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The promise of parent-child education programs on improving parenting practices and reducing stress in conflict-exposed families

April 30, 2020
by Bekir Artukoglu

A Yale-led randomized controlled trial recently published its findings showing that early childhood parenting education programs have a positive impact on disciplinary practices and parenting stress for families that experience humanitarian crises such as exposure to conflict, displacement, and economic marginalization. Dr. James F. Leckman (Principal Investigator, CSC), Liliana A. Ponguta (CSC), Kaveh Khoshnood (EPH), Rima Salah (CSC), Pia Britto (CSC) and Liliya Katsovich (CSC) are among the authors of an article that was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) in early 2020. The publication investigates the effects of a group-based intervention, the Mother Child Education Program (MOCEP), on parenting stress and practices among two refugee communities and one other marginalized community in Beirut, Lebanon. MOCEP, designed by the Mother Child Education Foundation (AÇEV) in Turkey, is a 25-session group-based program, which also includes home visits by trainers, designed to foster positive parenting practices and to promote early childhood development (ECD). Several evaluations in Turkey have demonstrated the positive impacts of MOCEP on child and maternal outcomes and the intervention has been implemented in 11 countries to date, according to the paper. The recent study is the first randomized controlled trial of MOCEP, and the first time the program was implemented in a humanitarian context.

[Read the JAACAP article: Effects of the Mother−Child Education Program on parenting stress and disciplinary practices among refugee and other marginalized communities in Lebanon: A pilot randomized controlled trial.]

The authors underscored that humanitarian emergencies can have severe, negative effects on children’s developmental trajectories, with families struggling to support and provide nurturing care for their children. Quality ECD programs can ameliorate these disadvantages but current research efforts are severely lacking, they wrote.

About the MOCEP evaluation study

MOCEP was implemented among three vulnerable populations in Beirut, Lebanon, between April 2015 and April 2016. According to the JAACAP paper, this project was a collaboration among: the Arab Resource Collective (ARC) led by Dr. Ghassan Issa (Site-Principal Investigator, Beirut, Lebanon); AÇEV; Yale University; UNICEF; and the Early Childhood Peacebuilding Consortium (ECPC).

According to the authors, the components of the MOCEP curriculum are child development, the importance of play in development, parenting practices, health and hygiene, and maternal empowerment. The program includes lectures, group meetings (such as the Mother Support Program and a cognitive training program for mothers on techniques to support several child development domains), practical demonstrations, and home assignments. In the study, the authors examined whether the program led to improvements in maternal knowledge and disciplinary style, and children`s social-emotional development. They also examined possible secondary outcomes such as parenting stress, perceived social support, maternal empowerment, and mother-child dyadic interactions.

Study findings

Mothers who participated in the MOCEP reported less harsh disciplinary practices and less parenting stress, the authors wrote. Mothers who attended 14 or more sessions were also impacted positively on self-reported responsive parenting, perceived social support, individual distress, and women’s empowerment. The authors suggested that there may be a program dose-response effect. A positive impact on behavioral and emotional status of the children was not detected, according to the paper. The authors argued that these outcomes may be related to the fact that most children already had access to early childhood development and education programs or the fact that they were not followed longitudinally until at a later stage of the children’s development when impacts may manifest.

Additional study-related peer-reviewed publications

In a second study-related article, published in PLOS ONE in early 2020, authors led by Sascha Hein (Free University of Berlin) wrote that fathers can be an important source of support for mothers in resource-constrained communities affected by conflict, displacement, and marginalization. Although the MOCEP study was conducted with groups of mothers and their children, mothers’ perceptions of greater paternal involvement were significantly associated with a better sense of subjective psychological well-being and lower levels of personal distress. Mothers who reported higher levels of distress also reported lower levels of parenting stress and harsh discipline, according to the paper. The authors underscored the need for paternal involvement in such interventions.

We need to take immediate action to support these families. This requires an unprecedented coordination of services that extend well beyond online programs to address this unprecedented need.

James F. Leckman, MD, PhD (Principal Investigator)

[Read the PLOS ONE article: Maternal perceptions of father involvement among refugee and disadvantaged families in Beirut, Lebanon.]

In a third study-related article, published in New Directions for Child and Adolescent Development (NDCAD) in late 2019, authors led by Liliana Angelica Ponguta (CSC) report on an implementation evaluation on the MOCEP trial. They wrote that implementation and robust evaluations of early childhood parenting programs in fragile contexts are feasible and urgently needed. Some of their findings which may have implications for the implementation of MOCEP or similar interventions across the globe are as follows: paternal support is an enabler to program participation, mothers value skills-based programs, ensuring suitable childcare options is an important consideration to ensure fidelity of implementation in future applications, participants may already be enrolled in an ECD program or a nursery, disability in children is an issue that warrants attention in highly vulnerable contexts.

[Read the NDCAD article: Implementation Evaluation of the Mother‐Child Education Program Among Refugee and Other Vulnerable Communities in Lebanon.]

Next steps

When asked about a study follow up, Professor Leckman commented, "Sadly, during these challenging and uncertain times, the in-person ECD and parenting programs in Lebanon have been put on hold. Fortunately, the Early Childhood Development Action Network (ECDAN) is actively developing and implementing virtual-online programs parents, children, educators, administrators, child protection workers, health practitioners, and policymakers. A similar reality is affecting vulnerable families in fragile contexts across the globe. We need to take immediate action to support these families. This requires an unprecedented coordination of services that extend well beyond online programs. We are most grateful for the efforts of ECDAN and the members and partners of the ECPC to address this unprecedented need".

For more information, please visit MOCEP, an integrated approach to early childhood development in Lebanon.

Submitted by Lauren Perry on April 30, 2020