1. 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

2. 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, 

3. 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

4. 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

5. 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

6. PLH Caring Families European version 2 – 9 structure

9. 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

10. 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

11. Parent satisfaction is high
(Parenting for Lifelong Health) PLH Caring Families 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.

12. 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

13. 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)

14. 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

15. 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

16. 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

17. 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.

18. Baseline characteristics
Mean age of primary parents was 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%

19. 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

20. 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

21. 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

22. 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

23. 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

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

25. SDQ child behaviour - total difficulties

26. Child behaviour - externalising

27. Arnold-OLeary parenting

28. Parenting – over-reactivity

29. Parenting - verbosity

30. Parenting total

31. Depression CES-D 10

32. 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

33. 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:  

34. Thank you For further information please visit our website