Improving family functioning and wellbeing among families of children with disabilities in Rwanda: an application of the SAFE child protection model.

Background: Families of children with disabilities in low-resource settings face heightened challenges to family functioning and wellbeing. Improving a child and caregiver's environment in these settings requires a broader understanding of the family ecosystem. This study aims to investigate factors that should be considered to enhance family functioning and inform family-centered interventions. Methodology: We conducted 34 in-depth interviews with 30 caregivers of children with disabilities aged 6-8 years enrolled in a larger cluster randomized trial of the Sugira Muryango parenting intervention. Additionally, six focus group discussions were conducted with 36 community workers, and 6 Early Childhood Developmental (ECD) advocates participants. Guided by the SAFE Model for child protection, content analysis was used to understand threats to child protection and caregivers' well-being among caregivers of children with disabilities enrolled in Sugira Muryango. Results: Consistent with the domains outlined in the SAFE Model, our analysis revealed the following threats to child safety: 1) Safety/Freedom from harm, including father's mental health and substance abuse, abandonment and stigma related to a child's disability; 2) Access to basic physiological needs and healthcare, including lack of basic necessities (food, utilities and housing), additional needs related to caring for a child with disabilities, caregiver mental health needs, limited access to health insurance and mother illness; 3) Family and connection to others, including the single-parent dilemma, lack of support from family and community, and father abandonment; and 4) Education and economic security, including additional expenses due to the child's disability and financial stress related to health care costs. Conclusion: Improving family functioning and wellbeing among caregivers of children with disabilities in limited resources requires a deep understanding of socioecological forces operating on the family system. These findings provide further evidence of how the threats to child safety highlighted by the SAFE Model can inform how researchers, and policy makers design and implement family-centered interventions tailored to children with disabilities in low-resource settings.