Parenting for Lifelong Health - Thailand

Change in frequency of physical and emotional abuse

Child maltreatment: physical and emotional abuse (self-report) Physical abuse (including abusive discipline) and emotional abuse will be measured using 20 items from an adapted and expanded version of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool-Trial Caregiver version (ICAST-T). The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-Parent version (ICAST-P), which has been used successfully in low and middle-income countries. The ICAST-T measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did you discipline \[Child Nickname\] by pushing, grabbing, or kicking him/her?"). This study will assess incidence of child maltreatment for physical abuse (13 items) and emotional abuse (7 items) by summing each individual subscale.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months)

Change in number of instances of physical and emotional abuse

Child maltreatment (physical and emotional abuse) will also be measured through the Home Observation for Measurement of the Environment (HOME) Inventory - Abusive and Harsh sub-scale. The original HOME Early Childhood and Middle Childhood Inventory Forms will be discussed and finalized by the Parenting Experts Working Group during the formative evaluation. The Abusive and Harsh sub-scale is expected to contain six items that utilize dichotomous scoring, with two items assessed via interview in the home regarding whether the parent used physical punishment or yelled at the child during the past week, and four items assessed via observation regarding whether the parent scolded or yelled; used physical restraint; hit, slapped, spanked, or kicked; and pushed, pulled, or pinched the child during the home visit.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of child maltreatment (physical and emotional abuse)

Child maltreatment: physical \& emotional abuse (self-report) Physical abuse (including abusive discipline) and emotional abuse will be measured using 20 items from an adapted and expanded version of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool-Trial Caregiver version (ICAST-T). The ICAST-T measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did you discipline \[Child Nickname\] by pushing, grabbing, or kicking him/her?"). This study will assess overall indication of previous child abuse (0 = no abuse; 1 = previous abuse), and frequency of overall abuse by summing all of the subscales.

Time frame: Differences between groups at T2 (4 months), controlling for T1 (baseline).

Change in frequency of positive parenting

Positive parenting behaviours will be assessed using the Parenting Young Children Scale (PARYC) (21 items), which measures the frequency of positive parenting (7 items), setting limits (7 items) and proactive parenting (7 items) by the parent/primary caregiver over the previous month on a 7-point Likert scale (0 = Never, 6 = Always). Items are summed to create total frequency scores for each subscale.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of dysfunctional parenting

Dysfunctional parenting behavior will be assessed using the Arnold Parenting Overreactivity subscale (PS, 10 items), which examines parent attitudes and beliefs regarding authoritarian discipline. PS responses are based on a 7-point Likert scale in which parents are presented with a situation and then are given two opposing responses at either side of the scale, with the mid-point representing neither one way or the other and the three points on either side of the mid-point representing "sometimes," "generally," and "very often" as one moves further out from the middle. One such item under this subscale is "When my child misbehaves, I raise my voice or yell…I speak to my child calmly." (7 = I raise my voice or yell; 1 = I speak to my child calmly.) Scoring for this subscale is computed by averaging the responses on these items.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of child monitoring and supervision practices

Parental monitoring and supervision practices will be measured using an adapted version of the Alabama Parenting Questionnaire (APQ) Poor Monitoring/Supervision subscale (11 items). The APQ measures parenting characteristics that have been associated with disruptive behaviour disorders in school-age children, although it has also been used with preschool children. The Poor Monitoring/Supervision subscale will be used to measure the frequency of negative parent monitoring and supervision practices over the past month through a 5-point Likert scale (0 = Never; 5 = Always). Items include "Does (the target child) stay out later than he/she is supposed to?" and "Is (the target child) left at home without adult supervision?" The items in the scale are summed to obtain a total scale score.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of child neglect

Child neglect will be assessed using an adapted version of the ICAST-T Caregiver tool (mentioned above) Neglect subscale. This subscale has 6 items for assessing medical, physical, and educational neglect, including "In the past month, how often was \[Child Nickname\] not taken care of when sick or injured, even when you or another caregiver were able to do so and could afford it?" and "In the past month, how often was \[Child Nickname\] not given a meal that he or she needed, even when you or another caregiver was able to afford it?"

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in levels of parental depression, anxiety and stress

Parental depression, anxiety, and stress will be assessed through the Depression, Anxiety, and Stress Scale short form (DASS-21) (21 items) . The DASS-21 will assess parent/primary caregiver depression and anxiety using a 4-point Likert scale \[0= Never; 3 = Always\] to measure the frequency of symptoms over the previous week. Items include statements such as "I felt that I had nothing to look forward to." Total DASS scores range from 0 to 63, with subscales from 0 to 21. The recommended cut-offs that indicate severity of depression are 5-6 (mild), 7-10 (moderate), 11-13 (severe), and 14 and up (extremely severe), while cut-offs for anxiety are 4-5 (mild), 6-7 (moderate), 8-9 (severe), and 10 and up (extremely severe). Cut-offs for stress are 8-9 (mild), 10-12 (moderate), 13-16 for (severe), and 17 and up (extremely severe).

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of child behaviour problems

For the purpose of assessing child behaviour problems by parent/primary caregiver self-report, the study will utilize the Eyberg Child Behaviour Inventory (ECBI) Intensity Scale and Problem Scale (36 items). The Intensity Scale measures the frequency of child externalizing behaviours over the past month, using a 7-point Likert-like scale (1 = Never occurs; 7 = Always occurs). Both scales are summed to create a total Intensity Score and Problem Score, with clinical cut-off scores for disruptive behaviour problems suggested as 131 for the Intensity Score and 15 for the Problem Score in the USA. However, no Thai norms are available.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in attitudes toward punishment

Attitudes toward punishment will be assessed using one item from the UNICEF Multiple Indicator Cluster Survey (MICS) 5 Child Discipline module. The MICS item asks the parent/primary caregiver: "In order to bring up, raise up, or educate a child properly, the child needs to be physically punished." Parents/primary caregivers will report whether they disagree or agree with the statement based on a 5-point Likert scale of 0 to 4 (0 = Disagree strongly; 4 = Agree strongly).

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in number of daily child behaviour problems and parenting behaviors

An adapted version of the Parent Daily Report Checklist (PDR, 44 items) will be used to assess day-to-day occurrences of child behaviour problems and parenting behaviour. In order to assess child behaviour, the PDR asks parents/primary caregivers whether a child externalizing behaviour (e.g. destructiveness, lying, hitting others) occurred within the previous 24 hours (34 items), as well as how much sleep the child had (1 item). To assess parenting behaviour, the PDR asks parents about their own behaviour (6 items, e.g. yelled or shouted at the child, praised child for doing something well) and self-efficacy (3 items, e.g. had a feeling that I could not cope with parenting). Responses to these items are dichotomous (0 = No; 1 = Yes), with items summed for each subscale on parent and child behaviour. The item regarding sleep is a numerical response.

Time frame: T1: baseline; T2: 1 month; T2: 2 months; T3: 3 months; T4: 6 months

Change in number of positive parent-child interactions

Parent-child relationships will be measured through a combination of interview and observational items (27 in total), using a combined and adapted version of the Early Childhood and Middle Childhood HOME Inventory record forms, as aforementioned. The HOME Inventory is scored dichotomously. The adapted version contains 16 items on the "responsivity" sub-scale; 6 relevant items on the "encouragement of maturity" sub-scale; 2 items on the "emotional climate" sub-scale; and 2 items on the "modelling" sub-scale.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of Intimate partner violence

Adult self-report of experiencing intimate partner violence over the past month will be assessed using an adapted version of the Revised Conflict Tactics Scale Short Form (CTS2S, 6 items). This scale includes 2 items on the frequency of negotiation (e.g., "partner suggested a compromise for a disagreement"), 5 items on physical assault (e.g., "partner pushed, shoved, or slapped me"), and 1 item on psychological aggression (e.g., "partner insulted, shouted, yelled, or swore at me"). Answers are coded on a frequency scale of 0 to 3 (0 = never happened; 1 = once or twice; 2 = 3-5 times; 3 = More than 5 times). The CTS2S will determine an overall indication of intimate partner violence on a level of severity (sum of items) and prevalence (dichotomous variable indicating experience of conflict or not), as well as for each subscale.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of attitudes towards corporal punishment

Adult report of ICAST-T Attitudes subscale (4 items). These items concern a hypothetical scenario of a child with behavioral problems, and parents report whether different disciplinary methods (e.g., "hitting or spanking the child") were effective or ineffective according to a 5-point Likert scale. Items are summed.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of parental sense of inefficacy

Parent sense of inefficacy will be assessed using an adapted version of the ICAST-Trial Inefficacy Subscale (2 items, e.g., "In the past month, how often did you not know what to do when your child misbehaved?") The items are summed for a total score ranging from 0 to 16 with higher scores indicating a greater sense of inefficacy in managing difficult child behaviour.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of intimate partner coercion

Adult report of partner coercion based on the WHO questionnaire on women's health and life events (10 items) (Garcia-Moreno, Jansen, Ellsberg, Heise, \& Watts, 2005). The WHO assesses experiences of partner coercion (e.g., "partner took your earnings or savings from you against your will"). Responses are scored on a frequency scale of 0-8, with items for each instrument summed to obtain a total score, as well as a score for the negotiation subscale.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)

Change in frequency of intimate partner negotiation

Adult report of Intimate partner violence (IPV) negotiation (2 items; e.g., "partner suggested a compromise for a disagreement"). Items are summed.

Time frame: Differences between groups at T2 (4 months) and T3 (7 months), controlling for T1 (baseline)