Phase 2: Intervention Development Parenting for Lifelong Health Ages 2-9: Development and Evaluation of a Parenting Programme to Reduce the Risk of Child Maltreatment in Cape Town, South Africa Background In high-income countries, parenting programmes have been shown to be effective in reducing the risk of child maltreatment. 1 However, there is limited evidence on their effectiveness in low- and middle-income countries. 2 In collaboration with the World Health Organisation and UNICEF, we have initiated a partnership called Parenting for Lifelong Health (PLH) to develop and test a suite of parenting programmes suitable for low- and middle-income countries. This study focused on the development and pilot feasibility randomised controlled trial of an evidence- informed parenting programme to reduce the risk of child maltreatment in low-income families with children ages 2 to 9 in South Africa. Lachman, J. M., Cluver, L. D., Ward, C. L., Mikton, C., Gardner, F., Hutchings, J. References 1. Barlow, J., Johnston, I., Kendrick, D., Polnay, L., & Stewart-Brown, S. (2006). Individual and group-based parenting programmes for the treatment of physical child abuse and neglect. Cochrane Database of Systematic Reviews, 3, Knerr, W., Gardner, F., & Cluver, L. (2013). Improving positive parenting skills and reducing harsh and abusive parenting in low- and middle-income countries: a systematic review. Prevention Science, 14(4), Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training programme effectiveness. Journal of Abnormal Child Psychology, 36(4), Eyberg, S. M., Ross, A. W. (1978). Assessment of Child-Behavior Problems - Validation of a New Inventory. Journal of clinical child psychology, 7(2), Theory of Change Model 3 Study Phases Praise and Rewards Naming Feelings Say What You See Special Time with Your Child Parent Goals and Ground Rules Problem Solving Cool-Down & Consequences Ignoring Difficult Behaviours Keeping Children Safe Giving Clear and Positive Instructions Sunshine of Positive Attention Building a Rondavel of Support for You and Your Child Mud Walls: Positive Parenting Thatch Roof: Limit Setting Phase 1: Needs Assessment AIMS: Examine challenges, coping strategies, and needs of Xhosa parents METHODS: Focus groups and Interviews 97 parents; 29 service providers Thematic analysis approach FINDINGS: Keeping children safe in violent communities Communicating about HIV/AIDS and poverty Stress reduction techniques Corporal punishment used widely BUT parents want alternatives “A PARENT IS A PARENT TO ALL CHILDREN” Low-cost delivery: Paraprofessional community facilitators Illustrated stories and SMS’s Creative Commons License – Free to use Social learning approach: 12 weekly group sessions Home visits to support learning Collaborative problem solving Phase 3: Pilot Feasibility Randomised Controlled Trial AIMS: Does the programme reduce risk of abuse and is it feasible? DESIGN: 68 low-income, isiXhosa-speaking caregiver-child dyads (98% female) Screened for child behaviour problems (ECBI > 10) 4 1 : 1 intervention : wait-list control Baseline and immediate post-test assessment MEASURES: Intervention exposure, engagement, fidelity, acceptability Self-report and observational assessments Child behaviour problems Positive and harsh parenting Parental depression, stress, social support RESULTS: 82% Enrolment 71% Attendance 91% Engagement in activities 93% Programme fidelity Strong acceptability of delivery and format Positive intervention effects for positive parenting (ES 0.49 to 0.68) No other differences between groups Challenges using Naming Feelings, Limit-setting Skills INITIAL INDICATIONS OF EFFICACY AND FEASIBILITY Phase 4 & 5: Further Testing and Dissemination MULTISITE RANDOMISED CONTROLLED TRIAL ( ): N = 280 dyads Post-test and 1-year follow-up assessments Subgroup, mediator, and moderator analyses DISSEMINATION AND SCALE-UP (2015 and onwards): Scalability (if effective) Implementation fidelity (training/supervision) Test in other settings (i.e. – rural communities, other countries)