Integrating Parent Management Training within a Conditional Cash Transfer System for Low-Income Families: Results from a Small-Scale Randomized Controlled Trial in the Philippines

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). Parenting interventions are effective approaches to prevent violence against children. Emerging evidence from trials 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: Parenting for Lifelong Health-Philippines examined 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.

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. 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.

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 11-month follow-up assessments will be available in January 2019. Trial registered on ClinicalTrials.gov: NCT03205449.