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The effectiveness of the parenting program in reducing violence in the Philippine cash transfer system: a follow-up RCT
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Parenting interventions and conditional cash transfer (CCT) programs are promising strategies to reduce the risk of violence against children, but there is insufficient evidence of the effectiveness of the combination of these programs for families low- and middle-income countries with children over the age of two. of age. . This study examined the effectiveness of a locally tailored parenting program run by the public CCT system for low-income families with children aged two to six years in Manila, Philippines.
= 120). Participation in both services was required as part of the conditions for receiving cash grants. Baseline assessments were conducted in July 2017, monthly post-intervention assessments in January-February 2018, and subsequent 12-month assessments in January-February 2019. All assessments were parent reports (ClinicalTrials.gov: NCT03205449) .
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= -0.59 [-0.95; -0.22]), physical violence (IRR = 0.51 [0.27; 0.74]) and neglect (IRR = 0.52 [0.18; 0.85]). Significant effects were also noted in terms of reduced parenting dysfunction, child behavior problems, and intimate partner violence, as well as improved parenting effectiveness and positive parenting. The reduction in overall violence, emotional abuse, and neglect was consistent over one year of follow-up.
The results suggest that culturally appropriate parenting interventions delivered as part of a CCT program can be effective in sustainably reducing violence against children in low- and middle-income countries.
This study was supported by the UBS Optimus Foundation and UNICEF in the Philippines, and the Complexity and Interconnection in Improving Health programs of the MRC Medical Research Council UK and the Chief Science Unit (Grant: MC_UU_00022/1 and CSO SPHSU16, MC_UU_00022/3 and CSO SPHSU18). .
Around one billion children are victims of violence each year, with around 64% of the incidence highest in Asia. Violence against children is a major global public health problem given its immediate and long-term adverse effects. Emerging evidence indicates that parenting programs and conditional cash transfers can be effective in reducing violence against children, and that parenting interventions can be equally effective when transferred from one setting to another. However, most research examining the impact of parental interventions within conditional cash transfer systems has focused on early childhood developmental outcomes in families with children under two. There are no evaluations of parenting interventions aimed at non-violent parenting and reduction of child behavior problems for families with older children that are integrated into conditional cash transfer systems in developing countries. low and middle income.
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To our knowledge, this is the first randomized controlled trial to investigate the effectiveness of a parenting program based on the principles of social learning theory, delivered as part of a conditional cash transfer system for low-income families with children over the age of two. . The results showed a reduction in child maltreatment compared to conventional family development services that was sustained one year after the intervention. Immediate post-test improvements in parenting effectiveness and positive parenting are also encouraging, as are reductions in dysfunctional parents and behavioral problems in children. Importantly, the program also showed a reduction in intimate partner violence immediately after testing and after one year of follow-up, suggesting the potential utility of parenting interventions in improving relationships with partners and reducing intimate partner violence. regard to women.
This study adds to a growing body of evidence demonstrating that culturally appropriate parenting interventions based on social learning theory can be effective in reducing violence against children over the long term in low- and low-income countries. intermediate. It also supports research on the effectiveness of transferring parenting programs from one setting to another and the importance of conducting field trials to test the effectiveness of programs in settings as close to delivery as possible. normal service. Additional sessions, such as peer support groups or digital interventions, may be needed to maintain impact on other outcomes and will need to be evaluated.
Around one billion children are exposed to violence every year, mostly at home, with an estimated incidence rate of 64%, the highest in Asia.
In the Philippines, the National Violence Against Children (VAC) Survey, which interviewed 3,866 children and youth aged 13-24, found that 80% of lifetime incidents of violence were victims of violence, almost 50% of whom had suffered physical or psychological abuse at home.
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Child protection council. National Baseline Violence Against Children Survey: Philippines. Child Welfare Council and UNICEF Philippines.
VAC is associated with numerous immediate and long-term negative health effects that affect multiple areas, including physical and mental health.
There are also significant financial costs to VAC, estimated at between 1.32% and 2.52% of GDP in East Asia and the Pacific.
The World Health Organization and other international agencies launched the INSPIRE framework in 2016 to coordinate government initiatives around seven different VAC prevention strategies. Thirty national governments have pledged to implement these strategies as pioneer countries, including the Philippines.
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Parenting interventions are one of the INSPIRE strategies with the most promising evidence for reducing the risk of ACC in low- and middle-income countries (LMICs).
Improving positive parenting skills and reducing abusive and abusive parenting practices in low- and middle-income countries: a systematic review.
Parental interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia: a systematic review and multilevel meta-analysis.
These programs, usually based on the principles of social learning theory, aim to strengthen the relationship between caregiver and child through positive parenting and to help parents deal with behavioral problems in the child. using effective, age-appropriate, non-violent discipline strategies.
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Evidence is also emerging of the tolerability of parenting interventions across cultures and settings, suggesting that evidence-based programs designed in one setting may be equally effective in another.
Income and economic growth programs, another INSPIRE strategy, can also be effective in reducing NNI by addressing social drivers of violence such as poverty and gender inequality.
Integrating parental support into conditional cash transfer (CCT) systems is consistent with this approach, requiring CTC beneficiaries to participate in parental programs as well as other human capital investments such as vaccination of children. children and school attendance.
In addition to potentially increasing parental involvement, integrating parenting interventions into existing CCTs offers the opportunity to scale up evidence-based programming, particularly in resource-limited settings. However, there are limited data on the effectiveness of parenting interventions when delivered as part of CCT, and no evidence of effectiveness for families with children over two years of age.
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Much of the existing research on parenting programs conducted within CCTs has focused on early parenting interventions in Latin America and Africa,
This study used a randomized controlled trial (RCT) with a one-year follow-up to test the effectiveness of a parenting program in Filipino families with children aged two to six years under CCT of the Philippine Department of Welfare and Development (DSWD). a program called Pantawid Pamilya Pilipino Program (4Ps). The 4Ps program provides monthly cash grants (about $10 to $30) to low-income families. Beneficiaries are required to respect health and school conditions and to follow monthly family development courses (FDS).
Philippine Pantawid Pamilyang (4P) Family Development Assessment Session: Assessment of FDS Modules (Final Report). Department of Human and Family Development Studies, College of Human Ecology.
We hypothesized that families receiving the parenting program would report a significantly reduced risk of VAC compared to those who were referred to receive conventional FDS services or conventional treatment (TAU).
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This RCT (1:1 distribution ratio) was conducted from June 2017 to February 2019 in an urban community of Taguig City in the National Capital Region of the Philippines (ClinicalTrials.gov #NCT03205449). The study site, in which the CCT program included a significant number of potentially eligible families, was selected based on recommendations from regional DSWD and 4P staff. Ethical procedures have been approved by the Central University of Oxford Research Ethics Board (ref: R43041/RE001), Ateneo de Manila University Research Ethics Board (ref: AdMUREC_16_014PA ) and the University of Cape Town Faculty of Psychology Research Ethics Committee. City (ref: PSY2016-041).
= 120) were recruited in June 2017 based on a target sample using recommendations from 4P staff. Inclusion criteria for participants included: 1) 18 years or older, 2) primary caregiver responsible for caring for a child aged 2-6 years; 3) the primary caregiver has spent at least four nights per week in the same household as the child in the previous month; 4) unemployed parent and 4Ps recipient; 5) consent to participate in the parenting program, if treatment is prescribed; 6) give consent to participate in the full study. Adults were excluded if they had significant mental health issues or disabilities, as the intervention did not address these issues. Screening for exclusion was based on an intelligence assessment performed during informed consent procedures at baseline (no one was excluded). Providers who have previously participated in a parenting program or who have been referred to child protection services due to
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