Introducing the Parenting for Lifelong Heath (PLH) Caring Families programme for parents of 2 – 9 year olds in Montenegro CEBEI Annual Conference 2nd April 2019 Professor Judy Hutchings, Centre for Evidence Based Early Intervention, Bangor University

The key role of parenting Although other social risk factors are associated with greater risk of poor child outcomes they are mediated through parenting So if parenting is positive other disadvantaging risk factors do not apply Patterson, G. R., Forgatch, M. S., Yoerger, K. L., & Stoolmiller, M. (1998). Variables that initiate and maintain an early-onset trajectory for juvenile offending. Development and Psychopathology, 10, 531-547

Key lessons from dissemination Parenting behaviours and programme content are remarkably similar across cultures But programme deliverers need to have relevant skills to address the challenges of the target population Programmes are costly so need evidence

WHO Parenting for Lifelong Health Project Four programmes Thula Sana mother and baby home visiting programme Early carer book sharing programme (three age group versions between 0 and 5 years) Sinovuyo caring families parenting programme for 2 – 9 year olds Sinovuyo teen programme for parents and teens

Parenting for Lifelong Health “SINOVUYO” CARING FAMILIES PROJECT Initial version co-written by Jamie Lachman and myself Thank you!!! Development and Evaluation of an Evidence Informed Early Childhood Development Parenting Programme for Vulnerable Families in South Africa for 2 – 9 year olds

PLH Caring Families European version 2 – 9 structure

Content - as found globally in best practice Relationship building Praise and rewards Giving good instructions and household rules Ignoring, distracting, redirecting Non-violent discipline practices Problem solving

Strategies used by the most successful programme globally Feedback on home activities Discussion of illustrated stories Identification of key principles Role-play practice of skills Goal setting Home activities

Parent satisfaction is high (Parenting for Lifelong Health) PLH Caring Families 2 - 9 - results to date Intervention parents self-report increased positive parenting and significantly reduced intensity of child conduct problems, compared with control parents. Parent satisfaction is high The Caring Families Programme may potentially be useful for improving positive parenting in low- and middle-income settings.

Dissemination of PLH - CARING FAMILIES for 2 – 9 year olds There is huge demand across low- and middle-income countries for low cost progs A trial in the Philippines where attendance is linked to conditional cash transfer A number of other trials in areas of South Africa and other parts of Africa and Asia A large scale Horizon 2020 trial started Jan 18 in Moldova, Macedonia and Romania to test various components, relationship building, weekly phone calls, incentives and a shorter version of the programme

The Montenegrin project Presentations on parenting in Montenegro by Frances (UNICEF) and myself (WHO) in 2017 UNICEF funded translation, training, supervision and evaluation and an interpreter for all training and supervision Five day training in October 17 for 24 people Skilled professional people (five nurses, nine psychologists, nine pedagogues /educators and one social worker)

Post-training plan and implementation Time taken to plan and prepare for groups Group leaders collected baseline data Eight groups run – some primarily prevention some focused on families with challenging children Groups run January – May 2018

Supervision All intervention sessions were videotaped Three live supervisions reviewing videos Seven skype supervisions Supervision attendance was very high 95% of all possible supervisions attended

Key measures A child behaviour problem measure the 25-item Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) that assesses the frequency of child behaviour problems and includes: - a total score two subscales assessing behavioural and emotional problems A parenting measure Arnold-OLeary A parental depression measure CES-D 10

Parenting scale subscale examples Laxness: When I say my child can’t do something, (situation) I let my child do it anyway or I stick to what I said   Over-reactivity: When my child misbehaves (situation) I usually get into a long argument with my child or I don't get into an argument with my child Verbosity: I threaten to do things which… (situation) I am sure I can carry out or I know I won’t actually do.

Baseline characteristics Mean age of primary parents was 34.85 years (sd 4.9) Sex of primary parents 77 female (94%) Mean age of children 5.12 years (sd 1.89) Percentage boys 59%, girls 41%

Baseline Measure Baseline mean score Clinical cut-off SDQ 11.79   SDQ 11.79 Borderline 14+ Abnormal 17+ Arnold-O’Leary Verbosity 4.5* 3.4 Laxness 3.28* 2.8 Over-reactivity 3.19* 3.0 Total 3.52* 3.1 CES-D 10 8.69* 4

Recruitment and retention Seventy-nine parents enrolled and completed baseline measures 71 (89%) attended at least one session 8 parents dropped out so retention of those that started was 86% Mean group attendance was 9.34 sessions Mean group size 9 ranging from 4-15 Percentage attending 9+ sessions 73% 64 (88%) completed f-u measures

Parent satisfaction Items were rated on a five point scale from very dissatisfied (1) to very satisfied (5) with 3 being a neutral point Question Mean response Benefits for child behaviour 4.6 Achieved my goal 4.8 Parenting skills helpful 4.7 Confidence in the future Leader quality 4.4 Supportive group 4.9 Recommend the programme to others 5

Question: What was the most useful aspect? - examples The most useful time 1 on 1 with the child, change for the better that followed, my better understanding of his wishes and needs  Instructions how to ignore it and redirect attention from unwanted behaviour  For me as a parent, the most useful aspect were the experiences we exchanged regarding specific situations and ultimately solving problems Exchange of experiences-understanding of child psychology; techniques I am satisfied and I think it is hard to add something, because it is created in a way to cover all of the most needed elements All stages were useful from the beginning to the end, especially interaction

Outcomes – child behavior and adult mental health Child SDQ Total p<.001 es .37 externalizing p<.001 es .53 internalizing p< .001 es.035 Depression CES-D 10 p< .001 es .61

Parenting outcomes Laxness p<.001 es .69 Over-reactivity p<.001 es .84 Verbosity p<.001 es .72 Total p<.001 es .61

SDQ child behaviour - total difficulties

Child behaviour - externalising

Arnold-OLeary parenting

Parenting – over-reactivity

Parenting - verbosity

Parenting total

Depression CES-D 10

Subsequent developments Five groups ran in the Autumn, Supervision - one live and two SKYPE Identification of potential supervisors Proposed training in 2019 with support from in-house supervisors Training of supervisors to provide future training

Accreditation of the training by the National Institute for Social and Child Protection in 2018, Accreditation by the Bureau for Education in hand; (ix) December 2018, the Committee for Human Rights and Freedoms of the Parliament of Montenegro, recommended scaling up the programme to all municipalities: http://skupstina.me/index.php/me/sjednice/sjednice-radnih-tijela/odbor-za-ljudska-prava-i-slobode-sjednice  

Thank you For further information please visit our website  http://www.centreforearlyinterventionwales.co.uk Email j.hutchings@bangor.ac.uk