on a larger scale.

“Seeing the success of an intervention is very heartening, of course, and it’s natural to want to make it widely available. But to continue seeing the same great outcomes we’ve had to date, we need to ensure the program isn’t straining resources or that its quality isn’t being diluted. This grant will enable us to test tools that could be used by the Rwandan government to greatly scale Sugira Muryango nationwide with the best possible outcomes.”

For more on the Research Program on Children and Adversity, see www.bc.edu/rpca