The Bertha Centre for Social Innovation and Entrepreneurship (CEI's South Africa hub) and the Children’s Institute recently hosted a seminar at the UCT Graduate School of Business on the impact of parenting programs in diverse settings. The session was moderated by Professor Emeritus Andy Dawes of the University of Cape Town and featured Professors Ria Reis (Children’s Institute, Leiden University Medical Centre, University of Amsterdam) and Mark Tomlinson (University of Stellenbosch, University of Cape Town) alongside Associate Professor Cathy Ward (University of Cape Town) as panelists.
Parenting programs are high on the global agenda. The UN’s Millennium Development Goals and their most recent revision; the Sustainable Development Goals, both recognized the critical role these programs play in Early Childhood Development (ECD). Major agencies such as the WHO, UNICEF and USAID are increasingly integrating them into their global development initiatives and the South African government has also acknowledged their importance by making provisions for them in key policy documents such as the National Development Plan and the amended Children’s Act.
Most parenting programs have similar principles underpinning their delivery. These programs are typically based on a collaborative relationship between parents and practitioners that promotes positive parenting techniques and problem solving to help reduce incidents of harsh discipline and child maltreatment. The programs often take on a socio-emotional coaching style; encouraging parents to set their own goals and introducing concepts like child led play as a means of enhancing the parent-child relationship. Reductions in harsh discipline and child maltreatment are often associated with improved mental health for both parent and child and can have a positive impact on cognitive development and school readiness.
However parenting programs are subject to a number of challenges including high costs of delivery and the fact that these programs have mostly been designed in the global north and there is little evidence to show their efficacy in developing contexts. Questions also exist surrounding approaches to scaling these programs to reach the most vulnerable families without diluting them too much and thereby losing the beneficial impact of critical success factors.
Assoc. Prof. Cathy Ward started off the presentations with a discussion of Sinovuyo, a parenting program revolving around improving child behavior and reducing maltreatment in low income households which targets children aged 2-9. Sinovuyo has demonstrated some success in increasing positive parenting although its impact on child behavior remains to be evidenced. The program uses weekly group meetings run by trained community facilitators and home visits as a delivery mechanism for parenting instruction and is currently undergoing a Randomized Control Trial (RCT) to further develop its evidence base. Assoc. Prof. Ward emphasized the value of this process as a conduit for scaling, accreditation for facilitator training and possible integration of interventions into a holistic set of Early Childhood Development tools under development by Ilifa Labantwana; a leading South African ECD program.
The value of forming a reliable evidence base and the challenges associated with the process was a theme also covered in Prof. Mark Tomlinson’s presentation. Prof. Tomlinson alluded to RCTs as the “gold standard” in developing an evidence base for interventions but noted that the cost and length of time required to conduct them can serve as significant barriers to roll out. Prof. Tomlinson discussed his experience with Thula Sana, a home visiting program targeted at mother-infant dyads in Khayelitsha, which underwent a RCT between 1999 and 2003. The program trained mothers in sensitive, interactive engagement with their children and recorded significant improvements in levels of attachment and sensitivity although associated reductions in maternal depression were not consistently significant.
The Thula Sana team had the opportunity to conduct a follow up study 13 years on and managed to re-enrol 74% of initial study participants. This follow up uncovered a significant improvement in maternal depression for the intervention group although whether this improvement in maternal mental health translates to improved child outcomes or not remains to be determined.
Prof. Tomlinson also discussed a RCT completed in 2013 for a book sharing program that involved 91 mother-infant dyads in Khayelitsha. This program enrolled children aged 14-18 months and encouraged mother-infant book sharing; story telling with a high element of child engagement through activities such as pointing, naming, commenting etc. The RCT uncovered significant improvements in language and attention; the improvement in the latter considered especially noteworthy with a benefit whose magnitude is roughly equivalent to 17 IQ points. Both of these interventions hold significant promise for use in the ECD space and the help of Prof. Tomlinson and his team has already been enlisted to provide book sharing training to community workers in Cameroon.
Prof. Ria Reis rounded off the presentations with an overview of the gezamenlijke inschatting zorgbehoefte (GIZ), an evaluation tool developed in the Netherlands with an emphasis on encouraging the assessment of strengths and development or care requirements in a conversational yet rigorous manner. Care professionals often frame their feedback to parents using a language and knowledge background that is unfamiliar to beneficiaries a fact that can leave much lost in translation and prove alienating to parents. The GIZ (a term which loosely translates as shared assessment of care needs) provides a visual map of important dimensions of care and an accessible, conversational protocol for discussing them with parents to assess their severity or complexity. This helps to promote a shared language between social practitioners and program participants and facilitate a more holistic assessment of the care needs of vulnerable youth.
Prof. Reis’ research suggests the tool removes the care professional’s monopoly on insight into care needs and promotes more fruitful engagement of program participants in the needs identification process. The tool has proved a success in the Netherlands with respondents suggesting its use provides an enriched care experience and there are signs that it empowers care professionals by enabling provision of tailored interventions.
The targeting of interventions was a key theme of the discussion that ensued and panelists generally agreed that initial screening tends to identify a high number of respondents that qualify for the interventions under consideration. This often renders a wider rollout infeasible despite the demonstrated need, something Prof. Andy Dawes suggests requires further refinement of needs to inform targeting whilst noting that practitioners generally appear to be moving towards ECD interventions focused within the first 1000 days. Prof. Ria Reis, building on this insight, identified the potential to employ assessments such as GIZ as screening tools in informing the targeting process but agreed that targeting can be a complicated process.
Panelists also discussed the difficulties involved in adapting tools for local use and cautioned against assuming that interventions proven in better resourced contexts can simply be extended to vulnerable areas domestically as critical success factors such as duration, quality supervision and well trained staff may prove expensive to replicate. The confluence of high demand and low resource contexts may require the piloting of what Prof.Cathy Ward alluded to as “lighter touch” programs which enable a wider initial rollout to more participants within applicable resource constraints; with the aim of eventually scaling as an evidence base accumulates.
Scaling was also identified as a critical consideration in its own right by participants who emphasized that different interventions require unique consideration of approaches to scaling but this is a matter often left unaddressed when interventions are planned. Participants agreed that scaling requires state involvement at some juncture and the development of a clear line of communication with government is important to facilitate scaling once a reasonable evidence base is accumulated.
The seminar culminated with Lizette Berry of the Children’s Institute and Camilla Swart of the Bertha Centre thanking everyone for attending and extending an invitation to engage further in future with the Bertha Centre, Children’s Institute and other stakeholders within this space to promote the use of evidence based practices in improving early childhood development outcomes in South Africa.