Randomised Controlled Trial of a Parenting Programme for Low-income Families on Welfare in the Philippines

• In Event: 2-079 - Parenting in the Global South: From Theory to the Evaluation of Interventions

Integrative Statement

Introduction: Over the past decade, there have been increasing calls for the scale-up of evidence-based interventions to reduce the risk of violence against children in low- and middle-income countries (LMIC) (World Health Organization, 2016). Parenting interventions are effective approaches to prevent violence against children (Chen & Chan, 2015). Emerging evidence from trials suggests that parenting interventions are also transferable across contexts and can be effective when delivered in LMICs (Gardner, Montgomery, & Knerr, 2015; Leijten, Melendez-Torres, Knerr, & Gardner, 2016). However, there are currently few programs that are both evidence-based and affordable for LMICs, where the need is greatest (Mikton, 2012). Moreover, it is vital that programs are implemented and tested within existing service delivery systems in order to maximize intervention sustainability and scalability (Mikton, MacMillan, Dua, & Betancourt, 2014).

Objective: The Parenting for Lifelong Health-Philippines Evaluation Study is a research-policy-practice partnership consisting of members from international and local universities, officials from UNICEF Philippines and the Philippine Department of Social Welfare and Development, and practitioners from the Philippine Ambulatory Pediatric Association and the Child Protection Network. Its focus is to culturally-adapt and test the effectiveness of an evidence-based parenting program on reducing risks of violence against children when delivered as part of an existing conditional cash transfer system to low-income families with children aged 2 to 6 in Metro Manila, Philippines (Alampay et al., 2018).

Study Population and Methods: Low-income families were randomly assigned on a 1:1 ratio to either a 12-session, bi-weekly, group-based parenting program or a treatment-as-usual control group receiving family development services (N = 120). Participation in either group was part of the conditionality for receiving cash grants from the Philippine government. The primary outcome was frequency of child maltreatment based on the ICAST-Intervention scale. Proximal outcomes included positive parenting behavior, dysfunctional parenting, and parental attitudes supporting corporal punishment. Secondary outcomes included child behavior problems, communication skills and socio-emotional development; parental depression, wellbeing, intimate partner violence, marital satisfaction, and hours of sleep. All outcomes were parent-reported. Baseline assessments were conducted in July 2017 with 1-month post-intervention assessments in January 2018 and 9-month follow-up in October 2018. Analyses used an intention-to-treat approach with multiple imputation to account for missing data. Multivariate mixed-effects models were used to test the preliminary effectiveness of the intervention on reducing risks for violence against children in comparison to treatment as usual.

Results: Results from one-month post-intervention assessments indicated moderate intervention effects for reduced overall child maltreatment (d = -0.68, 95% CI -1.05, -0.32), physical abuse (d = -0.54, 95% CI -0.90, -0.17), and emotional abuse (d = -0.64, 95% CI -1.00, -0.27), as well as small effects for reduced neglect (d = -0.38, 95% CI -0.74, -0.02), in comparison to controls. There were also significant intervention effects for reduced dysfunctional parenting, parental inefficacy, child intensity behavior problems, and daily child problem behavior, as well as for increased parental efficacy and daily positive parenting. Results from 9-month follow-up assessments will be available in January 2019. Trial registered on ClinicalTrials.gov: NCT03205449.

Authors

• Jamie M Lachman, Department of Social Policy and Intervention, University of Oxford and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
  Presenting Author

• Liane P. Alampay, Ateneo de Manila University
  Non-Presenting Author

• Cecilia D Alinea, Department of Pediatrics, University of the Philippines-Manila
  Non-Presenting Author

• Bernadette J Madrid, University of the Philippines-Manila
  Non-Presenting Author

• Judy Hutchings, Bangor University
  Non-Presenting Author

• Catherine L Ward, Department of Psychology, University of Cape Town
  Non-Presenting Author

• Bernice Vania N Landoy, Department of Psychology, University of the Philippines-Visayas
  Non-Presenting Author

• Maria Ana Victoria Felize V Garilao, Department of Psychology, Ateneo de Manila University
  Non-Presenting Author

• Rosanne M Jocson, Department of Psychology, Ateneo de Manila University
  Non-Presenting Author

• Jennel C Reyes, Department of Psychology, Ateneo de Manila University
  Non-Presenting Author

• Frances Gardner, Oxford University
  Non-Presenting Author