Parenting for Lifelong Health (PLH) for Young Children ... · Lifelong Health for children aged 2-9...

[1]Bornstein,M.Hetal.CognitiveandSocioemotionalCaregivinginDevelopingCountries.ChildDevelopment,201283:46–61.[2]McGrath,Petal.Remotepopulation-based intervention fordisruptivebehaviour:Studyprotocol fora randomized trialof Internet-assistedparent training (StrongestFamiliesFinland-Canada).BMCPublicHealth,2013,13(985):1-26[3]Lachman,J.M.,etal.,Integratingevidenceandcontexttodevelopaparentingprogramforlow-incomefamiliesinSouthAfrica.JournalofChildandFamilyStudies,2016.25(7):p.2337-2352.[4].Cluver,L.,etal.,AparentingprogrammetopreventabuseofadolescentsinSouthAfrica:Studyprotocolforarandomisedcontrolledtrial.Trials,2016.17(1):p.1.[5].Ward,C.L.,etal.,ParentingforLifelongHealth:FromSouthAfricatootherlow-andmiddle-incomecountries.EarlyChildhoodMatters:ResponsiveParenting:AStrategytoPreventViolence,2014.49.[6]‘Primarycaregivers’isdefinedhereasthosepersons-suchasgrandparents,otherrelativesorneighbours-whoassumethemostresponsibilityincaringforachild.

Introduction Parenting programmes that strengthenfamilies through the development andreinforcement of positive parentingpractices and enhancement of positiveparent-child relations are an effectivestrategy to reduce the risk of violenceagainst children [1]. Theseinterventions promote parentingbehaviours that build functionalparenting competencies of parents orcaregivers to connect and provideadequate support and care for theirchildren. Parenting interventions havealso been shown to be effective inpreventingandtreatingchilddisruptivebehaviour and reducing maternalmental health problems [2]. Althoughthere is much evidence on theeffectivenessofparentingprogrammesin high-income countries, there arecurrently few evidence-basedinterventions that are well-suited forlow- and middle-income countries. Torespond to this need, Parenting forLifelong Health for children aged 2-9years (PLH 2-9) was developed basedon programmes that have been testedin the UK, US, Australia, theNetherlands, and Hong Kong. The PLH2-9 prototype was adapted to andtested in South Africa as the SinovuyoCaring Families Programme (SinovuyoKids), with a 2014 randomisedcontrolled trial (RCT) (N=68) showingimprovements in observed and self-reported positive parenting behaviourfor families who participated in the

programmeincomparisontocontrols [3]. A larger RCT(N=296) demonstratedimprovements in parentingand child behaviour atimmediate post-interventionand reductions in harshparenting at 1-year follow-up[4].

Parenting for Lifelong Health (PLH) ParentingforLifelongHealth(PLH)isaninitiative led by experts from theWorld Health Organization, UNICEF,theUniversitiesofBangor,CapeTown,Oxford, Reading, and Stellenbosch(www.who.int/violence_injury_prevention/violence/child/plh/en/). PLH iscommitted todevelopingand testingasuite of effective, feasible, culturallyrelevant, and scalable parentingprogrammes to reduce the risk ofviolence against children and improvechild wellbeing in low- and middle-incomecountries[5].

Project aim Theaimof thisproject is toadaptandtestPLH2-9withlow-incomefamiliesinThailand. In order to determine thecultural appropriateness, feasibility,andeffectivenessofPLH2-9inreducingtheriskofviolenceagainstchildrenandimprovingpositiveparentingbehaviourintheThaicontext,theprojectpartnersproposeafeasibilitystudyprojecttobeimplemented in a selected province in

North Eastern Thailand in closecollaborationwith theProvincialPublicHealthOffice,theDepartmentofSocialDevelopment andHuman Security, theDepartment of Local Administration,Thai parenting professionals, andparents and primary caregivers [6]themselves.

Objectives1. Todeterminetheneedsofparents,

primary caregivers, and publichealth practitioners in receivingand providing parenting servicesfor violence prevention andimproving positive parentingbehaviour;

2. To adapt the PLH 2-9 programmeformat and materials so that theyare appropriate to the culturalcontextand thecapacity forpublichealthservicesinThailand;

3. To test the adaptedprogramme inhospital/clinic or communitysettings in Thailand in order toassess intervention acceptability,impact on parenting behaviours,andpotentialforscaling-up;and

4. Tobuildtheknowledgeandskillsofpublic health practitioners todeliver high quality parentingeducationandsupport.

Parenting for Lifelong Health (PLH) for Young Children Aged 2-9 A feasibility study of an evidence-based parenting intervention to prevent violence and improve positive parenting in Thailand

PROGRAMME PROFILE: Parenting for Lifelong Health (PLH) for Young Children Aged 2-9

2

Project activities Phase1:Prototypedevelopment

1.1Formativeevaluation

A qualitative study will be conductedwith policymakers and designatedpublic health practitioners, in order tocapture theirviewsonthePLH2-9keyparentingprinciples,howthematerialscould be best adapted to suit Thaicultural norms, and how the groupeducationformatwithoccasionalhomevisits may be compatible with theexistingservicedeliverysystem.

1.2Cultural&contextualadaptation

Based on the findings from theformative evaluation, and inconsultationwith a reference group ofThai parenting experts, the projectteamwilladaptthePLH2-9programmematerials to reflectThaiculturalnormsand the public health service deliverycontext. Adaptation will involvetailoring the key principles to theappropriatetargetgroup;adjustingtheformat and frequency of trainings tomeet the needs of parents/primarycaregivers and service providers;developing a facilitator’s manual; anddesigning and producing materials forparent/primarycaregiverparticipants.

1.3Capacitybuilding

A team of six facilitators and twosupervisorswillbeidentifiedwithinthedesignated local health service incollaborationwith theProvincialPublicHealthOffice,andwillundergoaweek-long training led by a Master Trainerfrom the PLH-PrototypeImplementationNetwork(PIN).Ateam

of 10 data collectorswillalso be trained toconduct interviews andcollect observationaldata.

1.4Feasibilitypilot

The feasibility pilot willtest the degree towhichthe adapted version ofPLH 2-9 is accepted by asmall group of 30parents/primarycaregivers, whetherthere are preliminarysigns of effectiveness,and whether the intervention can bedeliveredwithahighdegreeoffidelity.

Phase2:SmallRCT

2.1Communitymobilization,recruitment&logisticalsupport

In order to prepare for the smallrandomized controlled trial (RCT), theproject partners will work closely withthe Provincial Public Health Office,other local government counterparts,and target communities to manageintervention facilitators, supervisors,anddatacollectors,aswellastorecruitand retain 120 parents and primary

caregiversforthetrial.

2.2Groupsessionsforparents/primarycaregivers

The trial participants will berandomly allocated to interventionand control groups, followed by thecollection of pre-interventionbaseline data. Intervention groupfamilieswill receive the interventionthrough a weekly group sessionformat, with assigned weekly home

practice activities and home visits forthose familieswhomissedasessionorwhoareinneedofadditionalsupport.

2.3Outcomeevaluation

The University of Oxford will evaluatetheeffectivenessoftheinterventionbycomparing the outcome effectsbetween the intervention group (60

families) and the control group (60families) at two time points post-intervention: two weeks and fourmonths. The outcomes to be assessedinclude reductions in incidents ofviolenceagainst children; reductions inrisk factors for violence, includingnegative child behaviours; andimprovements in parent-childinteractions.

Phase3:Dissemination&planning

The findings from the outcomeevaluationwillbesharedwith theThaiGovernment andother stakeholders atthe national and provincial levels todiscuss the impact of the programme,any revisions thatmaybeneeded,andwhetheritshouldandcanbescaleduptootherareas.

More information Formoreinformation,pleasecontact:

Prof.FrancesGardnerCo-PrincipalInvestigator

ProfessorforChild&FamilyPsychologyfrances.gardner@spi.ox.ac.uk

Dr.JamieLachmanCo-PrincipalInvestigator

jamie.lachman@spi.ox.ac.uk

AmaleeMcCoyCo-Investigator&ResearchManager

amalee.mccoy@gtc.ox.ac.uk

CentreforEvidenceBasedInterventionDepartmentofSocialPolicy&Intervention

UniversityofOxford

Overview of the PLH 2-9 curriculum Session1: BuildingaHomeofSupportinyourfamily–Qualitytime

withyourchildSession2: Qualitytimewithyourchild–SaywhatyouseeSession3: Qualitytimewithyourchild–TalkingaboutfeelingsSession4: PraisingourchildrenSession5: Rewards(alittlesomethingextra)Session6: Givingclearandpositiveinstructions

Session7: Keepingourchildrensafe–HouseholdrulesandroutinesSession8: DistractandignoreforchallengingbehavioursSession9: Cooldownforaggressive,dangerous,anddestructive

behavioursSession10: Usingconsequencesforrefusingcooldown&

refusingtofollowinstructionsSession11: ProblemsolvingwithyourchildSession12: KeepingthefirealiveinourHomeofSupport–Reflecting

andmoving