Family Strengthening to Prevent Family Separation and Entrance into Residential Care Institutions in Sierra Leone: A Quasi-experimental Study.

Background: Recognizing children's right to grow up in a family, advocates have long called for evidence-based interventions to prevent children from needlessly entering residential care. However, such programs have rarely been evaluated in low- and middle-income countries (LMICs).

Objective: To assess the "Firmly Rooted" program's associations with improved relationship behaviors, relationship quality, emotional regulation, and economic stability in Sierra Leone.

Methods: This non-randomized, two-group pre-test/post-test study compared n = 50 pairs of caregivers and their children aged 9-13 who underwent a two-day workshop plus special home visits with n = 63 pairs receiving care-as-usual. Data were collected via survey interviews with participants at baseline and endline on measures of relationship behaviors, relationship quality, emotional regulation, and economic stability.

Results: Intervention-associated improvements included the following: caregivers talked to children more, according to child report; caregivers and children reported apologizing more; caregivers reported comforting children more; and children reported sharing their feelings more. However, intervention caregivers reported more "malicing" and smaller improvements on hostility/aggression than comparison caregivers, and intervention children reported worse performance accepting emotions. Other areas had no significant differences.

Conclusions: The program was associated with important improvements in caregiver-child relationship-enhancing behaviors, suggesting the promise of interventions to prevent family separation. Given other mixed and null effects, the program is being revised to strengthen other areas. Evidence on preventing children from entering residential care in LMICs is extremely lacking, despite the consensus on its importance; more investigation in this area is urgently needed.