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.
Few interventions exist to explicitly prevent mental health problems in school-aged children both directly and indirectly affected by HIV. This study focuses on this population of children by using a home-visiting preventative intervention to examine its feasibility and effects on parent-child relationships and child mental health within HIV-affected households in rural Rwanda.
Measurement & Metrics
FSI-HIV is delivered in approximately 90-min weekly home-visiting sessions which span an initial pre meeting, the six core modules including a culminating family meeting, and a follow-up to the family meeting in order to debrief together about what occurred during the family meeting. The core modules address four themes: (a) psychoeducation about HIV and its effects on families and how families can succeed despite HIV; (b) skills development in communication, responsive parenting, and stress management/alternatives to violence and harsh punishment; (c) development of a family strengths-based narrative that identifies sources of family resilience and hope from the perspective of the caregivers, the children, and a combined family narrative; and (d) problem solving around eliciting formal and informal support structures. Children reported on their own mental health, functional impairment, and the parenting they received. Trained research staff conducted blinded baseline, post, and three-month follow-up assessments via in-person interviews using hand-held Android devices. Assessments were conducted within a month of both beginning and completing the intervention and then three months after the end of the intervention.
- At three-month follow-up, children in the FSI-HIV group had fewer symptoms of depression three months after the treatment both by self-report and care-giver report.
- Of 139 caregivers and children enrolled in FSI-HIV who completed the post assessment, 129 rated their satisfaction with the intervention. The intervention was seen as highly feasible, acceptable, and flexible to account for family needs.
- Children and caregivers reported high satisfaction with FSI-HIV, including FSI-HIV meeting their own needs, willingness to recommend FSI-HIV to others, excellent attendance, and willingness to participate again.