The lasting and detrimental consequences of physical, verbal, and sexual abuse endured by young children are clear, and children in post-conflict settings are often at elevated risk. As parents are often perpetrators of child maltreatment, interventions at the parent and family levels allow the important opportunity to decrease negative or abusive behavior. The IRC and researchers at Duke University developed a positive parenting intervention in Liberia called “Parents Make the Difference” (PMD). This 10-session intervention is designed to help parents and guardians of young children learn and practice alternatives to harsh punishment; develop more nurturing, warm relationships with their children; and to actively participate in promoting their child’s positive emotional and pre-academic skills development.
This study used a parallel randomized superiority trial design with equal allocation to three study arms to estimate the impact of the PMD program on parent/guardian and child outcomes. Parents were randomly assigned to either the group parenting program (PMD) alone or the group parenting program plus home visits (PMD+). The waitlist control arm was offered the group parenting program (without home visits) after the 12-month post-intervention survey round was completed.
Follow-up surveys were conducted with participants in all study arms at 3-months and 12 months post-intervention. This study found that PMD reduced child maltreatment, as measured by caregivers’ discipline preferences, and improved parent-child interactions 3-months after the intervention concluded. However, one year after the intervention, we no longer see differences between the intervention and control groups on our primary outcomes of harsh discipline or parent-child interactions. This suggests that we are not seeing continual growth in parenting skills over time post-intervention. We observed clinically meaningful reductions in parent depression, and found some support for improved attitudes about discipline practices at 3-months post-intervention. Couples’ relationships also appear to have improved as a result of the intervention, but the estimates carry more uncertainly because only a subset of the sample was married or in a union (i.e., we have fewer data points to estimate the effect). At the child level, we have some evidence for small improvements in perceived child
behavior problems as assessed by parents’ levels of anger related to specific problem behaviors.
Results suggest that home visits did not uniquely impact any of the study’s primary outcomes. Although, it is notable that children of families receiving home visits experienced benefits in academic readiness. However, as conducting home visits is incredibly time and resource-intensive, the inclusion of home visits does not appear critical and is very unlikely to be cost effective.
Importantly, we do have limited evidence of longer lasting program impacts on parents of children in the sample with the highest levels of behavior problems at baseline. These results suggest that children and families who need the intervention the most receive the most benefit. If this is the case, targeting children and caregivers with existing problems may increase the positive impact of PMD and, ultimately, cost effectiveness.
The Airbel Impact Lab at IRC is a team of researchers, strategists and innovators committed to the accelerated design, rigorous evaluation and cost-effective scaling of the most impactful solutions supporting people affected by crisis.