Integration of a Parenting Program within a Conditional Cash Transfer System for Low-Income Filipino Families with Children Ages 2 to 6: Results from a Small-Scale Randomized Controlled Trial in Metro Manila

Background: 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). Parenting interventions are particularly effective approaches to prevent violence against children. Emerging evidence from trials and systematic reviews suggests that parenting interventions are also transferable across contexts and can be effective when delivered in LMIC. However, there are currently few programs that are both evidence-based and affordable for LMIC, where the need is greatest. Moreover, it is vital that programs are implemented and tested within existing service delivery systems in order to maximize intervention sustainability and scalability.

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.

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 for the study 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, and marital satisfaction; and parent/child sleep. All outcomes were parent-report. Baseline assessments were conducted in July 2017 with one-month post-intervention assessments planned in January 2018. Analyses will use an intention-to-treat approach with multiple imputation to account for missing data. Multivariate mixed-effects models will be 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 a previous small pre-post pilot study completed in early 2017 showed large effects for reduced child maltreatment when comparing post-test with baseline scores (N = 28, d = -0.74, 95% CI -1.28 to -0.20). The RCT is currently underway and will provide more robust evidence of effects at one-month post-intervention in comparison to controls. Final results will be available in February 2018. Trial registered on ClinicalTrials.gov: NCT03205449.