Parents Make the Difference II: Trial of a Parenting Intervention

Study Overview
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Brief Summary
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Multisite randomized trial of a parenting intervention in Liberia for caregivers of young children. Two main objectives of the Parents Make the Difference program are to teach parents (a) skills for decreasing harsh punishments and replacing those with positive ways to manage children's behavior and (b) skills for having more positive interactions with their children, including interactions that encourage learning. As a result of positive changes in parenting, the investigators expect that, over time, children's behavioral and cognitive well-being will improve and that future abuse and poor developmental outcomes will be prevented in the long-term.

Detailed Description
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This is a multisite randomized trial of a parenting intervention in Liberia for caregivers of young children. The Parents Make the Difference program is designed to teach parents (a) skills for decreasing harsh punishments and replacing those with positive ways to manage children's behavior and (b) skills for having more positive interactions with their children. As a result of positive changes in parenting, the investigators expect that, over time, children's behavioral and cognitive well-being will improve and that the intervention will prevent future abuse and poor developmental outcomes in the long-term. This study will randomize 816 caregivers of children ages 3 or 4 years to 1 of 3 study arms: standard group program, group program plus home visits, waitlist control.

Official Title
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Parents Make the Difference II: A Randomized Experiment of a Parent Training Program for Caregivers of Young Children Designed to Reduce the Use of Harsh Punishment and Improve Child-caregiver Relationships

Conditions
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Parenting, Child Abuse

Intervention / Treatment
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* Behavioral: Parents Make the Difference
* Behavioral: Parents Make the Difference Plus


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: caregiver of child ages 3 or 4 live within catchment area of each study site caregiver is at least 18 years old Exclusion Criteria: does not live with child

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Parents Make the Difference<br>Parents Make the Difference (Caregivers attend 10 group parent training sessions) | Behavioral: Parents Make the Difference<br>* 10 parent training sessions delivered to groups of caregivers<br>|
| Experimental: Parents Make the Difference Plus<br>Parents Make the Difference Plus (Caregivers attend 10 group parent training sessions and receive 3 home visits) | Behavioral: Parents Make the Difference Plus<br>* 10 parent training sessions delivered to groups of caregivers, with 3 home visits<br>|
| No Intervention: Waitlist Control<br>No parenting intervention until the end of the study period | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Caregiver use of harsh discipline practices; assessed using Discipline Interview, Locally-derived items | Extent to which caregivers engage in harsh discipline practices | 1 month post treatment | 
| Parent-Child Interactions (Parental Acceptance-Rejection Questionnaire; Locally-derived items assessing positive interactions) | Quality of parent-child relationships and interactions | 1 month post treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Caregiver use of harsh discipline practices; assessed using Discipline Interview, Locally-derived items | Use of harsh discipline practices, including physical and verbal strategies | 12 months post treatment | 
| Parent-Child Interactions (Parental Acceptance-Rejection Questionnaire; Locally-derived items assessing positive interactions) | Quality of parent-child relationships and interactions | 12 months post treatment | 
| Child social-emotional development and functioning: Ages and Stages Questionnaire; Strengths and Difficulties Questionnaire: emotion problems and peer problems subscales | Indicators of child emotional problems and problems in peer relationships | 1 and 12 months post treatment | 
| Child behavior: Locally-derived measure of disruptive/non-compliant behaviors; Strengths and Difficulties Questionnaire (conduct problems subscale) | Frequency of disruptive behaviors / SDQ items related to behavioral problems | 1 and 12 months post treatment | 
| Parental Stress: Parental Stress Scale | Level of caregiver parenting-related stress | 1 and 12 months post treatment | 
| Parental knowledge of child development: Locally-derived scale | Locally relevant indicators of parental knowledge about child development | 1 and 12 months post treatment | 
| Marital relationship quality: selected items from Conflict Tactics Scale and locally-derived scale of marital relationship quality | Indicators of quality of marital interactions, including relationship violence | 1 and 12 months post treatment | 
| Caregiver mental health: General Health Questionnaire (subscale A), Patient Health Questionnaire-9 | Indicators of caregiver mental health symptoms | 1 and 12 months post treatment | 
| Handwashing Behavior Indicators (e.g., access to hand washing station) | Basic indicators of hand washing behavior and resources | 1 and 12 months post treatment | 
| Child cognitive skills (verbal ability); assessed with a story comprehension task and instruction-following task | Child verbal abilities (brief assessment) | 1 and 12 months post treatment |