Reducing Child Maltreatment in South Africa: Feasibility of a Locally Developed Parenting Program for At-Risk

Low-Income Families

- Lachman, J. M.; Ward, C. L.; Cluver, L.; Hutchings, J.; Gardner, F.

Department of Social Policy & Intervention, University of OxfordDepartment of Psychology, University of Cape Town

Department of Psychiatry and Mental Health, University of Cape TownSafety and Violence Initiative, University of Cape Town

School of Psychology, University of Bangor Wales

• Study Objectives• Background• Methods• Results• Conclusion and Recommendations

Outline

Study Objectives

Programme Feasibility

◦ Is a locally developed parenting programme derived from evidence-based parenting principles feasible for families affected by HIV/AIDS, intimate partner violence, and poverty in Cape Town?

Evaluation Feasibility

◦What is the feasibility of conducting a randomised controlled trial of a locally developed parenting programme in impoverished communities in Cape Town?

Risk factors for child abuse

ONTOGENIC

i.e.

Inter-generational

abuse

Parent depression

Attribution bias

MICROSYSTEM

i.e.

Intimate Partner Violence

Marital conflict

HIV/AIDS

Poverty

Step-parents

EXOSYSTEM

i.e.

Social isolation

Unemployment

Community violence

Lack of Social Services

MACROSYSTEM

i.e.

Cultural values

Gender relations

(Belsky, 1980, 1993; Cicchetti & Manly, 2001; Stith, 2009)

Parenting as a mediator of risk factors for abuse

• Systematic review showed parenting programmes best evidence (Mikton and Butchart 2009)

• Good effect sizes in developed world trials (Barlow, 2006)

• Group-based programs tend to be less costly• Problem: High costs of established programs• No evidence in sub-Saharan Africa for families

with children 2-9 (Knerr, Gardner & Cluver, Prevention Science 2013)

Evidence-based parenting programmes

Developing free child abuse prevention programs

Project Phases

• Phase 1: Intervention Development (2012)

• Phase 2: Feasibility Pilot Randomised Controlled Trial (2013)

• Phase 3: Larger Randomised Controlled Trial (2014-2015)

• Phase 4: Dissemination and Scale-Up (2015)

Collaborative research

Universities: Oxford Bangor, & UCT

Research, policy and clinical practice working together

• Derived from evidence-based parenting principles (Kaminski, 2008)

• Group-based approach to behavioural change– 12-weekly group sessions

– Home visit consultations to support learning

– Role-plays and group problem solving

• Programme delivery by paraprofessionals– Early Childhood Development Level 4

– Training, Mentoring, Supervision

• Low-cost materials– Illustrated stories of parenting

– SMS reminders and booster messages

– User-friendly programme manual and parent handbook

• Creative Commons licensing – FREE access & Low Cost!

Sinvouyo Caring Families Programme – Designed to go to scale

• Collaborative approach to problem-solving (Webster-Stratton, 1998)

• Developmentally appropriate activities (Hutchings et al., 2004)

• Culturally sensitive forms of communication (Kumpfer et al., 2002)

• Positive parenting skills (Webster-Stratton et al., 2008)

• Effective supervision and parent-child communication (Coley and Hoffman, 1996)

• Nonviolent discipline strategies (Gross et al., 2003)

• Parental self-management, care, and stress relief (Hutchings, in press)

Evidence-based parenting principles based on social learning theory (Bandura, 1977)

Location: Khayelithsa, Cape Town

Participants

• Primary caregivers of children ages 3 to 8 (n = 68)

• Reside in same household > 4 nights a week

• isiXhosa speaking

• Recruitment• Ikamva Labantu’s OVC programme• Development study participants• Referrals from other local NGOs

• Available for weekday morning sessions

• Intervention effects - quantitative data– Parent-self report using mobile phones

– Home observation assessments with video recordings

• Programme feasibility – quantitative data– Participant satisfaction surveys

– Attendance registers

– Facilitator fidelity checklists

• Programme feasibility – qualitative data– In-depth interviews with randomly selected sample (n=12)

– Focus group with paraprofessional facilitators

– Programme notes and feedback forms

– Video recordings of sessions

Data collection

• High recruitment rate (93 out of 126, 73.8%)

– 68 participants enrolled (73.1%)

– Most females (98.5%)

– Most unemployed (97.0%)

• High retention rate (66 out of 68, 97.0%)

– Lost 2 participants in control group

– Only male dropped out

• Mobile phone assessment method appropriate– Reduced data entry and cleaning costs

– Assessment procedure acceptable

• Video observations– Acceptable though awkward

Results: Evaluation feasibility

• Dosage/Attendance: Mean = 9 sessions (75%)– SMS reminders, home visits

– Childcare, Public transportation

– Employment = Dropout

• Participant satisfaction– High rates of weekly and overall satisfaction

– Positive feedback on content and collaborative approach (brainstorms, illustrated stories, role-plays, problem solving, home practices)

– Sinovuyo partner system

Results: Programme feasibility

• Programme fidelity– Content delivered with high degree of fidelity

– Substantial training and ongoing supervision required

– Issue of staff retention

• Cultural acceptability– isiXhosa framework

• Rondavel of support model

• Children’s songs, stories, and structure of day

– Nonviolent approaches acceptable

– Challenges with Time-Out and emotional labelling

Results: Programme feasibility

Building a Rondavel of Support

• Weekend sessions for employed parents.• Target men’s groups and utilize male facilitators• Additional materials and activities increase

participation and engagement• IsiXhosa specific programme content supports

behavioural change model • Programme fidelity requires ongoing training,

supervision, and logistical support• Some evidence-based behavioural principles

may require additional sessions and time

Conclusion – Recommendations for future practice

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

World Health Organisation

• 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

• 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