Approximately 75% of children aged 2 to 4 worldwide are regularly subjected to violent discipline. We study the impact of a digitally delivered intervention on positive parenting practices in Jamaica using a randomized controlled trial. Results show that the intervention improves caregiver knowledge (0.52 SD), attitudes toward violence (0.2 SD), and reduces caregiver violence against children (0.12 SD). Treatment children experience fewer emotional problems (0.17 SD). We also find reductions in caregiver depression (0.12 SD), anxiety (0.16 SD), and parental stress (0.16 SD) for treatment caregivers nine months later. The digital delivery has important scalable policy implications that could help decrease violence against children worldwide.

Background Violence against children (VAC) is highly prevalent in Jamaica, and scalable parenting programs are central to prevention. The Irie Homes Toolbox (IHT) is an evidence-based, violence prevention, parenting intervention, developed for scale within the preschool system. Objective To assess the feasibility, acceptability, and preliminary effectiveness of the IHT when delivered by preschool teachers as part of routine services. Participants and Setting: Twenty four community preschools in Kingston were randomly assigned to intervention (n=12) or wait list control (n=12). Ten caregivers per school were recruited (n=240, n=120 per group), each with a child aged 2–6 years. Methods A mixed-method cluster randomized feasibility trial was conducted. Caregivers in intervention schools were offered eleven one-hour group parenting sessions facilitated by a preschool teacher. Quantitative assessments examined quality and fidelity of implementation, caregiver attendance, and effects on caregivers’ use of VAC, attitudes to VAC, preferences for harsh punishment, involvement with their child, parenting self-efficacy, and child conduct problems. Qualitative data included teacher interviews and research team logs. Results Caregivers attended a mean of 4.0 sessions. Significant benefits were found for caregivers’ use of VAC (effect size (ES)=–0.22, p=0.04), attitudes supporting VAC (ES=–0.36), caregiver involvement (ES=0.30), and self-efficacy (ES=0.29), with a marginal effect on preference for harsh punishment. No benefits were found for child conduct problems. Qualitative findings identified key enablers, barriers, and areas for improvement. Conclusion Preschool teacher delivery of the IHT is feasible and shows promise for large scale dissemination within Jamaica’s preschool system to reduce violence against children.

Violence against women and children is widespread globally, especially among refugees and underprivileged populations. We investigated the prevalence of violence against children (VAC) and intimate partner violence (IPV) among Rohingya refugee families and families from the neighboring host communities in Cox's Bazaar, Bangladesh. We also explored the predictors of VAC and IPV. This was a cross-sectional survey embedded into the endline of a cluster-randomized controlled trial of an early childhood parenting intervention for families with children aged 6-16 months. Mothers and fathers were interviewed on their use of VAC and their attitudes towards VAC. Mothers were asked about their experience of IPV. Fathers reported on their use of IPV, their use of violence in front of children, and their attitudes to IPV. We interviewed 689 and 87 fathers from the Rohingya community, and 862 mothers and 90 fathers from the host community. In both communities, over 45% of mothers reported IPV, and over two-thirds reported VAC. Fathers reported higher levels of VAC (85.6% in host community; 77% in Rohingya community) and over a quarter reported use of IPV. In both communities, lower household wealth was associated with increased odds of mothers experiencing IPV, and mothers who experienced IPV were more than twice as likely to report use of VAC Conversely, higher maternal education increased the odds of both mother- and father-reported IPV in the Rohingya community and of father-reported IPV in the host community. Participation in an early childhood parenting intervention led to less agreement with the use of VAC by mothers in both communities, while also increasing the odds of mother-reported IPV. It is important to integrate evidence-based interventions to reduce VAC and IPV into early childhood development programs within these communities. Ensuring a combined focus on mothers and fathers is also recommended.

Social and emotional skills develop within cultural contexts and shape parenting behaviors, yet little work has examined the specific skills parents themselves consider important for parenting, or the factors they perceive as supporting these skills, in low- and middle-income countries (LMICs). Centering parents’ own conceptualizations, this two-phase descriptive qualitative study with 54 parents living in Colombia combined an initial phase of focus groups and individual interviews with a second phase of targeted individual interviews, and used thematic analysis to explore the social and emotional skills parents identify as relevant to parenting and the risk and protective factors perceived to hinder or enhance their development. Our findings highlight the importance of emotional awareness, self-regulation, communication, cooperation, and problem-solving skills in adulthood for nurturing parenting and promoting children’s social and emotional development. Parents’ upbringing and support networks emerged as significant factors shaping skill development and child-rearing practices. These findings emphasize the need for policies and interventions, grounded in caregivers’ own perspectives, to promote social and emotional skills for parents in LMIC contexts.

Background:This study presents results of a cost and cost-effectiveness analysis of two parenting interventions (group-based and pairs) integrated into primary health care centers in rural Bangladesh. Methods:A within-trial cost-effectiveness analysis was conducted for two trials of parenting interventions aiming to support child development through play and interactions. Eligible participants for both trials were underweight children aged 5-24 months. Participants in the control arms in both trials received standard health services. Intervention costs were estimated rom the provider perspective over the time horizon of each study (21 months for the group-based intervention; 24 months for the pair-based intervention). Incremental cost effectiveness ratios were estimated for all primary child development outcomes and presented in terms of cost per standard deviation improvements in the outcomes. A series of cost scenario analyses were conducted to assess the effect of changing cost assumptions on the cost and cost-effectiveness results. All results are presented in 2022 USD. The studies were registered with ClinicalTrials.gov (NCT02208531). Findings:Total provider costs in the within-trial analysis were US$ 67,668 for the group-based intervention and US$ 117,028 for the pair intervention. Estimated cost per child covered by the interventions was US$ 156 for the group intervention and US$ 136 for the pair intervention, reflecting likely economies of scale in delivery of the pair intervention. An additional US$ 100 expenditure on the group intervention is estimated to lead to a 0.55 SD improvement in cognition, 0.44 SD in language development and 0.33 SD in motor development. For the pair intervention, the corresponding estimates are improvements of 0.95 SD, 0.81 SD, and 0.88 SD, respectively. Under potential scale up scenarios, the economic cost per child could reduce substantially to US$ 61 and US$ 77 for group and pair interventions, respectively. Interpretation:The findings indicates that cost-efficiency and cost-effectiveness results for both interventions are comparable with the results from limited similar interventions in LMICs. However, implementation costs of the interventions will be substantially lower at scale due to lower monitoring costs, economies of scale, and full integration into the public health system. Funding:This work was supported by Grand Challenges Canada. ICDDR,B and core unrestricted support form the Government of Bangladesh and the Government of Canada.

Violence against children is a global public health issue that can lead to long-lasting negative consequences for child outcomes. The Irie Homes Toolbox (IHT) is an early childhood, violence prevention, parenting program designed for integration into early childhood educational services in Jamaica. We have previously shown that the program is effective in reducing child maltreatment when implemented by the research team. For wide-scale dissemination, the IHT needs to be delivered by preschool staff as part of their routine duties. We adapted the IHT using results from our previous evaluations, and we are conducting a mixed-method feasibility trial of the IHT fully integrated into preschool provision. Twenty-four basic schools in Kingston and St. Andrew, Jamaica, have been randomly assigned to intervention (n = 12) or wait-list control (n = 12) with 10 caregivers per school participating in the study (240 caregivers, 120/group). The intervention is delivered through 12 weekly, 1-hr sessions by a preschool teacher with groups of 10 caregivers of children aged 2-6 years. An ongoing process evaluation includes quantitative measures of caregiver attendance, teacher compliance, and fidelity of intervention implementation and qualitative measures of enablers and barriers to implementation and suggestions for improvement. In the impact evaluation, the primary outcome is the frequency of caregivers' use of violence against their child. Secondary outcomes are caregiver attitudes to violence, preferences for harsh punishment, involvement with their child, and child conduct problems. All outcomes are measured through caregiver report. The results of the study will be used to inform revisions of the IHT for implementation at scale. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

OBJECTIVE:Violence against children (VAC) is a global public health and human rights issue that can lead to long-lasting negative consequences for individual and societal outcomes. While extensive evidence indicates that parenting programmes might be effective in preventing VAC, there are several unsolved questions on how to ensure interventions are acceptable, feasible, effective and sustainable, particularly in low- and- middle-income countries (LMICs). METHOD:In this study, we report findings from a qualitative examination of policymakers' (N = 10), early childhood and parenting programme facilitators' (N = 20) and parents' and other caregivers' (N = 38) perspectives on VAC prevention to examine the implementation ecosystem of parenting programmes in Colombia, including contextual risk and protection factors, features of existing programmes, and stakeholders' needs. We conducted interviews and focus groups using a semistructured format, along with a thematic approach, to analyse the data from each group of participants (i.e., policymakers, facilitators and caregivers) independently. RESULTS:Overall, the data revealed the critical role of intersecting and interacting factors at the micro (e.g., caregivers' capabilities and beliefs), meso (e.g., programme content and delivery approaches) and macro (e.g., policymakers' vision and existing infrastructure) levels in exacerbating risks/imposing barriers versus protecting/promoting VAC prevention. CONCLUSIONS:These findings provide evidence on the implementation ecosystem of prevention programmes to inform the design of novel strategies and programmes aimed at preventing violence and promoting families' well-being and young children's development.

In response to the global pandemic, we adapted a Jamaican early childhood, violence prevention, parenting program (the Irie Homes Toolbox (IHT)) for virtual delivery. The resultant virtual IHT (vIHT) is a 10-week program that consists of weekly, one-hour, virtual group parenting sessions and e-summary sent via WhatsApp, three SMS messages/week, and access to a data-free app. The vIHT was implemented with 557 Jamaican caregivers of 2- to 6-year-olds with virtual groups conducted by government officers. We conducted an ongoing process evaluation to identify enablers and barriers to implementation. Key enablers included high compliance by government officers in conducting virtual sessions, sessions were implemented with adequate levels of quality, 90% participants read the SMS/WhatsApp messages, and 79% attended at least one virtual group with 52% attending five or more. Barriers included poor internet connectivity, difficulty navigating the online environment, low usage of the app, and inconsistent caregiver attendance at virtual sessions.

OBJECTIVES:We conducted a cluster-randomized trial of an enhancement to an existing parenting program in rural Colombia (called the Family, Women, and Infancy Program [FAMI]), and found benefits to parenting practices and child development. In this study, we examine the effects of the enhancement on the quality of intervention implementation and examine associations between quality and child and maternal outcomes.METHODS:In Colombia, 340 FAMI mothers in 87 towns were randomly assigned to quality enhancement through the provision of structured curricula, play materials, and training and supervision from professional tutors, or to control (no enhancement). Children aged <12 months were enrolled (N = 1460). A subsample of 150 FAMI mothers (83 intervention, 67 control) in 29 towns (17 intervention, 12 control) participated in the assessment of the quality of group parenting sessions through independent observation. Child development and parenting practices were measured at endline (10.5 months after baseline).RESULTS:In intention-to-treat analyses, we found significant benefits of intervention for the observed quality of group sessions (1.67 SD [95% confidence interval, 1.23-2.11]). An SD increase in session quality predicted an increase in treatment mothers' attendance of 4.68 sessions (95% confidence interval, 1.37-7.98). Session quality partially mediated the effect of the intervention on parental practices and child development.CONCLUSIONS:Enhancing an existing parenting program led to large benefits to the observed quality of intervention implementation. Quality was associated with increased maternal engagement, parenting practices, and child development. The observational measure of quality has potential to promote and maintain quality at scale.

BACKGROUND AND OBJECTIVES:Evidence is needed on effective approaches to build parents' ability to promote child development feasible in low- and middle-income countries. Our objective was to synthesize impact of the Reach Up early childhood parenting program in several low- and middle-income countries and examine moderation by family and implementation characteristics.METHODS:Systematic search using PubMed and Academic Search Elite/EBSCO Host. Randomized controlled trials of the Reach Up program from 1985 to February 2022 were selected. Data were extracted by 2 independent researchers. Primary outcomes were child cognitive, language, and motor development. Secondary outcomes were home stimulation and maternal depressive symptoms. We synthesized pooled effect sizes using random effect inverse-variance weighting and effect modification by testing pooled subgroup effect estimates using the χ2 test for heterogeneity.RESULTS:Average effect size across 18 studies ranged from 0.49 (95% confidence interval [CI] 0.32 to 0.66) for cognition, 0.38 (CI 0.24 to 0.51) for language, 0.27 (CI 0.13 to 0.40) for motor development, 0.37 (CI 0.21 to 0.54) for home stimulation, and -0.09 (CI -0.19 to 0.01) for maternal depressive symptoms. Impacts were larger in studies targeted to undernourished children, with mean enrollment older than age 12 months and intervention duration 6 to 12 months. Quality of evidence assessed with the Cochrane Assessment of Risk of Bias and GRADE system was moderate. Instruments used to assess child development varied. In moderator analyses, some subgroups included few studies.CONCLUSIONS:Reach Up benefits child development and home stimulation and is adaptable across cultures and delivery methods. Child and implementation characteristics modified the effects, with implications for scaling.

BACKGROUND: Violence is a global public health problem, and early childhood interventions are a core component of violence prevention programming. Interventions to support parents and teachers of young children can prevent violence against children by caregivers and prevent the early development of antisocial behavior. However, there is limited guidance on how to scale up these programs in low- and middle-income countries. METHODS: In this article, we describe how we applied implementation science principles in the design, implementation, evaluation, and initial scaling of 2 complementary early childhood, violence prevention, caregiver training programs in Jamaica: the Irie Classroom Toolbox (a teacher-training program) and the Irie Homes Toolbox (a parenting program). RESULTS: We identified 7 implementation science principles most relevant to our work in scaling the Irie Toolbox programs and describe how these principles were operationalized in the Jamaican context. The principles are: (1) design programs for scale from the outset; (2) use learning cycles for quality improvement; (3) plan strategically for government agency adoption; (4) provide high-quality initial and ongoing training and regular supervision; (5) monitor implementation quality; (6) use flexible delivery modes; and (7) plan for program sustainment. CONCLUSIONS: Through applying these principles to scale the Irie Toolbox programs, we aim to promote a consistent approach to reducing violence against children, reducing child behavior problems, and increasing caregiver and child competencies across both home and school contexts at the population level. The principles and processes described in this article are relevant to other behavior change interventions in early childhood development, education, and public health.

Introduction:Sustainable implementation of early childhood programs requires resources, materials and methods that are adaptable, scalable and feasible for delivery through multiple sectors. Additional or modified program resources may be required to meet emerging needs, as programs go to scale. An active and effective monitoring, evaluation and learning (MEL) process may enable programs to be responsive to demands. The Reach Up: Early Childhood Parenting program, is designed primarily for disadvantaged children under 4 years of age in low- and middle-income countries (LMICs) to promote their development through playful caregiver interactions. The curriculum, training manuals and other materials and resources support implementers in the adaptation of the intervention, implementation, workforce training, monitoring and evaluation. This paper reports on how data collected from key informants drove modifications to program processes, materials and resources.Methods:We conducted in-depth interviews with 14 key informants (including program managers, lead trainers, academics, consultants and workforce personnel) on their experiences with Reach Up across 15 LMICs where the program has been implemented. We also reviewed written records generated from (i) structured small group discussions at a Knowledge Exchange meeting of 31 Reach Up partners and (ii) notes from working groups formed at the meeting and tasked to continue working post-meeting to find solutions to support ongoing implementation. The transcripts from the in-depth interviews and the meeting records were analysed using thematic analysis with a mixture of pre-defined categories and data-driven sub-themes.Results:The main findings indicated that there was a need to: (i) develop advocacy and communication resources and materials to aid prospective implementers and other stakeholders, to make decisions for implementation, (ii) revise and/or add to the content and format of the curriculum and add content in the training and other supporting manuals and (iii) enhance the training process.Conclusion:The feedback from the key global partners informed the development of new knowledge materials, resources and processes and modifications to existing program materials and resources. These will help to support advocacy, ongoing implementations, and the process of transitioning the Reach Up early childhood intervention to scale.

We evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties. We randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions ( n  = 59 health workers, n  = 24 clinics) were trained to deliver a group-based parenting intervention, with training and supervision provided by government supervisors. In each of the 24 intervention clinics, we recruited 24 mothers of children aged 6–24 months to participate in the parenting sessions ( n  = 576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four to five participants for 6 months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers' attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control) and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother-reported home stimulation, measured at baseline and endline. Supervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs [3.4%] refused) and mothers' attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size = 0.53SD, 95% confidence interval: 0.50, 0.56, p  < 0.001). HW burnout was low in both groups. Integration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.

BACKGROUND:Violence against children (VAC) is a global public health problem, and parenting programmes are a key strategy to reduce VAC at home. We developed and evaluated a preschool-based, early childhood, violence prevention, parenting programme (the Irie Homes Toolbox) in Jamaica and reported significant reductions in parents' use of VAC [Effect size (ES) = -0.29] and increases in parents' positive practices (ES = 0.30). This study presents qualitative findings on the mechanisms of action of the programme.METHODS:As part of a cluster randomized trial, 115 parents from nine preschools participated in the Irie Homes Toolbox parenting programme. The programme consisted of eight 90-min sessions with groups of six parents and focussed on strengthening parent-child relationships, understanding children's behaviour, using appropriate discipline strategies and understanding and managing emotions. We conducted in-depth, semi-structured interviews with a stratified random sample of 28 parents (two to four parents per school) and with nine preschool teachers (one teacher per preschool). Topic guides were developed to explore participants' perspectives of the mechanisms of action of the programme. All interviews were audio-recorded and transcribed, and data were analysed using the framework approach.RESULTS:The most salient direct pathways to reduced VAC by both parent and teacher reports were through parents' use of alternative strategies to manage child misbehaviour and through improved parent well-being, especially parents' self-management skills. Other factors leading to reduced VAC by parents, reported by both parents and teachers, included self-identification as an 'Irie parent', use of proactive parenting strategies and improved child behaviour. Parents reported that the main factors leading to continued use of VAC were their inconsistency in using positive discipline strategies and poor emotional self-regulation.CONCLUSION:Reports from participating parents and preschool teachers indicate that contents related to parental self-management and how to use positive discipline strategies to manage child misbehaviour were important factors on the pathway to reduced VAC.

BackgroundOver 250 million children globally do not reach their developmental potential. We tested whether integrating a group-based, early childhood parenting program into government healthcare clinics improved children’s development, growth, and behavior.MethodsWe conducted a cluster-randomized controlled trial in 40 community clinics in the Kishorganj district of Bangladesh. We randomly assigned clinics (1:1) to deliver a group-based parenting interventions or to a comparison group that received no intervention. Participants were children aged 5–24 months, with weight-for-age z-score of ≤ −1.5 SDs of the WHO standards, living within a thirty-minute walking distance from the clinic (n = 419 intervention, 366 control). Government health staff facilitated parenting sessions in the clinic with groups of four mother/child dyads fortnightly for one year as part of their routine duties. Primary outcomes measured at baseline and endline were child development assessed using the Bayley scales, child behaviors during the test by tester ratings, and child growth. The trial is registered at ClinicalTrials.gov, NCT02208531.Findings:91% of children were tested at endline (396 intervention, 319 control). Multilevel analyses showed significant benefits of intervention to child cognition (effect size 0.85 SDs, 95% CI: 0.59, 1.11), language (0.69 SDs, 0.43, 0.94), and motor development (0.52 SDs, 0.31, 0.73), and to child behaviors during the test (ranging from 0.36 SDs, 0.14, 0.58, to 0.53 SDs, 0.35, 0.71). There were no significant effects on growth.ConclusionA scalable parenting intervention, integrated into existing government health services and implemented by government health staff, led to significant benefits to child development and behavior.

AimsWe evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties. MethodsWe randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions (n = 59 health workers, n = 24 clinics) were trained to deliver a group-based parenting intervention, with training and supervision provided by government supervisors. In each of the 24 intervention clinics, we recruited 24 mothers of children aged 6-24 months to participate in the parenting sessions (n = 576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four to five participants for 6 months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers' attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control) and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother-reported home stimulation, measured at baseline and endline. ResultsSupervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs [3.4%] refused) and mothers' attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size = 0.53SD, 95% confidence interval: 0.50, 0.56, p < 0.001). HW burnout was low in both groups. ConclusionIntegration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.

Violence against children (VAC) is a major global issue with long-lasting negative consequences on individuals and societies. The present study presents a review of the literature on drivers of VAC and the core components of evidence-based violence prevention programs. Moreover, it analyzes the existing services and social infrastructure in Colombia to rigorously inform the design of the Apapacho violence prevention parenting program for families with children younger than five targeted toward Colombia. Findings indicate that (1) VAC in Colombia is a multidimensional issue with roots at the individual, family, community, and society levels, (2) evidence-based violence prevention programs share a common set of content and delivery strategies that could inform the components of the Apapacho program, and (3) there is an urgent need for scalable and flexible violence prevention programs for families with young children in Colombia. Considering existing evidence, the Apapacho violence prevention parenting program will be designed using ecological, developmental, and neuroscience-informed perspectives. This article concludes by presenting the initial components of the theory of change and discussing future directions for the design of the Apapacho program and other violence prevention interventions in LMICs.