1. 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 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. Outline Study Objectives Background Methods Results
Conclusion and Recommendations

3. Study Objectives Programme Feasibility Evaluation 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?

4. 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)

5. Parenting as a mediator of risk factors for abuse

6. Evidence-based parenting programmes
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)

7. Developing free child abuse prevention programs

8. Project Phases Phase 1: Intervention Development (2012)
Phase 2: Feasibility Pilot Randomised Controlled Trial (2013)
Phase 3: Larger Randomised Controlled Trial ( )
Phase 4: Dissemination and Scale-Up (2015)

9. Research, policy and clinical practice working together
Collaborative research
Universities: Oxford Bangor, & UCT

10. Sinvouyo Caring Families Programme – Designed to go to scale
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!

11. Evidence-based parenting principles based on social learning theory (Bandura, 1977)
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)
Non didactic experiential approach – Parents are experts
Sensitive to children ages 3-8
Storytelling, songs, metaphors, and session structure
Child-led play, descriptive commenting, emotional labelling, praise and rewards
Clear, positive instructions, household rules, consistent supervision
Ignoring, Time-Out, consequences, and problem solving with children
MBSR, emotional regulation

14. Location: Khayelithsa, Cape Town

15. 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

16. Data collection 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

17. Results: Evaluation feasibility
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

19. Results: Programme 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

20. 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
“The illustrated stories are good because they are visuals, which works really well with this kind of group. They can describe what they see happening in the blocks, and you can take them slowly, block by block, instead of reading and listening. They are connecting what they see and what they are saying, and then in that it is easy for them to actually grasp what you are trying to give them.”

21. Building a Rondavel of Support

23. Conclusion – Recommendations for future practice
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
Parenting programmes require budgeting for transport, meals tea, and childcare
SMS reminders, manuals, handbook, Sinovuyo partners, and pre-programme home visits

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

26. References
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,
Belsky, J. (1993). Etiology of child maltreatment: a developmental-ecological analysis. [Review]. Psychological Bulletin, 114(3),
Cicchetti, D., & Manly, J. T. (2001). Operationalizing child maltreatment: developmental processes and outcomes. Dev Psychopathol, 13(4),
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),
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), doi: Doi / x
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.

27. 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), doi: /s
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),
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),
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),