The Sinovuyo Caring Families Programme, which was developed in the Western Cape and underwent a randomised control trial (RCT) supported by Ilifa Labantwana, is now being implemented in six countries outside of South Africa.
The RCT, which ran from 2014 to 2016, showed that the programme creates positive change by equipping caregivers living in high-risk environments with parenting skills, preventing child maltreatment and improving family dynamics.
Since the RCT’s conclusion, Sinovuyo Caring Families has been implemented in South Sudan, Kenya, Uganda, the DRC, South Africa, Thailand and the Philippines, with support of Clowns Without Borders South Africa (CWBSA) – the core implementing partner of the programme as part of the Parenting for Lifelong Health (PLH) initiative. Internationally, the programme is known as PLH for Young Children (PLH for Kids).
“It has been amazing to see how well-received the programme has been in the various countries,” says Anna Booij, Technical Programme Specialist for PLH for Kids.
In South Sudan, Booij has found that facilitators and parents alike are turning into PLH for Kids ambassadors.
“Based on the changes they experience in their own families and lives, they also get their neighbours and wider communities involved in learning how to also build Beit-Salaam, a ‘house of peace’. It is very encouraging to see such a positive development in a violence-prone context like South Sudan.”
In Kenya, PLH for Kids’ partner AMPATH, has implemented an adapted version of the programme, called Malezi Mema, for mothers of children aged one to five years. The team has conducted a feasibility study and its first results have shown improvements in children’s social and emotional development, as well as strong reductions in abuse and parenting stress.
“These research results serve to further build the evidence-base of PLH for Kids and its adapted versions,” says Booij.
Adapting the programme for new environments
Certain contexts have called for adaptations to the design of the programme, which was originally madeup of 12 group sessions and home-visit follow-ups for the parents unable to attend sessions.
In Uganda, the PLH team collaborated with Catholic Relief Services/4Children to pilot and test a home-based adaptation of PLH for Kids, to support the reunification of children from residential care facilities back into their families.
“We are about to finalise the pilot and we have found that the children involved are so surprised to see what is happening to their parents, now that they communicate with them in a more positive and open way,” says Booij.
“It took two or three sessions for the parents to get used to the non-didactic interactive approach of the parenting programme, but they are looking forward to their sessions every week now and are reporting positive changes in their families. While the trauma that children often experience during institutionalisation needs to be taken into account, the benefits of basic parenting strategies like one-on-one time and positive instruction giving become clear in this setting as well.”
The first results of the project’s RCT will be available next year.
Another adaptation is a shorter version of PLH for Kids, made up of six sessions. In the coming months, this adaptation will be implemented by the PATCH Child Abuse Centre in the Helderberg area of the Western Cape, with support from the DG Murray Trust. In addition to the six group sessions, this programme includes two structured home visits to increase support to parents.
PLH for Kids has also collaborated with Unicef to create an adaptation for the Philippines and Thailand, which will be followed by a feasibility study and RCT of its own.
Challenges of global roll-out
“In our global roll-out, we are continuously exploring with our partners how we can best overcome challenges to ensure that we reach the targeted beneficiaries through high-quality programme delivery,” says Booij.
“Every context has its unique prerequisites and challenges depending on who delivers the programme (government staff or community volunteers), where the programme is delivered (in remote villages or urban neighbourhoods), who the target population is (vulnerable households, people living with HIV/AIDS), who funds the programme, and so forth. It requires a lot of creative thinking and ad hoc problem solving to reach set targets and support family strengthening in a structured way. But, like with the initial implementation in the Cape, PLH for Kids has great potential to change the lives of children and families, and get both project staff and beneficiaries committed to making it work.”
“Guaranteeing quality programme delivery can be difficult because coaching and skills assessments are mainly done remotely via Skype and videos, and often involves multiple local languages,” she adds.
“We have managed to improve quality control by doing skills assessment through video or in-person observations. These help identify the strengths and challenges of facilitators in the various projects and allow for targeted coaching where needed,” says Booij.
To further overcome quality control issues with larger scale-up projects, PLH aims to build the capacity of a small core team within their partner organisations during the initial phases of the project.
“This core team can master PLH for Kids with intensive support from our trainers, and once certified as coaches and trainers, they can then continue to safeguard the quality and fidelity of the programme delivery with our remote support. If a strong foundation is not established, it is hard to monitor what is happening on the ground,” says Booij.
Booij’s team has already trained such a core team in Kinshasa, DRC – an important milestone.
The programme is delivered to communities by local volunteers and paraprofessionals, who have an intrinsic understanding of the local context. By modelling joint problem-solving as a core programme skill, staff and participants are encouraged to come up with and try out locally appropriate solutions for challenges that may arise.
Prior to programme delivery, it is essential to invest in implementation readiness reflections to ensure adequate recruitment, budgeting, monitoring and evaluation, and feasible timelines. Along with programme adaptations in terms of language revisions, redesign of illustrations, inclusion of local stories and songs, this preparation ensures that the content and approaches of the programme are accessible and acceptable to targeted families.
Establishing a core team of trainers for scale-up projects enables the development of sustainable in-country capacity, and helps to overcome logistical challenges of observing sessions or acquiring quality videos in a language spoken by trainers, she adds.
Lastly, the PLH team is exploring the possibility of a mobile application to strengthen fidelity and quality delivery of PLH for Kids across the globe.
“A key question that we often run into when implementing PLH for Kids is how the programme can be most effective, economic, and scalable. We have had an exciting new opportunity to once again answer this question in relation to more contexts,” says Booij.
CWBSA Executive Director and PLH research team member, Dr. Jamie Lachman, has received a prestigious research grant to adapt, deliver and test PLH for Kids in various formats in Eastern Europe over the next four years. The aim of this project is to identify what programme components are most effective and how the programme could be delivered at scale in the most cost-effective way.
“This research on scalability is an important step, as it allows us to learn how we can help strengthen as many families as possible in the most efficient way, which opens doors for further integration into existing service delivery structures at scale.”
“It is very interesting to be able to combine the high demand for parenting programmes from implementers and service providers worldwide, with research to strengthen the evidence-base of our parenting programmes in various contexts and with specific target populations.”
“It would be wonderful to engage in further optimisation work to see how PLH for Kids can be delivered at scale in South Africa as well.”