The bidirectional temporal relationship between parenting stress and child maltreatment: a cross-lagged study based on intervention and cohort data
March 2024
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Journal article
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Journal of Affective Disorders
A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial.
February 2024
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Journal article
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Trials
BackgroundEvidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group.MethodsThis study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10-17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff.DiscussionApp-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings.Trial registrationThe trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ .
Humans, Parenting, Parents, Violence, Child Abuse, Adolescent, Child, Tanzania, Randomized Controlled Trials as Topic, Pragmatic Clinical Trials as Topic
The efficacy of an evidence-based parenting program in preventing child maltreatment in mainland China.
January 2024
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Journal article
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Child abuse & neglect
BackgroundThere is limited evidence regarding the effectiveness of online parenting programs for preventing child maltreatment in low- and middle-income countries. Therefore, this study aimed to examine the effectiveness of the online Parenting for Lifelong Health for Young Children (PLH-YC) program in preventing child maltreatment among Chinese families specifically.MethodsA quasi-experiment was conducted, wherein 274 parents with children aged 2-9 years were assigned to either the online PLH-YC group (n = 135) or a waitlist control group (n = 139). Data were collected at baseline and one week after intervention. A difference-in-differences (DiD) design with propensity score weighting was used to estimate the between-group difference for child maltreatment as well as the associated risk and protective factors.ResultsCompared to the parents in the control group, parents in the online PLH-YC intervention reported a significant reduction in the occurrence of corporal punishment (b = -1.21; 95 % CI [-2.37, -0.03]), emotional abuse (b = -3.09; 95 % CI [-5.36, -0.82]), and general maltreatment (b = -4.94; 95 % CI [-8.86, -1.02]) as well as an increased frequency of positive parenting strategies (b = 6.46; 95 % CI [2.21, 10.72]). Additionally, parents with high levels of depressive symptoms were significantly more likely to drop out of the program, and those with lower education levels engaged in fewer sessions.ConclusionThe online PLH-YC program can benefit families with young children by reducing the incidence of child maltreatment through improved positive parenting strategies. More randomized controlled trials with long-term follow-ups are required to further verify the accuracy of the results obtained in this study.
Parenting Interventions That Promote Child Protection and Development for Preschool-Age Children with Developmental Disabilities: A Global Systematic Review and Meta-Analysis.
November 2023
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Journal article
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Trauma, violence & abuse
Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent-child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries.
How are parental mental health and parenting practices associated with externalizing behaviors among young children with autism in China? A cross-sectional study and indirect effect analysis
September 2023
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Journal article
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Family Process
Children with autism are more likely to exhibit externalizing behaviors than children without autism. A cross-sectional study was undertaken to investigate how parental mental health status and parenting practices contributed to the variance in externalizing behaviors among families of young children with autism in Chinese mainland, and whether parenting behaviors had any indirect effects on the relationship between parental mental health symptoms and externalizing behaviors. Data were drawn from the baseline assessment of a quasi-experimental study of a parent training program delivered to Chinese caregivers of children with autism aged 3 to 6 from diverse backgrounds (N = 111). Results showed that parental mental health symptoms and parenting behaviors explained the variance in child externalizing behaviors. Parental mental health problems and parental over-reactivity were linked to higher levels of child externalizing behaviors, whereas positive parenting was associated with less frequent externalizing behaviors. Positive parenting partially explained the relationship between parental mental health symptoms and externalizing behaviors. The findings of this study highlight the importance of actively attending to the psychological and parenting needs of caregivers in autism treatment programs. It points to the need for the development of culturally sensitive strategies to promote parental mental health and increase the use of positive parenting skills among parents of children with autism.
Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection.
September 2023
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Journal article
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BMC public health
<h4>Background</h4>Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes.<h4>Methods</h4>The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement.<h4>Results</h4>Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content.<h4>Conclusions</h4>This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.
Violence, Intimate Partner Violence, Data Collection, COVID-19, Child, Parenting, Humans
Climate change is a threat multiplier for violence against children.
August 2023
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Journal article
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Child abuse & neglect
<h4>Background</h4>The climate crisis is the biggest threat to the health, development, and wellbeing of the current and future generations. While there is extensive evidence on the direct impacts of climate change on human livelihood, there is little evidence on how children and young people are affected, and even less discussion and evidence on how the climate crisis could affect violence against children.<h4>Participants and setting</h4>In this commentary, we review selected research to assess the links between the climate crisis and violence against children.<h4>Methods</h4>We employ a social-ecological perspective as an overarching framework to organize findings from the literature and call attention to increased violence against children as a specific, yet under-examined, direct and indirect consequence of the climate crisis.<h4>Results</h4>Using such a perspective, we examine how the climate crisis exacerbates the risk of violence against children at the continually intersecting and interacting levels of society, community, family, and the individual levels. We propose increased risk of armed conflict, forced displacement, poverty, income inequality, disruptions in critical health and social services, and mental health problems as key mechanisms linking the climate crisis and heightened risk of violence against children. Furthermore, we posit that the climate crisis serves as a threat multiplier, compounding existing vulnerabilities and inequities within populations and having harsher consequences in settings, communities, households, and for children already experiencing adversities.<h4>Conclusions</h4>We conclude with a call for urgent efforts from researchers, practitioners, and policymakers to further investigate the specific empirical links between the climate crisis and violence against children and to design, test, implement, fund, and scale evidence-based, rights-based, and child friendly prevention, support, and response strategies to address violence against children.
Climate change, Climate crisis, Violence against children, Social-ecological perspective
Co-Occurrence of Intimate Partner Violence Against Mothers and Maltreatment of Their Children With Behavioral Problems in Eastern Europe.
July 2023
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Journal article
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Violence against women
This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (<i>N</i><sub>1</sub><i><sub> </sub>= </i>112, <i>N</i><sub>2</sub><i><sub> </sub></i>= 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Motheŕs own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence.
Optimising engagement in a digital parenting intervention to prevent violence against adolescents in Tanzania: protocol for a cluster randomised factorial trial
June 2023
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Journal article
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BMC Public Health
<p><strong>Background:</strong> Violence against adolescents is a universal reality, with severe individual and societal costs. There is a critical need for scalable and effective violence prevention strategies such as parenting programmes, particularly in low- and middle-income countries where rates of maltreatment are highest. Digital interventions may be a scalable and cost-effective alternative to in-person delivery, yet maximising caregiver engagement is a substantial challenge. This trial employs a cluster randomised factorial experiment and a novel mixed-methods analytic approach to assess the effectiveness, cost-effectiveness, and feasibility of intervention components designed to optimise engagement in an open-source parenting app, ParentApp for Teens. The app is based on the evidence-based Parenting for Lifelong Health for Teens programme, developed collaboratively by academic institutions in the Global South and North, the WHO, and UNICEF.</p>
<p><strong>Methods/design:</strong> Sixteen neighbourhoods, i.e., clusters, will be randomised to one of eight experimental conditions which consist of any combination of three components (Support: self-guided/moderated WhatsApp groups; App Design: sequential workshops/non-sequential modules; Digital Literacy Training: on/off). The study will be conducted in low-income communities in Tanzania, targeting socioeconomically vulnerable caregivers of adolescents aged 10 to 17 years (16 clusters, 8 conditions, 640 caregivers, 80 per condition). The primary objective of this trial is to estimate the main effects of the three components on engagement. Secondary objectives are to explore the interactions between components, the effects of the components on caregiver behavioural outcomes, moderators and mediators of programme engagement and impact, and the cost-effectiveness of components. The study will also assess enablers and barriers to engagement qualitatively via interviews with a subset of low, medium, and high engaging participants. We will combine quantitative and qualitative data to develop an optimised ParentApp for Teens delivery package.</p>
<p><strong>Discussion:</strong> This is the first known cluster randomised factorial trial for the optimisation of engagement in a digital parenting intervention in a low- and middle-income country. Findings will be used to inform the evaluation of the optimised app in a subsequent randomised controlled trial.</p>
<p><strong>Trial registration:</strong> Pan African Clinical Trial Registry, PACTR202210657553944. Registered 11 October 2022, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051.</p>
Feasibility and acceptability of parenting for lifelong health program in Mainland China
May 2023
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Journal article
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Research on Social Work Practice
<strong>Purpose: <br></strong>Parenting for Lifelong Health for Young Children (PLH-YC) is a program to prevent child maltreatment. This study aimed to examine the feasibility, acceptability and preliminary effects of the adapted program for Chinese parents.
<br><strong>Methods: <br></strong>A pre–post single-arm pilot trial was conducted with 21 Chinese parents. A mixed-method design was utilized to collect questionnaire-based quantitative data and qualitative data of interviews and focus group discussions.
<br><strong>Results: <br></strong>Program implementation was feasible, with overall high recruitment, enrollment, attendance, acceptability and fidelity. Quantitative results demonstrated reductions in general child maltreatment, physical and emotional abuse, child behavioral problems, and improvements in positive parenting. Thematic analyses identified reduced violent discipline, psychological aggression, and child behavioral problems, strengthened parent–child bonds, increased parenting confidence, and decreased family conflict.
<br><strong>Conclusion: <br></strong>The adapted PLH-YC program for Chinese parents has shown good feasibility and acceptability, and exhibited a significant association with reduced child maltreatment. Further randomized controlled trials are required.
child maltreatment, Mainland China, abuse prevention, FFR, parenting program
Promoting family well-being at scale: optimising and re-designing a digital parenting programme for reducing violence against children in lmics using the 6squid framework
April 2023
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Conference paper
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Population Medicine
Pre-post mixed methods study of a parent and teen support intervention to prevent violence against adolescents in the Philippines
April 2023
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Journal article
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Journal of Adolescent Health
<p><strong>Purpose</strong></p>
This study examines the feasibility of a culturally adapted parenting intervention (MaPa Teens) within the national cash transfer system to reduce violence against adolescents, the first such program in the Philippines.
<p><strong>Methods</strong></p>
Thirty caregiver-adolescent dyads who were beneficiaries of a government conditional cash transfer program participated in a pilot of a locally adapted version of the Parenting for Lifelong Health for Parents and Teens program. Primary outcomes of reducing child maltreatment and associated risk factors were evaluated using a single-group, pre-post design. Focus group discussions explored the perceptions of participants and facilitators regarding program acceptability and feasibility.
<p><strong>Results</strong></p>
Significant and moderate reductions were reported in overall child maltreatment and physical abuse (caregiver and adolescent reports) and in emotional abuse (adolescent report). There were significant reductions in neglect, attitudes supporting punishment, parenting stress, parental and adolescent depressive symptoms, parent-child relationship problems, and significant improvement in parental efficacy in managing child behavior. Adolescents reported reduced behavior problems, risk behavior, and witnessing of family violence. Participants valued learning skills using a collaborative approach, sustained their engagement between sessions through text messages and phone calls, and appreciated the close interaction with caring and skilled facilitators. Program areas of improvement included addressing barriers to attendance, increasing adolescent engagement, and revising the sexual health module.
<p><strong>Discussion</strong></p>
The study provides preliminary support for the effectiveness and feasibility of the program in reducing violence against Filipino adolescents. Findings suggest potential adaptations of the program, and that investment in more rigorous testing using a randomized controlled trial would be worthwhile.
The association between facilitator competent adherence and outcomes in parenting programs: a systematic review and SWiM analysis
March 2023
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Journal article
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Prevention Science
There is increasing interest about the fidelity with which interventions are implemented because it is theorized that better implementation fidelity by facilitators is associated with better participant outcomes. However, in the parenting program literature, there is mixed evidence on the relationship between implementation fidelity and outcomes. This paper provides a synthesis of the evidence on the relationship between facilitator delivery and outcomes in the parenting program literature. Following PRISMA guidelines, this paper synthesizes the results of a systematic review of studies on parenting programs aiming to reduce violence against children and child behavior problems. Specifically, it examines associations between observational measures of facilitator competent adherence and parent and child outcomes. A meta-analysis was not feasible due to study heterogeneity. As a result, Synthesis Without Meta-Analysis guidelines were followed. Searches in electronic databases, reference searching, forward citation tracking, and expert input identified 9653 articles. After screening using pre-specified criteria, 18 articles were included. The review found that most studies (<i>n</i> = 13) reported a statistically significant positive relationship with at least one parent or child outcome. However, eight studies reported inconsistent findings across outcomes, and four studies found no association with outcomes. The results suggest that better facilitator competent adherence is generally associated with positive parent and child outcomes. However, this finding is weakened by the methodological heterogeneity of included studies and due to the wide variety of ways in which studies conceptualized competent adherence-outcome relationships.
Screen use: its association with caregiver mental health, parenting, and children's ADHD symptoms
March 2023
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Journal article
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Family Relations
<p><strong>Objective:</strong> The aim was to examine the relationship between caregiver's mental health (parental psychological distress, and parenting stress), dysfunctional parenting (lax or overreactive parenting), and the screen media use in understanding attention-deficit/hyperactivity disorder (ADHD) symptoms of children within an integrated model framework.</p>
<p><strong>Background:</strong> Familial factors and screen use have shown to be significantly related to ADHD in children. However, theoretical models of the role of family environment, screen use, and ADHD have rarely been tested jointly, and little is known about these associations in southeastern European middle-income countries (MICs).</p>
<p><strong>Method:</strong> Data from 835 primary caregivers (92% biological mother, 4% biological father, 3% grandmother or grandfather, 1% other) of children (2 to 9 years) from three MICs were analyzed using path analyses, and models were tested for generalizability across education levels and marital status using multigroup analyses. ADHD-related symptoms were assessed with a structured clinical interview (Mini International Neuropsychiatric Interview for Children and Adolescents–Parent Version [MINI-KID-P]) and the Child Behavioral Checklist (CBCL).</p>
<p><strong>Results:</strong> Whereas screen use was directly associated with ADHD symptoms across measures, a significant indirect effect of lax parenting on attentional problems via screen use was found only for the CBCL parent report. The final models were tested using multigroup analyses across education levels and marital status with no significant differences.</p>
<p><strong>Conclusion:</strong> Investments in resource and capacity building for children's primary caregivers that target lax parenting and limiting of screen use may impact children's attentional problems across educational levels and married and nonmarried caregivers.</p>
basic behavioral and social science, behavioral and social science, psychology, good health and well being, clinical research, attention deficit hyperactivity disorder (adhd), clinical and health psychology, mental health, FFR, pediatric
"Before I was like a Tarzan. But now, I take a pause": mixed methods feasibility study of the Naungan Kasih parenting program to prevent violence against children in Malaysia
February 2023
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Journal article
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BMC Public Health
<strong>Background<br></strong>
Despite impressive strides in health, social protection, and education, children continue to experience high rates of child maltreatment in Malaysia. This mixed-methods study assessed the feasibility of a five-session, social learning-based parenting program delivered by government staff in a community setting to reduce violence against children.
<br><strong>
Methods<br></strong>
Parents of children from birth to 17 years were recruited from two communities near Kuala Lumpur to participate in the government-run program called the Naungan Kasih Positive Parenting Program (“Protecting through Love” in Bahasa Melayu). Quantitative data from female caregivers (N = 74) and children ages 10–17 (N = 26) were collected along with qualitative interviews and focus groups with parents, children, and facilitators. The primary outcome was child maltreatment with secondary outcomes including neglect, positive parenting, acceptability of corporal punishment, harsh parenting, positive discipline, and child behavior problems. Multilevel Poisson regression and multilevel linear regression were conducted to compare baseline and post-test outcomes. Qualitative interviews and focus groups examined how participants experienced the program utilizing a thematic analysis approach.
<br><strong>
Results<br></strong>
Quantitative analyses found pre-post reductions in overall child maltreatment, physical abuse, emotional abuse, attitudes supporting corporal punishment, parent sense of inefficacy, and child behavior problems. There were no reported changes on positive and harsh parenting, parental mental health, and marital satisfaction, nor were there any other significant changes reported by children. Qualitative findings suggested that the program had tangible benefits for female caregivers involved in the program, with the benefits extending to their family members.
<br><strong>
Conclusions<br></strong>
This feasibility study is one of the few studies in Southeast Asia that examined the feasibility and initial program impact of a parenting program delivered by government staff to families with children across the developmental spectrum from birth to 17 years. Promising results suggest that the program may reduce child maltreatment across a range of child ages. Findings also indicate areas for program improvement prior to further delivery and testing, including additional training and content on sexual and reproductive health, parenting children with disabilities, and online child protection.
child maltreatment, feasibility, mixed-methods, parenting, malaysia, FFR
Global child and adolescent mental health perspectives: bringing change locally, while thinking globally
December 2022
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Journal article
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Child and Adolescent Psychiatry and Mental Health
Child and adolescent mental health (CAMH) are a global priority. Different countries across the globe face unique challenges in CAMH services that are specific to them. However, there are multiple issues that are also similar across countries. These issues have been presented in this commentary from the lens of early career CAMH professionals who are alumni of the Donald J Cohen Fellowship program of the IACAPAP. We also present recommendations that can be implemented locally, namely, how promoting mental health and development of children and adolescents can result in better awareness and interventions, the need to improve quality of care and access to care, use of technology to advance research and practices in CAMH, and how investing in research can secure and support CAMH professionals and benefit children and adolescents across the globe. As we continue to navigate significant uncertainty due to dynamic circumstances globally, bolstering collaborations by “bringing change locally, while thinking globally” are invaluable to advancing global CAMH research, clinical service provision, and advancement of the field.
The development, reliability, and validity of the facilitator assessment tool: an implementation fidelity measure used in parenting for lifelong health for young children
November 2022
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Journal article
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Child: Care, Health and Development
<p><strong>Background:</strong> The Parenting for Lifelong Health for Young Children (PLH-YC) programme aims to reduce violence against children and child behaviour problems among families in low- and middle-income countries (LMICs). Although the programme has been tested in four randomised controlled trials and delivered in over 25 countries, there are gaps in understanding regarding the programme's implementation fidelity and, more generally, concerning the implementation fidelity of parenting programmes in LMICs.</p>
<p><strong>Aims:</strong> This study aims to address these gaps by examining the psychometric properties of the PLH-YC-Facilitator Assessment Tool (FAT)—an observational tool used to measure the competent adherence of PLH-YC facilitators. Examining the psychometric properties of the FAT is important in order to determine whether there is an association between facilitator competent adherence and programme outcomes and, if correlated, to improve facilitator performance. It is also important to develop the implementation literature among parenting interventions in LMICs.</p>
<p><strong>Methods:</strong> The study examined the content validity, intra-rater reliability, and inter-rater reliability of the FAT. Revision of the tool was based on consultation with programme trainers, experts, and assessors. A training curriculum and assessment manual was created. Assessors were trained in Southeastern Europe and their assessments of facilitator delivery were analysed as part of a large-scale factorial experiment (<em>N</em> = 79 facilitators).</p>
<p><strong>Results:</strong> The content validity process with PLH-YC trainers, experts, and assessors resulted in substantial improvements to the tool. Analyses of percentage agreements and intraclass correlations found that, even with practical challenges, assessments were completed with adequate yet not strong intra- and inter-rater reliability.</p>
<p><strong>Conclusions:</strong> This study contributes to the literature on the implementation of parenting programmes in LMICs. The study found that the FAT appears to capture its intended constructs and can be used with an acceptable degree of consistency. Further research on the tool's reliability and validity—specifically, its internal consistency, construct validity, and predictive validity—is recommended.</p>
problem behavior, reproducibility of results, Europe, parenting, FFR, preschool child
Adaptations and staff experiences in delivering parenting programmes and other family support services in three community-based organisations in Cape Town, South Africa during the COVID pandemic
November 2022
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Journal article
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Global Public Health
We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020–May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial programmes were adapted – e.g. by changing the physical delivery settings, reducing group sizes, and taking up digital and phone implementation. Participants reported improved perceptions of remote delivery as a feasible approach for working with families – but internet and phone access remained challenging. Third, the pandemic brought new responsibilities for staff, and both the challenges of working from home and the health risks of in-person work.
South Africa, COVID-19, pandemic, families, parenting, children
Global child and adolescent mental health perspectives: bringing change locally, while thinking globally
November 2022
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Journal article
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Child and Adolescent Psychiatry and Mental Health
Child and adolescent mental health (CAMH) are a global priority. Different countries across the globe face unique challenges in CAMH services that are specific to them. However, there are multiple issues that are also similar across countries. These issues have been presented in this commentary from the lens of early career CAMH professionals who are alumni of the Donald J Cohen Fellowship program of the IACAPAP. We also present recommendations that can be implemented locally, namely, how promoting mental health and development of children and adolescents can result in better awareness and interventions, the need to improve quality of care and access to care, use of technology to advance research and practices in CAMH, and how investing in research can secure and support CAMH professionals and benefit children and adolescents across the globe. As we continue to navigate significant uncertainty due to dynamic circumstances globally, bolstering collaborations by “bringing change locally, while thinking globally” are invaluable to advancing global CAMH research, clinical service provision, and advancement of the field.
child mental health policies, communities, mental health professionals, child and adolescent mental health, global mental health, FFR, services, child and adolescent psychiatry, child mental health research
Exploring factors associated with parent engagement in a parenting program in southeastern Europe
August 2022
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Journal article
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Journal of Child and Family Studies
Parental engagement in parenting programs is essential for good outcomes but can be challenging for many families. In low- and middle-income countries, where resources are limited and there are fewer support services, there is little research examining the factors that influence engagement. This mixed-methods study explored factors associated with parent engagement, as well as barriers and supports, in a pilot evaluation of a parenting program with 140 parents in North Macedonia, Republic of Moldova, and Romania. The relationship between various quantitative types of engagement (e.g., premature drop-out, participation) and a range of demographic, personal, and implementation factors were examined. Qualitative parent interviews explored barriers and supports to program engagement. Implementation variables (e.g., phone calls with parents, program fidelity and text messages sent to parents) were consistently positively associated with different types of engagement after controlling for other factors. Parents of boys, being a victim of intimate partner violence, more children in the household and better parental well-being were positively associated with premature drop-out whilst having a child enrolled in school was positively associated with participation. Barriers included logistical factors such as timing and lack of childcare facilities. Factors that increased engagement included facilitator skills/support, weekly text messages and phone calls and engagement strategies such as transport and childcare. The results emphasise the importance of implementation factors in increasing parent engagement in parenting programs and will help to inform the next phase of the project as well as other family-support initiatives in the three countries. The trial is registered on ClinicalTrials.gov (ID: NCT03552250).
FFR
‘Tipping the balance' – an evaluation of COVID-19 parenting resources developed and adapted for child protection during global emergency responses
August 2022
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Journal article
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Health Psychology and Behavioral Medicine
<p><strong> Background:</strong> Parenting was severely affected by lockdown, school closure, illness, movement restrictions and the many sudden changes wrought by the global emergence of COVID-19. Responding to the need for a rapid emergency response to support parents and caregivers, a consortium of providers developed a suite of COVID-19 parenting resources based on evidence-based parenting interventions. Launched in March 2020, these were adapted for online use, with versions in over 100 languages, and the possibility for downloading, radio, and oral provision. A rapid qualitative evaluation initiative was conducted from September 2020 to February 2021 to inform the procedure, understand the impact and to drive future provision.
<p><strong> Methods:</strong> The evaluation collected openended responses surveys (n = 495 participants) and in-depth interviews with parents, providers, and adolescent children (n = 22) from 14 countries and one global source. Data were gathered on parenting challenges during COVID-19 and the utility of the COVID-19 parenting resources. In-depth, semi-structured interviews explored the same concepts and elaborated on challenges, utility of the resources, and recommendations for the future. Data were coded in a hierarchy from basic, organising and global theme generation.Results: The parenting resources equipped parents with information and practices transforming everyday lives, and interactions. The tips provided prompts and permissions related to children’s behaviour, enabled communications, and offered ways to reduce stress, monitor behaviour and navigate discipline challenges. The timeliness of the resources as well as the clarity and ease of use were seen as advantages. Future direction and possible hurdles related to adaptations needed according to recipient, child age, local context, culture, and new challenges.
<p><strong> Conclusions:</strong> Overall findings point to the value and utility of this unprecedented global response to theCOVID-19 pandemic. Results suggest that rapid provision of parenting resources at scale is feasible and of use and opens a pathway for providing evidence-based interventions under COVID-19 constraints.
Measuring dysfunctional parenting: psychometrics of three versions of the Parenting Scale
July 2022
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Journal article
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Family Relations: Interdisciplinary Journal of Applied Family Science
<p><strong>Objective</strong>
This study assessed the psychometric properties of three versions of the Parenting Scale (PS; original PS, 13-item version, and 10-item version) in three European middle-income countries.<br><br>
<strong>Background</strong>
The PS is one of the most frequently used questionnaires for measuring dysfunctional discipline strategies. Although its validity has been extensively investigated in American samples, there are mixed results regarding the recommended number of items and subscales, raising the question of replicability across European middle-income countries.<br><br>
<strong>Method</strong>
Multigroup confirmatory factor analysis (MCFA) and item response theory (IRT) were applied to <em>N</em> = 835 parents from North Macedonia, Moldova, and Romania.<br><br>
<strong>Results</strong>
All three versions were significantly correlated with parental- and child-related variables. Confirmatory factor analysis indicated the best model fit for the 10-item version, and configural and partial metric invariance across countries could be established for this version. Item response theory analyses also supported this measure.<br><br>
<strong>Conclusions</strong>
Our findings show that the 10-item version performed better than the 13-item version and the original PS both overall and on the country level. Reliability values were somewhat lower than reported in studies from the United States.<br><br>
<strong>Implications</strong>
The 10-item version constitutes a promising short measure for assessing dysfunctional parenting in European middle-income countries for researchers and practitioners.<p>
Parenting Scale (PS), Item response theory (IRT), Low- and middle-income countries (LMICs), Psychometric evaluation, Dysfunctional parenting, FFR
Controlled trial of a short-term intensive parent training program within the context of routine services for autistic children in China
May 2022
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Journal article
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Psychosocial Intervention
Recent systematic reviews found limited rigorous research conducted to date of the effectiveness of parent training programs in reducing behavioral problems for autistic children in low- and middle-income countries. This study is aimed at evaluating the effectiveness of a short-term intensive parent training program for autistic children aged three to six in the context of routine service provision in China. A quasi-experiment was conducted involving the local implementing organization and using a waitlist control. Data were collected at baseline and immediate post-intervention. The primary outcome was child behavioral problems measured using the Child Behavior Checklist Externalizing scale. Between-group comparisons used a difference-in-differences design with propensity score weighting to reduce sources of bias. A process evaluation was undertaken in parallel to assess participant involvement, program acceptability, and delivery. The protocol was prospectively registered with ClinicalTrials.gov (NCT04257331). The final sample size was 111 (treatment: 63; comparison: 48). Results suggest that the program was associated with improvements in child externalizing behaviors (b = -2.71, 95% CI [-5.23, -0.18]), parental mental health symptoms (b = -5.96, 95% CI [-11.74, -0.17]), over-reactive parenting (b = -0.63, 95% CI [-0.98, -0.27]), and parental knowledge (b = 2.08, 95% CI [2.07, 2.17]). Exploratory analysis of factors related to implementation indicated that baseline parental mental health was related to participant engagement, and that satisfaction and engagement levels were potentially linked to positive treatment effects. Findings suggest that short-term intensive parent training programs that are provided by trained non-specialists, could potentially be used as an alternative to traditional prohibitively costly services that are delivered intensively for consecutive years in low-resource contexts. Follow-ups are needed to investigate its long-term benefits.
FFR
Global estimates of violence against children with disabilities: an updated systematic review and meta-analysis
March 2022
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Journal article
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Lancet Child & Adolescent Health
<p><strong>Background</strong></p>
Previous meta-analysis evidence shows that children (aged 0–18 years) with disabilities experience high amounts of violence. During the past decade, there has been a substantial increase in the volume of available data, and we therefore aimed to update the evidence and provide a current global estimate of violence against children with disabilities.
<p><strong>Methods</strong></p>
For this systematic review and meta-analysis, we searched 18 English-language international databases for observational studies published in English or Chinese between Aug 17, 2010, and Sept 16, 2020, and three Chinese databases for studies published from database inception to Sept 16, 2020. We used search terms structured around the concepts of disability, child, and violence—defining violence as physical, emotional, or sexual violence, or neglect, and considering disability as physical, mental, intellectual, and sensory impairments, and chronic diseases. We also searched 11 grey-literature repositories and hand searched the reference lists of included records for observational studies. We double screened records for studies that measured violence against children with disabilities. We excluded studies that included only people who had experienced violence or that did not provide separate estimates for children if adults were also included. Two authors independently extracted data and appraised study quality. We pooled estimates using three-level, mixed-effects meta-analyses, and did subgroup analyses. This study was prospectively registered with PROSPERO, CRD42020204859.
<p><strong>Findings</strong></p>
We found and screened 26 204 records, of which we excluded 25 844. We assessed 386 full text articles and finally included 98 studies (with 16 831 324 children) in our analysis. Our results showed that the overall prevalence of violence against children with disabilities was 31·7% (95% CI 27·1–36·8; I2=99·15%; 16 807 154 children, 92 studies) and the overall odds ratio of children with versus without disabilities experiencing violence was 2·08 (1·81–2·38; I2=91·5%; 16 811 074 children, 60 studies). Sensitivity analyses suggested a high degree of certainty for these estimates, although there was a high degree of heterogeneity across most estimates. There was some risk of publication bias, although the included studies were, on average, of medium quality. The estimates of violence differed by the type of violence, disability, and perpetrator. Children in economically disadvantaged contexts were especially vulnerable to experiencing violence.
<p><strong>Interpretation</strong></p>
This review shows that children with disabilities experience a high burden of all forms of violence, despite advances in awareness and policy in the past 10 years. Our results indicate a need for increased partnerships across disciplines and sectors to protect children with disabilities from violence. Additional well designed research is also needed, especially in under-represented and economically disadvantaged populations.
<p><strong>Funding</strong></p>
There was no funding source for this study.
A virtuous circle: stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China
January 2022
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Journal article
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Autism
Although the evidence of parent training programmes for families of autistic children has continued to grow, little is known about the experiences and perceptions of key stakeholders, especially in low- and middle-income countries. This qualitative study was part of a larger real-world evaluation of a short-term intensive parent training programme in routine services delivered to caregivers of autistic children aged 3–6 years in China. It aimed to provide insights into programme acceptability, reasons for participant involvement, and factors related to programme implementation. Fourteen caregivers participated in the in-depth interviews, and two focus group discussions were conducted with eight practitioners. Data were analysed using a combination of data- and theory-driven approaches. Findings point to the needs in low autism resource settings for substantial practice and feedback; group support; individualised coaching; more autism-related knowledge, resources and activities for children and extended family members; and organisational support to practitioners. Further research is suggested to address the recommendations and assess their effectiveness empirically.
autism spectrum disorders, qualitative research, family functioning and support, FFR, interventions – psychosocial/behavioural, pre-school children
Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial
December 2021
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Journal article
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Trials
<p><strong>Background</strong>
Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children’s future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs.<br><br>
<strong>Methods/design</strong>
A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group.<br><br>
<strong>Discussion</strong>
This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme.
What can good leadership do to support the digital revolution in health?
November 2021
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Journal article
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Health Policy and Technology
Effectiveness of a parenting programme to reduce violence in a cash transfer system in the Philippines: RCT with follow-up
October 2021
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Journal article
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Lancet Regional Health: Western Pacific
<p><strong>Background</strong></p>
Parenting interventions and conditional cash transfer (CCT) programmes are promising strategies to reduce the risk of violence against children, but evidence of the effectiveness of combining such programmes is lacking for families in low- and middle-income countries with children over two years of age. This study examined the effectiveness of a locally adapted parenting programme delivered as part of a government CCT system to low-income families with children aged two to six years in Metro Manila, Philippines.
<p><strong>Methods</strong></p>
Participants were randomly assigned (1:1) to either a 12-session group-based parenting programme or treatment-as-usual services (N = 120). Participation in either service was required among the conditions for receiving cash grants. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments in January-February 2018 and 12-month follow-up in January-February 2019. All assessments were parent-report (ClinicalTrials.gov: NCT03205449).
<p><strong>Findings</strong></p>
One-month post-intervention assessments indicated moderate intervention effects for primary outcomes of reduced overall child maltreatment (d = -0.50 [-0.86, -0.13]), emotional abuse (d = -0.59 [-0.95; -0.22]), physical abuse (IRR = 0.51 [0.27; 0.74]), and neglect (IRR = 0.52 [0.18; 0.85]). There were also significant effects for reduced dysfunctional parenting, child behaviour problems, and intimate partner violence, and increased parental efficacy and positive parenting. Reduced overall maltreatment, emotional abuse, and neglect effects were sustained at one-year follow-up.
<p><strong>Interpretation</strong></p>
Findings suggest that a culturally adapted parenting intervention delivered as part of a CCT programme may be effective in sustaining reductions in violence against children in low- and middle-income countries.
RCT, violence against children, parenting, conditional cash transfer, Philippines, FFR
Mediation pathways for reduced substance use among parents in South Africa: a randomized controlled trial.
September 2021
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Journal article
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BMC public health
<h4>Background</h4>Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty.<h4>Methods</h4>The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa's Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects.<h4>Results</h4>Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty.<h4>Conclusions</h4>The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity.<h4>Trial registration</h4>Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. The trial can be found by searching for the key word 'Sinovuyo' on the Pan-African Clinical Trials Registry website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119.
Preventing child mental health problems in southeastern Europe: feasibility study (phase 1 of MOST framework)
September 2021
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Journal article
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Family Process
The prevalence of child emotional and behavioral problems is an international problem but is higher in low- and middle-income countries (LMIC) where there are often less mental health supports for families. Parenting programs can be an effective means of prevention, but must be low-cost, scalable, and suitable for the local context. The RISE project aims to systematically adapt, implement, and evaluate a low-cost parenting program for preventing/reducing child mental health problems in three middle-income countries in Southeastern Europe. This small pre–post pilot study is informed by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework and tested the feasibility of the intervention, the implementation, and evaluation procedures: Phase 1 of the three-phase Multiphase Optimization Strategy (MOST) for program adaptation. Local facilitators delivered the Parenting for Lifelong Health (PLH) for Young Children program to parents of children aged 2–9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre- and post-program. Results demonstrated positive pre–post change for participating families (N = 140) on various outcomes including child externalizing and internalizing symptoms and parenting behavior, in all three countries, all in the expected direction. Program participation was associated with positive outcomes in participating families. Based on the experiences of this pilot study, we outline the practical implications for the successful implementation of parenting programs in the three countries that will inform our next study phases, factorial experiment, and RCT.
Feasibility pilot of an adapted parenting program embedded within the Thai public health system
May 2021
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Journal article
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BMC Public Health
<strong>Background</strong>
This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators.
<br>
<strong>Method</strong>
Sixty primary caregivers of children aged 2–9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman’s ANOVA, and thematic analysis.
<br>
<strong>Results</strong>
Participants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d = − 0.58, p
Measures of facilitator competent adherence used in parenting programs and their psychometric properties: a systematic review
May 2021
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Journal article
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Clinical Child and Family Psychology Review
Implementation fidelity is a critical component of intervention science, which aims to understand how interventions unfold in practice to improve outcomes. A key element of fidelity is facilitator competent adherence—the extent to which a program is delivered as prescribed with the specified level of quality. We conducted a two-part systematic review examining these aspects in parenting programs aiming to reduce child behavior problems and maltreatment. Part One reviews measures of facilitator competent adherence and Part Two examines the psychometric properties of the observational measures found. Searches identified 9153 articles from electronic databases, citation tracking, and expert input. After screening using pre-specified criteria, 156 (Part One) and 41 (Part Two) articles remained. In Part One, measure, facilitator, and intervention characteristics were extracted and synthesized from 65 measures. Most measures were observational, used by facilitators and researchers, and employed Likert-scale ratings. In Part Two, evidence on the reliability (internal consistency, inter-rater, intra-rater, test–retest) and validity (content, construct, convergent/divergent, criterion) of 30 observational measures identified from Part One was synthesized and evaluated. An adapted COSMIN checklist was used to assess study and measure quality. We found most studies to be of reasonably high quality. This is the first review to summarize and critically appraise measures of facilitator competent adherence used in the parenting program literature and establish their psychometric properties. The findings underscore the need to advance research on measures of facilitator competent adherence; reliable, valid, and high-quality implementation measures allow for evidence-based decisions regarding the delivery and scale-up of parenting programs. PROSPERO Registration Number: CRD42020167872.
FFR
A mixed methods evaluation of the large-scale implementation of a school- and community-based parenting program to reduce violence against children in Tanzania: a study protocol
May 2021
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Journal article
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Implementation Science Communications
Background
Despite the rapid dissemination of parenting programs aiming to reduce and prevent violence against children (VAC) worldwide, there is limited knowledge about and evidence of the implementation of these programs at scale. This study addresses this gap by assessing the quality of delivery and impact of an evidence-based parenting program for parents/caregivers and their adolescent girls aged 9 to 14—Parenting for Lifelong Health Teens (PLH-Teens), known locally as Furaha Teens—on reducing VAC at scale in Tanzania. The study will explore participating family and staff perspectives on program implementation and examine factors associated with implementation and how implementation quality is associated with intervention outcomes when the program is delivered to approximately 50,000 parent-child dyads (N = 100,000) in schools and community centers across eight districts of Tanzania.
Methods
This mixed-methods study will answer the following research questions: (1) what is the implementation quality and fidelity of PLH-Teens at scale in Tanzania; (2) what factors are associated with the quality of delivery and implementation fidelity of PLH-Teens; (3) how are implementation quality and fidelity associated with intervention outcomes; (4) what are participant and implementing staff perspectives on the acceptability, appropriateness, feasibility, benefits, and challenges of delivering PLH-Teens in their schools and communities; (5) what is the impact of PLH-Teens on VAC and participant well-being; and (6) how much does it cost to deliver PLH-Teens at scale? Qualitative and quantitative data will be collected directly from implementers, parents/caregivers, and adolescents using pre-post questionnaires, observational assessments, cost surveys, focus groups, and interviews. Qualitative data will be analyzed thematically with the aid of NVIVO software. Quantitative data will be cleaned and analyzed using methods such as correlation, regression, and structural equation models using Stata and R. COREQ and TREND guidelines will be used, where appropriate.
Discussion
Findings will provide vital insights into some of the factors related to quality implementation at scale. Lessons learned regarding the implementation of PLH-Teens at scale will be applied in Tanzania, and also in the delivery of PLH parenting programs globally.
FFR
“From Analog to Digital”: The Feasibility, Acceptability, and Preliminary Outcomes of a Positive Parenting Program for Street-Connected Mothers in Kenya
May 2021
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Journal article
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Children and Youth Services Review
The science of scale for violence prevention: A new agenda for family strengthening in low- and middle-income countries
March 2021
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Journal article
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Frontiers in Public Health
Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in lowand middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.
parenting, implementation science, FFR, violence -- prevention and control, parenting (MeSH), violence against children and adolescents
A South-to-South cultural adaptation of an evidence-based parenting program for families in the Philippines
January 2021
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Journal article
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Family Process
Rates of child maltreatment are higher in low- and middle-income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence-based parenting program with the eventual goal of integrating it within a nationwide conditional cash transfer program for low-income Filipino parents with children aged 2–6 years. We document the systematic adaptation of the Parenting for Lifelong Health for Young Children program that was developed and tested in South Africa, for low-resource Filipino families using the heuristic framework for the cultural adaptation of interventions. We underscore the merits of conducting a multistage top-down and bottom-up process that uses a participatory approach among cultural insiders and outsiders to develop a parenting intervention that reflects the contextual realities and cultural values of end users. The adapted program, Masayang Pamilya Para sa Batang Pilipino, is the product of a delicate and deliberate effort to balance Filipino childrearing goals and values with the scientific evidence on components of parenting interventions known to promote positive parenting and prevent child maltreatment.
child maltreatment, cultural adaptation, 养育计划, adaptación cultural, 菲律宾养育, parenting program, 儿童虐待, Filipino parenting, maltrato infantil, 文化适应, programa de crianza, FFR, crianza filipina
Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: Study protocol
December 2020
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Journal article
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Implementation Science Communications
<p><strong>Background:</strong><br />
Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs.</p><br />
<p><strong>Methods:</strong><br />
The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation.
Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification.</p><br />
<p><strong>Discussion:</strong><br />
This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.</p>
FFR, dissemination, scale-up, parenting, violence against children, evidence-based practice implementation
Corrigendum: Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence (Frontiers in Public Health, (2020), 8, 10.3389/fpubh.2020.00115)
July 2020
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Journal article
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Frontiers in Public Health
Copyright © 2020 Jansen, Lachman, Heinrichs, Hutchings, Baban and Foran. In the original article, we neglected to include the funder Faculty of Humanities at the Alps-Adria University Klagenfurt, to Elena Jansen covering the article processing charges. The corrected Funding statement appears below.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.
Parenting, mental health and economic pathways to prevention of violence against children in South Africa
July 2020
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Journal article
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Social Science & Medicine
<p>Background</p>
<p>Parenting programs based on social learning theory have increasing empirical evidence for reducing violence against children. Trials are primarily from high-income countries and with young children. Globally, we know little about how parenting programs work to reduce violence, with no known studies in low or middle-income countries (LMICs). This study examines mechanisms of change of a non-commercialized parenting program, Parenting for Lifelong Health for Teens, designed with the World Health Organization and UNICEF. A cluster randomized trial showed main effects on parenting and other secondary outcomes. We conducted secondary analysis of trial data to investigate five potential mediators of reduced violence against children: improved parenting, adolescent behaviour, caregiver mental health, alcohol/drug avoidance, and family economic strengthening.</p>
<p>Methods</p>
<p>The trial was implemented in rural South Africa with 40 sites, n = 552 family dyads (including adolescents aged 10–18 and primary caregivers). Intervention sites (n = 20) received the 14-session parenting program delivered by local community members, including modules on family budgeting and savings. Control sites (n = 20) received a brief informational workshop. Emotional and physical violence against children/adolescents and each potential mediator were reported by adolescents and caregivers at baseline and 9–13 months post-randomisation. Structural equation modelling was used to test simultaneous hypothesized pathways to violence reduction.</p>
<p>Results</p>
<p>Improvements in four pathways mediated reduced violence against children: 1) improved parenting practices, 2) improved caregiver mental health (reduced depression), 3) increased caregiver alcohol/drug avoidance and 4) improved family economic welfare. Improved child behaviour was not a mediator, although it was associated with less violence.</p>
<p>Conclusions</p>
<p>Simultaneously bolstering a set of family processes can reduce violence. Supporting self-care and positive coping for caregivers may be essential in challenging contexts. In countries with minimal or no economic safety nets, linking social learning parenting programs with economic strengthening skills may bring us closer to ending violence against children.</p>
Combining parenting and economic strengthening programmes to reduce violence against children: a cluster randomised controlled trial with predominantly male caregivers in rural Tanzania
July 2020
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Journal article
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BMJ Global Health
Introduction Parenting programmes may reduce the risk of violence against children and improve child well-being. However, additional economic support may be necessary in highly deprived rural communities in sub-Saharan Africa. Furthermore, delivering programmes within farmer groups may increase male caregiver recruitment and engagement.
<br></br>
Methods A parallel cluster randomised controlled trial examined the combined and separate effects of parenting and economic strengthening programmes on reducing violence against children aged 0–18 years in farming communities in Tanzania (n=248 families; 63% male caregivers). Eight villages were randomly assigned to four conditions (2:2:2:2): (1) 12-session parenting programme (n=60); (2) agribusiness training (n=56); (3) parenting and agribusiness combined (n=72); (4) control (n=60). Parent-report, child-report and early childhood observation assessments were conducted at baseline, mid-treatment and post-treatment. Primary outcomes were child maltreatment and parenting behaviour. Secondary outcomes included corporal punishment endorsement, parenting stress, parent/child depression, child behaviour, economic well-being and child development.
<br></br>
Results At post-treatment, parents and children receiving the combined interventions reported less maltreatment (parents: incidence rate ratio (IRR=0.40, 95% CI 0.24 to 0.65; children: IRR=0.40, 95% CI 0.17 to 0.92). Parents reported reduced endorsement of corporal punishment (Dw=−0.43, 95% CI −0.79 to 0.07) and fewer child behaviour problems (Dw=−0.41, 95% CI −0.77 to 0.05). Parents in parenting-only villages reported less abuse (IRR=0.36, 95% CI 0.21 to 0.63) and fewer child behaviour problems (Dw=−0.47, 95% CI −0.84 to 0.11). Parents in agribusiness-only villages reported fewer child behaviour problems (Dw=−0.43, 95% CI −0.77 to 0.08) and greater household wealth (Dw=0.57, 95% CI 0.08 to 1.06). However, children in agribusiness-only villages reported increased physical abuse (IRR=2.26, 95% CI 1.00 to 5.12) and less positive parenting (Dw=−0.50, 95% CI −0.91 to 0.10). There were no other adverse effects.
<br></br>
Conclusion Parent training may be the active ingredient in reducing maltreatment in farmer groups with majority male caregivers, while agribusiness training programmes may have unintended negative consequences on children when delivered alone. Locating parenting support in existing farmer groups can engage much higher proportions of fathers than stand-alone programmes.
Transferability of Evidence-Based Parenting Programs to Routine Implementation in Postconflict South Sudan
June 2020
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Journal article
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RESEARCH ON SOCIAL WORK PRACTICE
© The Author(s) 2020. Purpose: This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods: These group-based programs were delivered by trained facilitators to 97 caregivers (PLH for Young Children) and 108 caregiver–adolescent dyads (PLH for Adolescents) over 12 or 14 (respectively) weekly sessions. Routine monitoring data were collected by the implementing partners using standardized self-report measures. Reducing harsh discipline was specified as the primary outcome, with secondary outcomes including improvements in positive parenting and reductions in poor parental supervision and parental inefficacy. Results: Analyses were intention to treat. Both PLH programs retained effectiveness in routine conditions in a postwar setting, with moderate to large effect sizes. The programs also had high enrollment and attendance rates, indicating high acceptability. Conclusions: Findings suggest promising viability for the implementation of evidence-based parenting programs in challenging postconflict contexts.
Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence
April 2020
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Journal article
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Frontiers in Public Health
© Copyright © 2020 Jansen, Lachman, Heinrichs, Hutchings, Baban and Foran. Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors—lack of financial, mental, familial, and social resources. Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress. Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.
Parenting in a time of COVID-19
March 2020
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Journal article
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Lancet
FFR
Combining Economic Strengthening and Parenting Programmes to Reduce Violence Against Children in Rural Tanzania: A Cluster Randomised Controlled Trial
January 2020
|
Journal article
parenting; economic strengthening; Low- and middle-income countries; child maltreatment; RCT
Department of Orphans and Vulnerable Children, United States Agency for International Development, Washington, DC, USA (vol 395, pg e64, 2020)
January 2020
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Journal article
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LANCET
Preventing child mental health problems through parenting interventions in Southeastern Europe (RISE): protocol for a multi-country cluster randomized factorial study
October 2019
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Journal article
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Contemporary Clinical Trials
<p><strong>Background:</strong> Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs). Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries.</p> <p><strong>Methods:</strong> This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages 2–9 years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families, 108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components.</p> <p><strong>Discussion:</strong> This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021.</p>
FFR
Parenting for lifelong health for young children: a randomized controlled trial of a parenting program in South Africa to prevent harsh parenting and child conduct problems
September 2019
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Journal article
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Journal of Child Psychology and Psychiatry
<p><strong>Background</strong></p>
<p>Parenting programs suitable for delivery at scale in low‐resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low‐cost 12‐session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2–9.</p>
<p><strong>Methods</strong></p>
<p>Two hundred and ninety‐six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t0, and at 4–5 months (t1) and 17 months (t2) after randomization, research assistants blind to group assignment assessed (through caregiver self‐report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165371); Pan African Clinical Trial Registry (PACTR201402000755243); Violence Prevention Trials Register (http://www.preventviolence.info/Trials?ID=24).</p>
<p><strong>Results</strong></p>
<p>Caregivers attended on average 8.4 sessions. After adjustment for 30 comparisons, strongest results were as follows: at t1, frequency of self‐reported positive parenting strategies (10% higher in the intervention group, p = .003), observed positive parenting (39% higher in the intervention group, p = .003), and observed positive child behavior (11% higher in the intervention group, p = .003); at t2, both observed positive parenting and observed positive child behavior were higher in the intervention group (24%, p = .003; and 17%, p = .003, respectively). Results with p‐values < .05 prior to adjustment were as follows: At t1, the intervention group self‐reported 11% fewer child problem behaviors, 20% fewer problems with implementing positive parenting strategies, and less physical and psychological discipline (28% and 14% less, respectively). There were indications that caregivers reported 20% less depression but 7% more parenting stress at t1. Group differences were nonsignificant for observed negative child behavior, and caregiver‐reported child behavior, poor monitoring or supervision, and caregiver social support.</p>
<p><strong>Conclusions</strong></p>
<p>PLH for Young Children shows promise for increasing positive parenting and reducing harsh parenting.</p>
low- and middle-income countries, parenting, Parenting for Lifelong Health, prevention, FFR, violence against children
Prevention of child mental health problems in Southeastern Europe: a multicentre sequential study to adapt, optimise and test the parenting programme ‘Parenting for Lifelong Health for Young Children’, protocol for stage 1, the feasibility study
January 2019
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Journal article
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BMJ Open
<p>Introduction: Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme.</p> <p>Methods and analysis: This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2–9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre–post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre–post differences using ANCOVA, χ2 tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied.</p> <p>Ethics and dissemination: The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study.</p>
Preventing Child Maltreatment in Low‐ and Middle-Income Countries: Parenting for Lifelong Health in the Philippines
October 2018
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Chapter
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Developmental Science and Sustainable Development Goals for Children and Youth
The 2030 Global Agenda for Sustainable Development includes ending all forms of violence against children as an explicit goal (SDG target 16.2). This chapter highlights the scientific basis and potential of parent education and skills development programs to prevent child maltreatment, and describes the Parenting for Lifelong Health (PLH)-Philippines project as an example of such an initiative in a low-resource setting. PLH-Philippines is a local and international multi-sectoral collaboration that conducted a rigorous test of a culturally-adapted parenting intervention, the Masayang Pamilya Para Sa Batang Pilipino (MaPa; Happy Family for the Filipino Child), within the Philippines’ conditional cash transfer service delivery system. The contributions and challenges of Developmental Science in achieving the SDG target of preventing violence against children, particularly via family-focused interventions in low and middle-income contexts, are discussed.
Parenting programs for underserved populations in low- and middle-income countries: issues of scientific integrity and social justice
September 2018
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Journal article
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Global Social Welfare
Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing, and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the USA and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the USA, Latin America, Africa, and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale-up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.
FFR
Parenting programs for underserved populations: Issues of scientific integrity and social justice
September 2018
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Journal article
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Global Social Welfare
Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.
scale up, scale out, parenting, global mental health, implementation
Strengthening a culture of prevention in low- and middle-income countries: Balancing scientific expectations and contextual realities
July 2018
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Journal article
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Prevention Science
Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.
low- and middle-income countries, international prevention science, culture of prevention
Cash plus Care: Parenting support and violence reduction programme associated with reductions in adolescent HIV-risks in South Africa: A cluster randomized trial of a DREAMS and 4Children-implemented programme 'Parenting for Lifelong Health'
July 2018
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Conference paper
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Journal of the International AIDS Society
Adolescent HIV-risk behaviors are increased by family violence, low parental supervision, substance use and poverty. ‘Cash + care’ structural approaches can reduce adolescent HIV-risks, but parenting a teenager is complex and challenging. WHO, UNICEF, USAIDPEPFAR and academics developed and tested a parenting support and violence reduction program for low-resource settings, to be used as part of structural prevention programs.
Parenting for Lifelong Health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa
January 2018
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Journal article
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BMJ Global Health
Objective <p>To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low- and middle-income countries, on abuse and parenting practices.</p> Design <p>Pragmatic cluster randomised control trial.</p> Setting <p>40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.</p> Participants <p>552 families reporting conflict with their adolescents (aged 10-18).</p> Intervention <p>Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.</p> Main outcome measures <p>Primary outcomes: abuse and parenting practices at one and 5-9 months post-intervention. Secondary outcomes: Caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence, and family financial wellbeing at 5-9 months post-intervention. Blinding was not possible.</p> Results <p>At 5-9 months post-intervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, p<0.001); corporal punishment (caregiver report IRR=0.55 (0.37 to 0.83, p=0.004)); improved positive parenting (caregiver report d=0.25 (0.03 to 0.47, p=0.024)), involved parenting (caregiver report d=0.86 (0.64 to 1.08, p<0.001); adolescent report d=0.28 (0.08 to 0.48, p=0.006)) and less poor supervision (caregiver report d=-0.50 (-0.70 to -0.29, p<0.001); adolescent report d=-0.34 (-0.55 to -0.12, p=0.002)), but not decreased neglect (caregiver report IRR 0.31 (0.09 to 1.08, p=0.066); adolescent report IRR 1.46 (0.75 to 2.85, p=0.264)), inconsistent discipline (caregiver report d=-0.14 (-0.36 to 0.09, p=0.229); adolescent report d=0.03 (-0.20 to 0.26, p=0.804)), or adolescent report of abuse IRR=0.90 (0.66 to 1.24, p=0.508) and corporal punishment IRR=1.05 (0.70 to 1.57, p=0.819) Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management, and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.</p> Conclusions <p>This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.</p>
adolescents, RCT, parenting, low- and middle-income countries, child abuse
Developing a parenting programme to prevent child abuse in South Africa: A pre-post pilot study
November 2017
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Journal article
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Research on Social Work Practice
Background: Violence against children increases in adolescence, but there is a research and practice gap in evidence-based child abuse prevention for the adolescent years. A pilot programme for low-resource settings was developed in collaboration with NGOs, government and academics in South Africa, using evidence-based principles. Methods: This study used a pre-post design to test initial effects of a 10-session parenting programme with 60 participants (30 caregiver-adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Results: Pre-post findings show significant reductions in child abuse, violent discipline, adolescent problem behaviour, poor supervision and acceptance of violence. Improvements were seen in positive and involved parenting, and parent and adolescent social support. Conclusions: There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behaviour in rural South Africa through parenting programmes. Further development is required to improve skills such as non-violent and consistent discipline.
Parenting, Violence, South Africa, Abuse Prevention, Psycho-Social Aspects, Child Abuse
Randomized controlled trial of a parenting program to reduce the risk of child maltreatment in South Africa
September 2017
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Journal article
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Child Abuse and Neglect
Parenting programs in high-income countries have been shown to reduce the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. The objective of this study was to examine the initial effects of a parenting program in reducing the risk of child maltreatment in highly-deprived and vulnerable communities in Cape Town, South Africa. Low-income parents (N = 68) with children aged three to eight years were randomly assigned to either a group-based parenting program or a wait-list control group. Observational and parent-report assessments were taken at baseline and at immediate post-test after the intervention was delivered. Primary outcomes were parent-report and observational assessments of harsh parenting, positive parenting, and child behavior problems. Secondary outcomes were parent-report assessments of parental depression, parenting stress, and social support. Results indicated moderate treatment effects for increased frequency of parent-report of positive parenting (d = 0.63) and observational assessments of parent-child play (d = 0.57). Observational assessments also found moderate negative treatment effects for less frequent positive child behavior (d = −0.56). This study is the first randomized controlled trial design to rigorously test the effectiveness of a parenting program on reducing the risk of child maltreatment in sub-Saharan Africa using both observational and self-report assessments. Results provide preliminary evidence of effectiveness of reducing the risk of child maltreatment by improving positive parenting behavior. Further development is required to strengthen program components regarding child behavior management and nonviolent discipline strategies. Future research would benefit from a larger trial with sufficient power to determine program effectiveness.
child maltreatment, parenting, South Africa, intervention research
Different Strokes for Different Folks? Contrasting Approaches to Cultural Adaptation of Parenting Interventions.
August 2017
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Journal article
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Prevention science : the official journal of the Society for Prevention Research
Relevant achievements have been accomplished in prevention science with regard to disseminating efficacious parenting interventions among underserved populations. However, widespread disparities in availability of parenting services continue to negatively impact diverse populations in high-income countries (e.g., the USA) and low- and middle-income countries. As a result, a scholarly debate on cultural adaptation has evolved over the years. Specifically, some scholars have argued that in diverse cultural contexts, existing evidence-based parenting interventions should be delivered with strict fidelity to ensure effectiveness. Others have emphasized the need for cultural adaptations of interventions when disseminated among diverse populations. In this paper, we propose that discussions on cultural adaptation should be conceptualized as a "both-and," rather than an "either-or" process. To justify this stance, we describe three distinct parenting intervention projects to illustrate how cultural adaptation and efficacy of evidence-based interventions can be achieved using contrasting approaches and frameworks, depending on cultural preferences and available resources of local contexts. Further, we suggest the need to develop guidelines for consistent reporting of cultural adaptation procedures as a critical component of future investigations. This discussion is relevant for the broader public health field and prevention science.
Humans, Adaptation, Psychological, Parenting, Cultural Diversity
Reducing child abuse amongst adolescents in low-and middle-income countries: A pre-post trial in South Africa
July 2016
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Journal article
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BMC Public Health
<strong>Background:</strong> No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations. <strong>Methods:</strong> 230 participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use. <strong>Results:</strong> Participants reported high levels of socio-economic deprivation, e.g. 60% of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50% of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0% pre-test to 29.5% post-test, caregiver report 75.5% pre-test to 36.5% post-test, both p<0.001) poor monitoring/inconsistent discipline (p<.001), adolescent delinquency/ aggressive behaviour (both p<.001), and improvements in positive/involved parenting (p<.01 adolescent report, p<.001 caregiver report). Secondary outcomes showed improved social support (p<.001 adolescent and caregiver reports), reduced parental and adolescent depression (both p<.001), parenting stress (p<.001 caregiver report) and caregiver substance use (p<.002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity. <strong>Conclusions:</strong> The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects.
A parenting programme to prevent abuse of adolescents in South Africa: study protocol for a randomized controlled trial
June 2016
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Journal article
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Trials
Background <p>An estimated one billion children experience child abuse each year, with highest rates in low and middle income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting, and reduce adolescent behavior problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.</p> Methods <p>This is a pragmatic cluster randomized controlled trial, with stratified randomization of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavior problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24 month follow-up is planned, but this will depend on financial and practical feasibility given delays related to high levels of ongoing civil and political violence in research sites.</p> Discussion <p>This is the first known trial of a parenting programme to prevent abuse of adolescents in a low or middle income country. The study will also examine potential mediating pathways and moderating factors.</p>
low and middle income countries, parenting, Child abuse
Process evaluation of a parenting program for low-income families in South Africa
April 2016
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Journal article
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Research on Social Work Practice
<p><strong>Objective:</strong> This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3–8 years in Cape Town, South Africa (N = 68).</p>
<p><strong>Method:</strong> Quantitative measures included attendance registers, fidelity checklists, satisfaction surveys, and engagement in home practice activities. Qualitative data included parent interviews, facilitator focus groups, and transcripts from parent groups and facilitator supervision sessions.</p>
<p><strong>Results:</strong> Quantitative results show high levels of participant involvement, implementation, and acceptability. Thematic analyses identified seven themes related to program feasibility: (a) supporting participant involvement, (b) engagement in collaborative learning, (c) strengthening facilitator competency, (d) delivering nonviolent discipline skills, (e) contextualizing content, (f) receptivity to existing practices, and (g) resistance to new skills.</p>
<p><strong>Discussion:</strong> Findings suggest that parenting programs derived from evidence-based principles may be feasible in South Africa when situated within a culturally relevant context.</p>
child abuse, prevention, SBTMR, process evaluation, feasibility, mixed methods, parenting
Integrating evidence and context to develop a parenting program for low-income families in South Africa
February 2016
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Journal article
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Journal of Child and Family Studies
Children living in low- and middle-income countries, such as South Africa, face elevated risks of child maltreatment. Although evidence-based parenting programs have been shown to reduce rates of abuse in high-income countries, few studies have examined their effectiveness in low- and middle-income countries. Moreover, local cultural contexts may require the adaptation of evidence-based approaches in order to assure program acceptability and effectiveness. This study focused on the systematic development of an evidence-informed, locally relevant parenting program for socioeconomically disadvantaged families with parents of children aged 3?8 years, in Cape Town, South Africa. Intervention development took place over three stages: (a) identification of common core intervention components in evidence-based parenting programs (b) formative evaluation using qualitative in-depth interviews and semi-structured focus groups with local practitioners and low-income parents, and (c) development of intervention structure, format, and protocols. The process resulted in a manualized, group-based, 12-session parenting program that integrated existing evidence of effective components within a local, culturally relevant context. Recommended next steps are rigorous piloting to test feasibility and preliminary intervention effects followed by experimental trials to examine intervention effectiveness in a real-world setting.
SBTMR
Early intervention: A foundation for lifelong violence prevention
March 2015
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Journal article
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South African Crime Quarterly
High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home and community. There are high levels of physical abuse of children and the national under-five homicide rate is more than double that of other low- and middle-income countries. Rates of violence are particularly high in poorer communities in the country, and many children already made vulnerable by poverty are also at risk from increased exposure to violence.
Direct and indirect effects of caregiver social support on adolescent psychological outcomes in two South African AIDS-affected communities
January 2015
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Journal article
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American Journal of Community Psychology
Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource–scarce Southern African communities. A cross-sectional household survey was conducted over 2009–2010 with 2,477 South African adolescents aged 10–17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: (a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and (b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (p < .001), and indirect associations mediated through better parenting, were found for all adolescent outcomes. Findings reinforce the importance of social support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network.
child mental health, parenting, child behavior, caregiver mental health, South Africa, caregiver social support
Early intervention A foundation for lifelong violence prevention
January 2015
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Journal article
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SOUTH AFRICAN CRIME QUARTERLY-SACQ
Positive parenting for positive parents: HIV/AIDS, poverty, caregiver depression, child behavior, and parenting in South Africa.
January 2014
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Journal article
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AIDS Care
Families affected by HIV/AIDS in the developing world experience higher risks of psychosocial problems than non-affected families. Positive parenting behavior may buffer against the negative impact of child AIDS-orphanhood and caregiver AIDS-sickness on child wellbeing. Although there is substantial literature regarding the predictors of parenting behavior in Western populations, there is insufficient evidence on HIV/AIDS as a risk factor for poor parenting in low- and middle-income countries. This paper examines the relationship between HIV/AIDS and positive parenting by comparing HIV/AIDS-affected and non-affected caregiver-child dyads (n = 2,477) from a cross-sectional survey in KwaZulu-Natal, South Africa (27.7% AIDS-ill caregivers; 7.4% child AIDS-orphanhood). Multiple mediation analyses tested an ecological model with poverty, caregiver depression, perceived social support, and child behavior problems as potential mediators of the association of HIV/AIDS with positive parenting. Results indicate that familial HIV/AIDS’s association to reduced positive parenting was consistent with mediation by poverty, caregiver depression and child behavior problems. Parenting interventions that situate positive parenting within a wider ecological framework by improving child behavior problems and caregiver depression may buffer against risks for poor child mental and physical health outcomes in families affected by HIV/AIDS and poverty.
Social support, Parenting, Poverty, Orphan, HIV/AIDS, Child behavior, Depression, Caregiver
Project Njabulo. Using Storytelling, Drama, and Play Therapy for Psycho-Social Interventions in Communities Affected by HIV/AIDS in Southern Africa – Pathways to Empathetic Locally Sustainable Care
January 2013
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Journal article
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Matatu
HIV/AIDS impact on parenting behaviour in South Africa
January 2012
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Journal article
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INTERNATIONAL JOURNAL OF PSYCHOLOGY
Storytelling, drama and play in psychosocial interventions for communities affected by HIV/AIDS in Southern Africa—developing pathways to locally sustainable care
August 2011
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Journal article
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South African Theatre Journal
SBTMR
Combining agribusiness and skillful parenting to reduce the risk of violence against children in rural Tanzania: A small-scale cluster randomized controlled trial
Conference paper
Early Intervention: A foundation for lifelong violence prevention
Journal article
|
South African Crime Quarterly
High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home and community. There are high levels of physical abuse of children, and the national under-five homicide rate is more than double that of other low- and middle-income countries. Rates of violence are particularly high in poorer communities in the country, and many children already made vulnerable by poverty are also at risk from increased exposure to violence.
Effectiveness of a Parenting Programme Delivered Within a Conditional Cash Transfer System to Reduce Violence Against Children in the Philippines: Results From a Randomised Controlled Trial With 1-Year Follow-Up
Journal article
parenting, conditional cash transfer, Philippines, violence against children, RCT