Reintegration of Children From Institutions in Azerbaijan

Summary

To prevent mental health problems among 7-12 children from orphanages reunited with their biological or extended families in Azerbaijan, this study will refine and test three evidence-based intervention approaches (a) family strengthening intervention; b) mental health screening and referral for treatment; and c) economic empowerment in the form of Child Development Accounts.

The study will use a randomized experimental design and participating families will be assigned to receive the family strengthening, mental health, or economic interventions. Eligible and consenting 400 child-caregivers dyads will complete baseline, 1-year, and 2-year follow-up measures. Additionally, post-intervention qualitative interviews (n=60) will solicit narrative information about participants' and services providers' reactions and experiences with each intervention component and will provide more comprehensive evidence about the interventions' efficacy.

It is hypothesized that by enhancing children's coping skills, strengthening child-parent relationships, and reducing parental stress, an intervention can help children demonstrate fewer symptoms of: a) disturbances of attachment; b) internalizing problems (depressive or anxious mood), c) externalizing problems (aggressive, delinquent, or disruptive behaviors); d) post-traumatic stress; and e) lower prevalence of diagnoses (e.g. depression, anxiety, PTSD, oppositional-defiant disorder, and reactive attachment disorder).

Conditions

• Emotional Trauma
• Child Mental Disorder
• Child Maltreatment

Interventions

BEHAVIORAL

Usual Care

All participants will receive the following services: case management and psychosocial support (e.g., assessment and identification of families eligible for reunification; preparing children and parents for reunification; and assistance with receiving social benefits such as Targeted Social Assistance, alimonies, or disability benefits); referrals to schools outside of their orphanage; and leisure activities for children (e.g., music, sport, and drama) provided by the orphanage staff and municipal social services.

BEHAVIORAL

Family Strengthening

Due to its focus on family-strengthening, the study uses the evidence-based intervention, SAFE Children, which employs a multiple family group format and is designed to improve family functioning, strengthen child-parent relationships and communication, enhance supportive parenting strategies, and prevent emotional and behavioral problems among at-risk children. The family-focused intervention consists of weekly multiple family group meetings (e.g. about 5 families per group). All interested family members are invited to join the sessions. The adapted intervention incorporates new sessions that address unique issues faced by families reuniting with formerly institutionalized children, such as, separation and attachment issues, children's feelings of resentment, parents' feelings of guilt and shame, stigmatized status in the community. Each session lasts about one to one and a half hours and delivered by facilitator and co-facilitator at the SOS Child and Family Center.

BEHAVIORAL

Mental Health Screening, Referral and Connection to Services

Children assigned to this intervention will receive clinical assessment performed by psychiatrists at the National Mental Health Centre in Azerbaijan. From there, each child will have an individual plan developed by the multidisciplinary team and will be connected to the National Mental Health Centre clinicians to receive corresponding mental health services.

OTHER

Economic Empowerment

The economic component will be in the form of Child Development Accounts/CDAs, an asset-based strategy encouraging savings and investment. This component will connect families to a bank and train them on how to save small amounts, which will be matched by contributions from the project. Matched savings will be deposited in a separate account and can be used only towards a child's education or for housing. The project will provide $50 as seed money to open a savings account in the child's name. The child's family members will make small monthly contributions to the CDA, and savings of up to $20 per month will be matched with project funds at a rate of 2:1. Caregivers will also receive training on savings and financial planning. The curriculum will be taught by trainers from the SOS in a group format for 5 sessions and will cover these topics: The Importance of Saving; Identifying and Managing Resources; Setting Up a Savings System; Sources of Income; and Budgeting and Spending.

Sponsors & Collaborators

• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

  collaborator NIH

• National Mental Health Centre

  collaborator UNKNOWN

• SOS Children's Villages

  collaborator OTHER

• Research and Education Center

  collaborator UNKNOWN

• University of Chicago

  lead OTHER

Principal Investigators

• Leyla Ismayilova, PhD · University of Chicago

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Model

FACTORIAL

Eligibility

Min Age

7 Years

Max Age

12 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2021-05-01

Primary Completion

2025-09-30

Completion

2025-12-30

Countries

• Azerbaijan

Study Locations