1. The Sinvouyo Caring Families Programme for Parents of Children Aged 3-8 Years -Lachman, J. M. (co-I), Hutchings, J. (co-I), Cluver, L (co-PI), Ward, C. L., (co-PI), Gardner, F. (co-I) Department of Social Policy & Intervention, University of Oxford Department of Psychology, University of Cape Town Department of Psychiatry and Mental Health, University of Cape Town Safety and Violence Initiative, University of Cape Town School of Psychology, University of Bangor Wales

2. Project Objectives To develop a scalable, evidence-informed parenting programme to reduce the risk of child abuse and maltreatment for children ages 2 to 9 years old To pilot and evaluate the programme’s effectiveness using a gold-standard Randomised Controlled Trial design To evaluate programme feasibility and cultural acceptability To disseminate findings to stakeholders and promote large-scale implementation

3. Research, policy and clinical practice working together

4. Evidence-based approach to intervention development Medical Research Council Framework for Complex Social Interventions (Craig et al 2008)

5. Phase 1: Development -Step 1: Identification of problem theory, theory of change, evidence-base -Step 2: Qualitative research in Cape Town -isiXhosa parents (n=97) -Service providers (n=29) -Expert consultation (n=5) -Step 3: Curriculum and manual development -Step 4: Facilitator training -Step 5: Preparation for pilot feasibility trial

6. Step 1: Identifying theoretical foundation Problem Theory

7. Lots of evidence in HICs that parenting programmes can reduce child abuse and improve child behaviour (Barlow 2006, Mikton and Butchart 2009, Furlong 2012) Limited evidence in LICs with none for 3-8 age group ( Knerr, Gardner & Cluver in Prevention Science 2013 ) Problems: – High costs of established programmes – Maintaining fidelity – Balancing evidence with cultural/local context – Going to scale What is the evidence?

8. Social learning through rehearsal of skills (Bandura, 1997, Webster-Stratton, 1998) Principle based rather than techniques (Hutchings et al., 2004) Home practice of parenting skills (Patterson, 1982) Developmentally appropriate activities (Hutchings et al., 2004) Positive parenting combined with non-violent discipline (Patterson, 1974; Hobbs et al, 1990) Child-directed play (Hanf, 1969) Effective supervision and parent-child communication (Coley and Hoffman, 1996) Key components (Hutchings, Gardner & Lane, 2004)

9. Theory of Change

10. Step 2: Community-based participatory approach to programme development -Research Aims -Challenges and coping strategies of parents -Cultural applicability of evidence-based principles and approaches -Feasibility issues in implementing parenting programmes -Methods: -Semi-structured focus groups (n=14); -In-depth interviews (n=10) -97 parents; 29 service providers -Consultation with experts and community based organisations -Thematic analysis approach

11. Location: Khayelitsha, Cape Town

14. Step 2: Qualitative results -Challenges: -Financial stress -Crime/violence in community -Little father involvement -Child behaviour problems -Lack of time to interact with children -Core Themes/Needs: -Issue of RESPECT (communication, behaviour) -Relationship building with children -Keeping children safe in community -Stress reduction techniques -Widespread use of corporal punishment BUT expressed desire for alternative methods

15. Build on evidence and fit to local context – PMT, Triple-P, Incredible Years, PCIT, etc. Group-based approach to behavioural change – 12 to 14 weekly group sessions – Home visit consultations to support learning – Role-plays and group problem solving Low-cost materials w/ Creative Commons License – Illustrated stories instead of videos – SMS reminders and booster messages – User-friendly programme manual and parent handbook Step 3: Programme design

16. Building a Rondavel of Support

20. Programme facilitators selected from community Parents with basic ECD training Fluent in isiXhosa Experience facilitating groups Initial training in programme approach (5 days) Collaborative approach Group problem solving Core parenting principles or building blocks Additional training in session content (12 days) Ongoing supervision using videos, role-plays, and group problem-solving Step 4: Facilitator Training

22. Next Steps... -Small scale randomised controlled trial in 2013 -68 parents of children ages 3-8 -> 11 on Eyberg Child Behaviour Inventory Problem Scale -Wait-list control -Large randomised controlled trial 2014-2015 -240 families in Nyanga and Khayelitsha -No Wait-list Control Group -Baseline, Post-test, 12-month Follow-Up -Scale up: Parenting for Lifelong Health -South Africa as incubator -Suite of parenting programme for children from 0-2, 2-9, 10-17 -Oxford, UCT, Stellenbosch, Bangor, and WHO

24. THANK YOU!!! The John Fell Fund and the Clarendon Fund And all the research assistants, volunteers, group facilitators, project managers, and other unsung heroes! National Lottery Trust Distribution Fund Ilifa Labantwana Rand Merchant Bank Fund ApexHi Charitable Trust World Health Organisation

25. Bandura, A. (1977). Social Learning Theory.. New York City, NY: General Learning Press. 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, 1-20. Belsky, J. (1980). Child Maltreatment: An ecological integration. American Psychologist, 35, 320-335. Belsky, J. (1993). Etiology of child maltreatment: a developmental-ecological analysis. [Review]. Psychological Bulletin, 114(3), 413-434. Cicchetti, D., & Manly, J. T. (2001). Operationalizing child maltreatment: developmental processes and outcomes. Dev Psychopathol, 13(4), 755-757. Coley, R. L., & Hoffman, L. W. (1996). Relations of parental supervision and monitoring to children's functioning in various contexts: Moderating effects of families and neighborhoods. Journal of Applied Developmental Psychology, 17(1), 51-68. Gross, D., Fogg, L., Webster-Stratton, C., Garvey, C., Julion, W., & Grady, J. (2003). Parent training of toddlers in day care in low-income urban communities. Journal of Consulting and Clinical Psychology, 71(2), 261-278. doi: Doi 10.1037/0022-006x.71.2.261 Hutchings, J., Bywater, T., Williams, M.E., Whitaker, C. (in press). Parental Depression and Child Behaviour Problems. Behavioural Cognitive Pyschotherapy. Hutchings, J., Gardner, F., & Lane, E. (2004). Making evidence-based intervention work. In D. Farrington, C. Sutton & D. Utting (Eds.), Support from the Start: Working with Young Children and their Families to Reduce the Risks of Crime and Antisocial Behaviour. London: DFES. References

26. Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36(4), 567-589. doi: 10.1007/s10802-007- 9201-9 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. Mikton, C., & Butchart, A. (2009). Child maltreatment prevention: a systematic review of reviews. Bulletin of the World Health Organization, 87(5), 353-361. Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M.,... Dees, J. E. M. E. G. (2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14(1), 13-29. Webster-Stratton, C. (1998). Parent Training with Low-income Families: Promoting parental engagement through a collaborative approach. In J. R. Lutzker (Ed.), Handbook of Child Abuse Research and Treatment. New York: Plenum Press. Webster-Stratton, C., Reid, M. J., & Stoolmiller, M. (2008). Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools. Journal of Child Psychology and Psychiatry, 49(5), 471-488. References