Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care

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. 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). 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). 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.