Parents make the difference: a randomized-controlled trial of a parenting intervention in Liberia.


BACKGROUND: The objective of this study was to evaluate the impact of a brief parenting intervention, 'Parents Make the Difference'(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia. METHODS: A sample of 270 caregivers of children ages 3-7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at (NCT01829815). RESULTS: The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices (p < 0.001). The program also increased the use of positive behavior management strategies and improved caregiver-child interactions. The average caregiver in the treatment group reported a 4.4% increase in positive interactions (p < 0.05), while the average child of a caregiver assigned to the treatment group reported a 17.5% increase (p < 0.01). The program did not have a measurable impact on child wellbeing, cognitive skills, or household adoption of malaria prevention behaviors. CONCLUSIONS: PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.





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Publication Info

Puffer, ES, EP Green, RM Chase, AL Sim, J Zayzay, E Friis, E Garcia-Rolland, L Boone, et al. (2015). Parents make the difference: a randomized-controlled trial of a parenting intervention in Liberia. Glob Ment Health (Camb), 2. p. e15. 10.1017/gmh.2015.12 Retrieved from

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Eve S. Puffer

Pamela and Jack Egan Associate Professor

Dr. Puffer is a global mental health researcher and a licensed clinical psychologist. Her research focuses on developing and evaluating integrated community-based interventions to promote child mental health, improve family functioning, and prevent HIV risk behavior. Her work includes studies with families with young children through those with adolescents, as well as with couples. She has conducted much of this work in rural Kenya and is an investigator on multiple studies of child mental health, family well-being, and parenting interventions in Thailand, Ethiopia, Liberia, South Sudan, and Iraq.

Among Dr. Puffer's primary collaborators are the International Rescue Committee, a humanitarian organization, the Women's Institute for Secondary Education and Research in Kenya, and AMPATH, a consortium between North American medical schools and Moi University in Kenya.

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