Child maltreatment—a serious public health problem—is a global phenomenon. Parenting programs are considered effective approaches to preventing child maltreatment; however, comprehensive understanding is still lacking of the effectiveness of such programs in all areas of outcomes and the way parenting programs work. This thesis consists of two parts: a quantitative synthesis of high-level evidence about program effects and a qualitative integration of program process. The thesis employs two research methods: meta-analytic review and systematic review. I searched 11 electronic databases to identify studies published between 2000 and 2012. Forty-two studies meeting the eligibility criteria were included in the systematic review, and 21 of these were included in the meta-analysis. The total random effect size was 0.338. The research found that parenting programs successfully reduced substantiated child maltreatment reports. The programs also reduced risk factors and enhanced protective factors associated with child maltreatment. However, program effects began to decrease in the first year after program completion. Parenting programs function by remediating parental cognition, thus changing parenting behaviors and enhancing parent-child relationships. The successful program components include teaching child-rearing knowledge, improving parenting skills and changing parents’ inappropriate attitudes towards children. Parenting programs are demonstrated to be effective public health approaches to avoiding child maltreatment. Parenting programs could produce positive effects in both low- and middle-income countries, as well as high-income countries. The study recommends a longer-term intervention beginning prenatally or at an early age of the children and involving more male caregivers. The evidence-based service of parenting programs could be widely adopted in future practices. The research also indicates that parenting programs could be applicable within the Chinese context, where such programs have not been widely used to date. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

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The main aim of this research was to identify a family support programme which could be used as a primary prevention strategy against child abuse as a first positive step within the family, the basic unit of society, towards reducing community violence. The central focus of this intervention was that it should be appropriate for use in a multi-ethnic South African context and implementable by community health nurses or related lay health personnel with minimal training. No such programme was identified. The researcher attempted to integrate the most appropriate and scientifically substantiated features of existing programmes and develop a unique South African programme. This programme was developed and tested in a participatory manner with multiethnic communities. Community health nurse facilitators were trained and evaluated and the developed programme was then implemented by these facilitators in several sites. The influences of the developed programme were extensively evaluated. Changes in attitudes, feelings and behaviour of the child, the mother, the maternal-child interaction and the family system were explored. A quasi-experimental design with pre and post testing of the experimental group and two control groups (control 1 received social support and control 2 receiving routine clinic nursing only) was utilized. Completed analysis has yielded some exciting and provocative results. There are clear differences in each of the groups attitudes to their children. On the Mother-Child Relationship Evaluation (MCRE) positive gains in maternal-child relationship were established for the experimental group and this was greater than that of both controls (t-test = 4.151 @ alpha = 0.0013; H=4.0734 @ alpha = 0.04 and F=7.031 @ alpha = 0.0004). On the Family Assessment Device (FAD) some limited changes were observed in the experimental group over the controls (F= 3 .33 @ alpha = 0.05). This is a positive outcome indicating that the family support programme evidenced significant changes in the participants relationships with their children and in their families and wider social life. Mothers and facilitators qualitative feedback reported positive interaction with young and older children and changed maternal and child attitude and behaviour. Despite the critical shortage of staff in community health settings facilitators continue to implement the programme voluntarily in their service settings. / Thesis (Ph.D.)-University of Natal, Durban, 1995.

Clients involved with child protection systems due to issues of neglect are known to have multiple needs. The issues that they confront are personal, situational, and social in nature. The emphasis on risk reduction in many jurisdictions within North America has meant that needs have been given less priority. The aim of the exploratory study was to gain a better understanding of both the nature of needs and risks in cases of child neglect in Ontario, as well as the similarities and differences in the views of clients and child protection workers. It is posited that through the acquisition of knowledge in those areas, that improvements can be made in assessing and planning, in creating agreed upon expectations about the objectives of intervention, and in developing a better balance between the addressing of needs and risks. / For the study, an instrument was designed to measure client perceptions of their problems and needs. It was compared with workers' perceptions of risk as contained in the risk assessment instrument completed by all child protection workers in Ontario. The Client Perception of Problems and Needs Scale was administered to 77 parents receiving services from Family and Children's Services of Renfrew County due to concerns about child neglect. / The finding that participants felt their needs were greatest in dealing with issues of stress, child behaviour and mental health issues, and in coping with socio-economic disadvantage was congruent with the few studies that have been conducted on the perceptions of child protection clients about their needs and problems. The analysis of the risk assessment data provided evidence that reliance on risk reduction at the expense of needs-based approaches, is not warranted. Few similarities were found in the perceptions of clients and workers about the issues of greatest concern. However, it was surprising that few concerns emerged about the clients' living conditions, or the affective interaction between clients and their children. Finally, the study demonstrated that the participants were able to recognize their problems, used various coping strategies for dealing with them, and were able to articulate strengths and resources on which they relied.

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Indiana University-Purdue University Indianapolis (IUPUI) / Child abuse remains a serious health problem in the U.S. Yet, there are preventative programs that can significantly improve the parenting experienced by very young children and result in lower incidence of maltreatment. Home visitation is the most prevalent and successful form of primary prevention. These programs are staffed by home visitors who empower parents and are the lynchpin of home visitation programs. What makes some home visitors excel at this work is the focus of this research. A small, non-random, purposive sample of excellent home visitors and their administrators was used to learn about the personal characteristics of outstanding home visitors. The mixed methods design of this research included qualitative interviews, home visiting situational vignettes, and quantitative tests of personality attributes. The results indicated that this group of outstanding home visitors possessed important similarities. First, the home visitors were effective at forming and maintaining empathic relationships. The variables that facilitate the formation of the therapeutic relationships between home visitor and client include: (a) “good enough empathy” (need not be extraordinarily empathic but at least averagely so), (b) positive regard (showing respect to the families and recognizing that the parent is the expert on their child), and (c) congruence. Secondly, the home visitors possessed self-awareness allowing for reflective practice and forming and maintaining better client relationships. Thirdly, the excellent home visitors possessed an attitude of lifelong learning. Fourthly, the home visitors strongly believed in the ability of their clients to change. This was accomplished by focusing on client strengths. Finally, in order for the home visitors to assist parents in therapeutic change, they had a belief in and understanding of systems theory and the impact that the environment can or has had on those clients. Without an ecological approach, home visitors are likely to blame the families with which they work for their unfortunate situations such as poverty. Each of the five characteristics can be taught and improved, but entrenched beliefs are less easily manipulated. The five characteristics are ordered with the first (effective at forming relationships) the most amenable to change and the last (an ecological approach) the least.

With the increase in survival for children with cancer, part of the focus of current research is aimed towards evaluating how these children are adapting psychosocially. Neurocognitive deficits have been well established. However, there are multiple facets encompassing quality of life, including general mental health, lifestyles and health behaviors, and academic and cognitive functioning. The relationship between neurocognitive and psychosocial functioning has yet to be thoroughly evaluated. The purpose of this study was to investigate the relationship between neurocognitive and psychosocial functioning in survivors of brain tumors and acute lymphoblastic leukemia. Data was collected from existing archival database comprised of patients of the at Cook Children's Medical Center in Texas. The sample consisted of 177 patients between the ages of 3 and 12 who were at least two years post-diagnosis. Measures used included the NEPSY and the Behavioral Assessment for Children. Statistical analyses included a several one-way analysis of variances, an independent samples t-test, a univariate analysis of variance, a hierarchical multiple regression, and odds ratio analyses. Results indicated survivors treated with neurosurgery alone appear to be less at risk for developing behavior problems than other treatment modalities. Also, brain tumor survivors demonstrate more problematic behaviors than survivors of acute lymphoblastic leukemia. Visuospatial functioning, diagnosis, and type of treatment were found to be predictive variables of behavior problems. Attention, and perhaps language, deficits may predispose children to more problems in their behavior. It is concluded that there are other factors affecting behavior in this population that were not accounted for in this analysis. It is recommended for future studies to research the individual clinical scales of the Behavior Assessment System for Children, obtain information from multiple informants, study this relationship longitudinally, and research additional factors that may be influencing the relationship between neurocognitive and psychosocial functioning. This provides evidence of risk factors that should be monitored as the child returns home and to school.

This dissertation includes three papers that examine the role of antipoverty policies and programs in preventing child maltreatment. Paper one examines how access to Medicaid impacts child maltreatment as characterized by Child Protective Services (CPS) reports. Paper two considers how access to Early Childhood Education and Care (ECEC) programs affects child welfare involvement. Paper three assesses the relationship between temperature and CPS reporting, looking to air conditioning and state LIHEAP cooling policies as a potential source of mitigation.

Background: In high-income countries, parenting programmes have been shown to be effective in reducing the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. This thesis focuses on the development and pilot randomised controlled trial (RCT) of a parenting programme to reduce the risk of child maltreatment in low-income families with young children in Cape Town, South Africa. Methods: This thesis is comprised of three studies submitted as papers for publication. The first study focused on the development of an evidence-informed, locally relevant parenting programme for families with children aged three to eight years in Cape Town, South Africa. Intervention development took place over three stages: (a) identification of core intervention components common in evidence-based parenting programmes; (b) formative evaluation using qualitative in-depth interviews and semi-structured focus groups with South African practitioners and low-income parents; and (c) integration of evidence-based approaches and local contextual issues to develop the intervention structure, protocols, and manual. The second study used a pilot RCT (N = 68 parent-child dyads) to examine the evaluation feasibility and initial effects of the parenting programme developed during the first study in Cape Town - the Sinovuyo Caring Families Programme. Parents of children aged three to eight years with clinical levels of parent-reported child behaviour problems were randomly allocated to either a 12-session, group-based parenting programme or a wait-list control group. Primary outcomes included parent-report and observational assessments of positive parenting, harsh parenting, and child behaviour problems; secondary outcomes included parent-report of parent depression, parenting stress, and social support. Assessments occurred at baseline and immediate post-test (i.e., 3-months after baseline). The third study was a mixed-methods process evaluation assessing the feasibility of the parenting programme based on three theoretical dimensions: participation, implementation, and acceptability. Quantitative data included attendance registers, fidelity checklists, satisfaction surveys, and parent-report of engagement in home practice activities. Qualitative data included post-programme focus groups with community facilitators (n = 8), individual interviews with a randomly selected group of parents (n = 15), transcripts from parenting sessions, and minutes from supervision sessions with facilitators. Results: In the first study, the formative evaluation suggested that many evidence-based parenting programme components and approaches were compatible with the local cultural context. These included managing child behaviour problems, learning effective discipline strategies, building positive parent-child relationships, and reducing parenting stress. Findings also suggested that programmes may benefit from including additional content on keeping children safe in violent communities, communicating about HIV/AIDS and poverty, involving fathers and alternative caregivers, and incorporating cultural values of social responsibility and respect. The pilot RCT in the second study showed high levels of study recruitment and retention, outcome measurement reliability and response rates, and a minimal effect of clustering due to delivering the intervention in groups of parents. Analyses showed moderate intervention effects for parent-report of increased positive parenting and observations of improved child-led play. However, observational assessments also found reduced frequency of positive child behaviour in the treatment group in comparison to controls. In the third study, quantitative results showed high levels of programme acceptability, implementation, and participation. Thematic analysis of qualitative data identified seven themes related to feasibility: (a) receptivity to strengthening existing parenting practices, (b) initial resistance to new parenting skills, (c) contextualising content within a cultural framework, (d) reinforcing implementation fidelity and improving quality of delivery, (e) challenges delivering content on nonviolent discipline, (f) supporting participant involvement, and (g) engagement in a collaborative learning approach. Conclusion: This thesis is the first in sub-Saharan Africa to use a systematic approach to develop and rigorously pilot a parenting programme to reduce the risk of maltreatment against young children in low-resource settings. Initial results indicate that a parenting programme derived from evidence-based approaches is feasible, culturally acceptable, and has the potential to reduce the risk of child maltreatment by improving positive parenting behaviour. Further intervention development and testing is necessary to strengthen core programme components and determine programme effectiveness.

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