The Impact of a Positive Parenting Intervention on Child Maltreatment and Parent-Child Interactions: Results of a Randomized Controlled Trial in Monrovia, Liberia

Introduction. Consequences of physical and verbal abuse endured by young children are clear, and children in post-conflict settings are at elevated risk. As parents are often perpetrators of maltreatment, parenting interventions are particularly warranted, and previous studies support their efficacy. While many studies have been conducted in high-resource settings with clinical populations, a growing body of literature supports their efficacy in low- and middle-income countries as well. In this study, we evaluated a group-based intervention, “Parents Make the Difference (PMD),” delivered to caregivers of young children in post-conflict Liberia. We assessed impacts of the group sessions at 3- and 12-months post-intervention; the impact of adding home visits; and differential effects on children with the highest levels of behavior problems.

Methods. We used a parallel randomized superiority trial design. Participants were 813 caregivers of children ages 3-4 years who were randomly assigned (1:1:1) to 1 of 3 arms: a 10-session group parenting program (PMD), the group program plus home visits (PMD+), or a waitlist control group. We used linear mixed effects models to estimate impact and conducted intent-to-treat (ITT) and treatment on the treated (TOT) analyses. Qualitative interviews were conducted with a subsample (N=75).

Results. Three months post-intervention, PMD reduced parent preferences for harsh punishment (0.43 standard deviations, SD), increased positive interactions (0.17 SD), and reduced parental rejection (0.22 SD) in the ITT analyses. At 12 months, effect sizes on these outcomes decreased, with the control group also showing improvement over time. On secondary outcomes at 3 months, PMD reduced parental depression (0.34 SD) among compliers and likely improved attitudes about discipline practices. Most effects on secondary outcomes attenuated at 12 months, though TOT estimates suggest PMD reduced parent anger related to child behavior problems among compliers at one year. Home coaching visits did not lead to additional improvements on primary outcomes but may have led to gains on secondary outcomes of children’s receptive language abilities and parents’ concerns about children’s social-emotional well-being. Effect sizes on primary outcomes were larger for the parents of children in the highest quintile for behavior problems, and effects were maintained at 12 months.

Conclusions. Results highlight the importance of examining longer term outcomes, and attenuation of effects suggests that ongoing support may be beneficial to maintain or increase behavior change. However, the larger, sustained impacts on those with pre-existing behavior problems points to the need to consider indicated prevention approaches to prioritize those at higher risk.