Bake -Henningham, Helen; F ancis, Taja; Bowe s, Ma sha
Wo king Pape
A mixed-me hod easibili y ial o an ea ly childhood,
iolence p e en ion, pa en ing p og am in eg a ed in o
p eschool p o ision in Jamaica
IDB Wo king Pape Se ies, No. IDB-WP-1703
P o ided in Coope a ion wi h:
In e -Ame ican De elopmen Bank (IDB), Washing on, DC
Sugges ed Ci a ion: Bake -Henningham, Helen; F ancis, Taja; Bowe s, Ma sha (2025) : A mixed-
me hod easibili y ial o an ea ly childhood, iolence p e en ion, pa en ing p og am in eg a ed
in o p eschool p o ision in Jamaica, IDB Wo king Pape Se ies, No. IDB-WP-1703, In e -Ame ican
De elopmen Bank (IDB), Washing on, DC,
h ps://doi.o g/10.18235/0013518
This Ve sion is a ailable a :
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A
Mixed-me hod Feasibili y T ial o an Ea ly
Childhood, Violence P e en ion, Pa en ing
P og am In eg a ed in o P eschool P o ision
in Jamaica
Helen Bake -Henningham
Taja F ancis
Ma sha Bowe s
WORKING PAPER No IDB-WP-1703
In e -
A
me ican De elopmen Bank
Gende and Di e si y Di ision
May 2025
* Ca ibbean Ins i u e o Heal h Resea ch (CAIHR), Uni e si y o he Wes Indies
(UWI), and Bango Uni e si y
** CAIHR, UWI
A
Mixed-me hod Feasibili y T ial o an Ea ly
Childhood, Violence P e en ion, Pa en ing
P og am In eg a ed in o P eschool P o ision
in Jamaica
Helen Bake -Henningham*
Taja F ancis**
Ma sha Bowe s**
In e -
A
me ican De elopmen Bank
Gende and Di e si y Di ision
May 2025
Ca aloging-in-Publica ion da a p o ided by he
In e -Ame ican De elopmen Bank
Felipe He e a Lib a y
Bake -Henningham, Helen.
A mixed-me hod easibili y ial o an ea ly childhood, iolence p e en ion,
pa en ing p og am in eg a ed in o p eschool p o ision in Jamaica / Helen
Bake -Henningham, Taja F ancis, Ma sha Bowe s.
p. cm. — (IDB Wo king Pape Se ies ; 1703)
Includes bibliog aphical e e ences.
1. Violence-P e en ion-Jamaica. 2. Ea ly childhood educa ion-Jamaica. 3.
Child en and iolence-Jamaica. 4. Child abuse-P e en ion-Jamaica. I. Taja,
F ancis. II. Bowe s, Ma sha. III. In e -Ame ican De elopmen Bank. Gende
and Di e si y Di ision. IV. Ti le. V. Se ies.
IDB-WP-1703
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Abs ac *
We adap ed a iolence-p e en ion, pa en ing p og am ( he I ie Homes Toolbox, o
IHT) o in eg a ion in o Jamaican p eschool se ices. The adap ed IHT was
e alua ed in a mixed-me hod easibili y ial in Kings on, Jamaica. Twen y- ou
p eschools we e andomly assigned o in e en ion (n=12) o wai -lis con ol
(n=12). Ten ca egi e s pe school we e ec ui ed (n=240, n=120/g oup). The
p og am consis ed o ele en 1-hou pa en ing sessions deli e ed by a p eschool
eache wi h g oups o en ca egi e s o child en aged 2-6 yea s. In he impac
e alua ion, he p ima y ou come was ca egi e s’ use o iolence agains hei child
(VAC). Seconda y ou comes we e ca egi e s’ in ol emen wi h hei child, a i ude
o VAC, p e e ences o ha sh punishmen , sel -e icacy, and child conduc
p oblems. All ou comes we e measu ed by ca egi e - epo , and we es o and
ind no e idence o social desi abili y bias. We measu ed ideli y o implemen a ion
on an ongoing basis. We also conduc ed in-dep h in e iews wi h pa icipa ing
eache s and kep ongoing logs on in e en ion implemen a ion. Pa icipan s
a ended a mean (SD)=4.0(3.1) sessions. The IHT in e en ion led o educ ions in
ca egi e s’ use o VAC (ES=-0.22, p=0.04) and ca egi e s’ a o able a i udes o
VAC (ES=-0.36, p=0.01), and inc eases in ca egi e s’ in ol emen wi h hei child
(ES=0.30, p=0.005) and pa en ing sel -e icacy (ES=0.29, p=0.02). Reduc ions in
ca egi e p e e ences o ha sh punishmen we e signi ican a p=0.07 (ES=-0.21).
We ound no bene i s o child conduc p oblems. Th ough obse a ions o session
quali y, in e iews wi h p eschool eache s, and esea ch eam logs, we iden i ied
enable s and ba ie s o in e en ion implemen a ion and sugges ions o
imp o emen . The p og am has po en ial o la ge-scale dissemina ion o educe
VAC in Jamaica.
JEL classi ica ions: I10, I20, J12, J13
Keywo ds: Violence p e en ion, Violence agains child en, P eschool, Pa en ing
in e en ion
* Acknowledgemen s: The s udy was unded h ough GDLab, he Gende and Di e si y Knowledge Ini ia i e o he
In e -Ame ican De elopmen Bank. We hank he ad iso y boa d o hei suppo and o hei use ul commen s and
eedback. Special hanks o he ad iso s Ambe Pe e man and And és Moya o hei de ailed e iews o he wo king
pape . We also hank he p eschool eache s and ca egi e s who pa icipa ed in he s udy and he esea ch assis an s
o da a collec ion.
2
1. In oduc ion
Violence agains child en (VAC) is a global public heal h p oblem wi h high p e alence ac oss
La in Ame ica and he Ca ibbean (LAC), whe e wo- hi ds o child en aged 2 o 14 yea s
expe ience iolen discipline a home (UNICEF, 2022). Jamaica anks hi d highes ac oss he LAC
egion in e ms o VAC (Hai i and Su iname ank i s and second) (UNICEF, 2022). E idence
om me a-analyses show ha ca egi e - aining in e en ions in he ea ly childhood yea s ha e
po en ial o educe child mal ea men (Chen and Chan, 2015; Vlaho ico a e al., 2017), wi h some
e idence o sus ained e ec s o e he sho e m, albei wi h diminished e ec s (Backhaus e al.,
2023). The e is also g owing e idence om low- and middle-income coun ies (LMIC) ha
ca egi e aining p og ams can be e ec i e in educing VAC (Wang and Zhang, 2024), including
in he LAC egion (Mejía e al., 2015; San ini and Williams, 2017; Ska e al., 2017; Al a im and
Linha es, 2019). Howe e , ew e idence-based pa en ing p og ams ha e been implemen ed a
scale (B i o e al., 2018; Sande s e al., 2022). To maximize scalabili y and sus ainabili y,
e idence-based in e en ions need o be in eg a ed in o exis ing go e nmen se ices and be
deli e ed by exis ing s a .
We ha e p e iously de eloped an ea ly childhood, iolence p e en ion, pa en ing p og am
in Jamaica, he I ie Homes Toolbox (IHT). The IHT a ge s ca egi e s o child en aged 2 o 6 yea s
and includes con en on p omo ing child posi i e beha io , p e en ing child nega i e beha io ,
helping child en unde s and hei emo ions, p omo ing ca egi e emo ional sel - egula ion, and
managing child misbeha io . In p e ious ials, we ha e shown ha he IHT is e ec i e a educing
VAC by ca egi e s when deli e ed h ough in-pe son and h ough i ual modali ies (F ancis and
Bake -Henningham, 2021; Dina e-Díaz e al., 2023). The challenge now is o implemen he
p og am on a wide scale and o achie e his aim, we need o in es iga e how o in eg a e he IHT
in o he Jamaican ea ly childhood educa ional ne wo k and how i can be deli e ed by p eschool
eache s as pa o hei ou ine du ies (Bake -Henningham, Bowe s, and F ancis, 2023).
In his pape , we epo on a mixed-me hod easibili y s udy o he IHT p og am when
deli e ed by p eschool eache s. The e alua ion included an ongoing p ocess e alua ion, an impac
e alua ion, and a quali a i e in es iga ion o he IHT p og am. In he s udy, wen y- ou
communi y p eschools we e andomized o an in e en ion g oup (n=12 p eschools) o a wai -lis
con ol g oup (n=12 p eschools). We ec ui ed 10 pa en s in each p eschool o pa icipa e in he
in e en ion (n=120 pa en s/g oup). Two eache s in each in e en ion p eschool we e ained o
3
deli e he IHT sessions. The p og am was deli e ed h ough ele en, weekly, 1-hou g oup
sessions, wi h g oups o en ca egi e s. Pa icipan s we e also sen ma e ials, messages and sho
ideos ia Wha sApp be ween sessions (F ancis, Bowe s, and Bake -Henningham, 2025). In he
p ocess e alua ion, we measu ed ca egi e a endance, p eschool eache compliance, and he
quali y o implemen a ion. In he impac e alua ion, we examined he e ec i eness o he IHT in
educing ca egi e s’ use o VAC. We also measu ed impac s om he IHT o ca egi e
in ol emen , a i udes o VAC, p e e ences o ha sh punishmen , pa en ing sel -e icacy, and
child conduc p oblems. In he quali a i e in es iga ion, we in es iga ed he enable s and ba ie s
o implemen a ion and sugges ions o imp o emen om he pe spec i e o he p eschool eache s
and he esea ch eam.
Ca egi e s a ended a mean (SD) o 4.0 (3.8) sessions. Ac oss he wel e schools alloca ed
o in e en ion, eache s deli e ed a mean (SD) o 10.1 (1.2) sessions. Obse a ions o session
quali y indica ed ha eache s adhe ed o he session sc ip s, o med posi i e ela ionships wi h
pa icipan s, engaged pa icipan s well, used clea demons a ions and ga e all pa icipan s he
oppo uni y o p ac ice. Weaknesses included inadequa e p epa a ion, no highligh ing key poin s,
and insu icien suppo and eedback o pa icipan s du ing p ac ice ac i i ies. In en ion o ea
es ima es indica e ha he in e en ion educed VAC by ca egi e s by 0.22 SD (p=0.04).
Ca egi e s in he in e en ion g oup also inc eased hei in ol emen wi h hei child by 0.30 SD
(p=0.005), epo ed less a o able a i udes o VAC by 0.36 SD (p=0.01) and inc eased pa en ing
sel -e icacy by 0.29 SD, (p=0.02). Ca egi e epo s o p e e ences o ha sh punishmen educed
by 0.21 SD (p=0.07). No educ ions we e iden i ied o ca egi e epo s o child conduc p oblems
(e ec size=-0.06 SD, p=0.49). As he ou comes we e measu ed h ough ca egi e sel - epo , we
add essed expe imen e demand e ec s by examining he e ec o ea men on a social
desi abili y index (SDI) ha measu ed pa icipan s’ p opensi y o espond in a socially accep able
way. The e was no di e ence in SDI ac oss ea men g oups. In addi ion, con olling o SDI in
he mul ile el eg ession analyses did no impac he magni ude o signi icance o he impac s.
The e was also no e idence o he e ogeneous e ec s o SDI ac oss ea men g oups o any o he
ou come measu es.
Key enable s o implemen a ion om he pe spec i e o he eache s and he esea ch eam
we e ha eache s we e e y posi i e abou he IHT p og am, alued he ma e ials used, we e
mo i a ed o conduc he sessions and had good ela ionships wi h ca egi e s. Teache s epo ed
4
bene i s o hei p o essional and pe sonal de elopmen , and o ca egi e s’ knowledge and
beha io . Key ba ie s o implemen a ion we e eache s’ di icul ies in using highe -o de
acili a o skills in session deli e y and poo ca egi e a endance. The skills ha we e di icul o
eache s included e lec i e lis ening, dealing wi h esis ance, engaging pa icipan s in
collabo a i e p oblem-sol ing, and add essing ca egi e s’ a o able a i udes owa d VAC
(especially as some eache s also had posi i e a i udes owa d VAC). Teache s we e also o en
insu icien ly p epa ed o conduc he sessions. One sugges ion o imp o emen was o gi e all
eache s in he school a ole in he IHT p og am o embed he in e en ion mo e e ec i ely in o
he school cul u e. Fo example, o he eache s could help wi h ca egi e ec ui men and
engagemen and wi h p omo ing he s a egies wi h ca egi e s o child en in hei class du ing hei
egula in e ac ions wi h ca egi e s. Some eache s sugges ed sho ening he p og am and/o
al e ing session equency o make i mo e easible o i in o he school e mly ime able. The
esea ch eam iden i ied a need o mo e aining o eache s o ensu e ha hey belie ed in and
we e compe en in using he s a egies hemsel es, and o be e equip hem in add essing ca egi e
esis ance and esponding o que ies. The o e all objec i e o he s udy was o p epa e he IHT o
implemen a ion a scale.
In his s udy, we ound ha he IHT was e ec i e a educing ca egi e s’ use o VAC when
deli e ed by p eschool eache s and he eache s alued he p og am and showed high compliance
in conduc ing sessions. This gi es us con idence ha he p og am has po en ial o wide
dissemina ion wi hin he ea ly childhood educa ional ne wo k. Conduc ing a easibili y s udy has
p o ided he oppo uni y o iden i y implemen a ion p oblems p io o implemen ing he p og am
on a la ge scale. We will use he indings om his s udy o in o m u he e isions o he IHT
p og am and o de elop aining, supe ision, and moni o ing ools o p omo e he ideli y o
in e en ion implemen a ion when implemen ed on a la ge scale.
2. Li e a u e Re iew
Globally, o e one billion child en a e a ec ed by iolence each yea (Hillis e al., 2016). Violence
agains child en (VAC) is a iola ion o child igh s, has high p e alence in low- and middle-
income coun ies (LMICs), is associa ed wi h long- e m nega i e e ec s on child unc ioning, and
wi h high economic and social cos s (McCoy e al., 2022; Cua as e al., 2019; Hillis e al., 2017;
Heilmann e al., 2021; Pe enie o e al., 2014). In Jamaica, 84% o ca egi e s o child en aged 2-4
5
yea s epo using physical iolence, and 71% epo using psychological agg ession
demons a ing an u gen need o iolence-p e en ion p og amming (Lans o d and Dea e -
Decka d, 2012). This need has been ecognized a he na ional le el, as Jamaica is a pa h inde
coun y in he Global Pa ne ship o End Violence Agains Child en and he go e nmen has
launched “The Na ional Plan o Ac ion o an In eg a ed Response o Child en and Violence”
(Go e nmen o Jamaica, 2018). To espond o he need o iolence-p e en ion p og amming, we
ha e de eloped and e alua ed wo complemen a y ea ly childhood p og ams: i) o educe eache s’
use o VAC a school: he I ie Class oom Toolbox (Bake - Henningham, 2018; Bake -Henningham
e al., 2019; Bake -Henningham e al., 2021; Bowe s, F ancis and Bake -Henningham, 2022), and
ii) o educe ca egi e s’ use o VAC a home: he I ie Homes Toolbox (IHT) (F ancis and Bake -
Henningham, 2020; F ancis and Bake -Henningham, 2021; Dina e-Díaz e al., 2023; F ancis e
al., 2024). I ie is a Jamaican e m ha means “good” and “a peace wi h onesel and he wo ld.”
The p og ams a ge ca egi e s o child en aged wo o eigh yea s, and he aim is o educe VAC
a he popula ion le el by in eg a ing hese p og ams in o he ea ly childhood educa ional ne wo k.
We ha e been wo king wi h he Ea ly Childhood Commission (ECC) in Jamaica o
scale up he I ie Class oom Toolbox. The ECC is an agency o he Minis y o Educa ion ha has
o e sigh o all ea ly childhood ins i u ions and coo dina es all ac i i ies wi hin he ea ly
childhood sec o . The IHT was de eloped as a complemen a y p og am o he I ie Class oom
Toolbox o p omo e consis en beha io managemen s a egies by bo h eache s and pa en s. The
nex s ep is o also begin o scale up he IHT.
The IHT was speci ically designed o be easible, ele an , e ec i e, and scalable in he
Jamaican con ex (F ancis and Bake -Henningham, 2020). The con en o he IHT includes co e
componen s o e idence-based, iolence-p e en ion pa en ing p og ams ope a ionalized o he
Jamaican con ex . These co e componen s add ess he p oximal d i e s o VAC including
ca egi e s’ knowledge, a i udes, and skills ela ing o posi i e and non- iolen pa en ing,
ca egi e emo ional sel - egula ion, and ca egi e sel -e icacy. Violence is a complex,
mul idimensional p oblem wi h d i e s a he le el o indi idual (e.g., child age and beha io ),
ca egi e (e.g., educa ion, exposu e o ad e si y), household (e.g., in e pe sonal iolence, po e y,
numbe o child en), communi y (e.g., communi y iolence), and socie al (e.g., social no ms)
le els. Howe e , hese dis al d i e s equi e a mul i-sec o al app oach o iolence p e en ion, as
12
Panel 1 (con inued)
In e en ion Ma e ials o Facili a o s: Ma e ials o conduc he pa en ing sessions included: i) a
ully-sc ip ed manual con aining a sc ip o each session, ii
) isual aids used o in oduce and
p ac ice s a egies and o help pa icipan s unde s and child misbeha io s, iii) hand-held cha s wi h
key poin s o ein o ce he s a egies in oduced, i ) a pic u e
o he I ie Towe : a pic o ial
ep esen a ion o he s a egies in oduced in he p og am, ) pic u e books and low-cos , shop-
bough oys o p ac ice I ie Time, and i) phone ca ds wi h US$3.50 c edi pe week o acili a e
eache s’ communica ion wi h ca egi e s. Ma e ials o he school-wide elemen included: i
) a
weekly pos e o be placed on he school in o ma ion boa d wi h de ails o he I ie s a egy o he
week, and ii) a weekly guide o all eache s in he school on how o engage ca egi e s in he I ie
s a egy o he week
In e en ion Ma e ials o Ca egi e s En olled in Pa en ing Sessions: included: i) a homewo k
eco d o m (I ie Challenge) o each session o encou age pa icipan s o use he s a egies a home,
ii) h ee small pic u e books o pa en s o use wi h hei child du ing I ie Time, and iii) an I ie Pa en
Oa h ha each pa icipan signs on comple ion o he p og am o commi o con inued use o he
s a egies. Ca egi e s we e also p o ided wi h a small snack (juice and peanu s) a e each session.
Who p o ided: Two p eschool eache s wi hin each school we e ained o deli e he IHT sessions.
The eache s we e gi en au onomy in how o o ganize he sessions, wi h some eache s choosing o
ha e a “lead” eache aking p ima y esponsibili y o he sessions, some eache s aking i in u ns
o deli e sessions and some deli e ing he sessions oge he . P eschool eache s we e ained and
supe ised by wo membe s o he I ie Toolbox eam (TF and MB).
Whe e: The pa en aining sessions we e held on he p eschool compound. Teache - aining
wo kshops we e conduc ed in a cen ally loca ed communi y p eschool.
When and How Much: Pa en ing sessions we e held ei he a he beginning o he school day (when
ca egi e s we e d opping o hei child a school) o a e school (when ca egi e s came o pick up
hei child). The sessions we e held once a week, o up o 11 weeks, and each session las ed
app oxima ely one hou . Teache s we e o be ained in a 2-day ini ial wo kshop acili a ed by wo
membe s o he I ie Toolbox Team (TF and MB) in g oups o 12 eache s, and o ecei e o nigh ly
suppo om he wo membe s o he I ie Toolbox eam wi h six schools alloca ed o each eam
membe .
Tailo ing and Modi ica ions: Each session was ully sc ip ed and implemen ed in a simila way
ac oss all p eschools. Howe e , he e was lexibili y in he numbe o p ac ice ac i i ies comple ed
based on pa en in e es and he ime a ailable. Se en schools did no comple e all ele en sessions
due o delays in s a ing he in e en ion (see de ia ions om p o ocol sec ion o mo e de ails).
13
3.4 Measu es
In his mixed-me hod s udy, we collec ed h ee main ca ego ies o da a: i) implemen a ion
ou comes, ii) he impac o he IHT p og am on ca egi e and child ou comes, and iii) a quali a i e
in es iga ion o he pe cep ions o p eschool eache s and he esea ch eam. De ails o hese
measu es a e gi en in Panel 2.
Implemen a ion Ou comes. Implemen a ion ou comes included ca egi e a endance, p eschool
eache compliance and he quali y o he pa en ing sessions implemen ed by he p eschool eache .
Impac E alua ion. The p ima y ou come in he impac e alua ion was ca egi e s’ use o VAC
measu ed h ough ca egi e epo . Seconda y ou comes we e ca egi e in ol emen wi h hei
child, ca egi e s’ a i udes o VAC, ca egi e s’ p e e ence o ha sh punishmen , ca egi e sel -
e icacy, and child conduc p oblems, all by ca egi e epo . All p ima y and seconda y ou comes
we e measu ed a baseline (Decembe 2023 o Ma ch 2024) and pos -in e en ion (May o July
2024), wi h he excep ion o ca egi e sel -e icacy, which was measu ed a pos -in e en ion only.
All ou come measu es, excep o ca egi e p e e ences o ha sh punishmen , ha e been used
p e iously wi h his popula ion in Jamaica and show good psychome ic p ope ies (see Panel 2).
The measu e o ca egi e p e e ences o ha sh punishmen was designed o his s udy using an
adap ed e sion o a ques ionnai e used in Uganda (Sa insky e al., 2024).
As hese ou comes a e all measu ed h ough ca egi e - epo , we included a social
desi abili y index (SDI) in pos - es measu emen s. The aim was o measu e esponden ’s
p opensi y o epo in a socially desi able way on hei own beha io and a i udes. We used he
Ma lowe-C owne Social Desi abili y Scale – sho o m (C owne and Ma lowe, 1960; Reynolds,
1982) which consis s o 13 ques ions wi h a esponse scale o “T ue” o “False” ( o example, “I
some imes eel esen ul when I don’ ge my way,” “I ha e ne e delibe a ely said some hing
ha hu someone’s eelings,” “I’m always willing o admi i when I make a mis ake.”). P e ious
s udies ha e demons a ed signi ican co ela ions be ween SDI and sel - epo s o physical and
psychological iolence (Bell and Naugle, 2007; Fe nández-González e al., 2013). We pilo ed he
SDI p io o collec ing baseline measu emen s and es - e es o e 2 weeks was ICC=0.60 and
in e nal eliabili y was α=0.65 (n=31).
14
Quali a i e Da a. We also collec ed quali a i e da a including he pe cep ions o he
implemen ing eache s and he pe spec i es o he esea ch eam on he enable s and ba ie s o
implemen a ion and sugges ions o imp o emen .
Du ing ou s udies on he p e en ion o VAC, we ollow he epo ing equi emen s o he
Jamaican Child P o ec ion Ac ha manda es epo ing o se e e co po al punishmen . The limi s
o con iden iali y based on his epo ing manda e a e included in he in o med consen p ocess.
The measu e o ca egi e s’ use o VAC used in his s udy is a measu e ha was designed o use
in p e en ion s udies wi h communi y samples, and as such, we do no ask ca egi e s o epo on
se e e co po al punishmen . We ollow a s uc u ed esea ch p o ocol o collec da a on ca egi e s’
use o VAC ha includes guidelines o aining in e iewe s on how o conduc in e iews in a
sensi i e way (including how o espond o pa icipan dis ess and how o espond o disclosu e
o se e e VAC), in e iews conduc ed ou o lis ening ange o o he pe sons, and e e al
mechanisms o addi ional se ices i equi ed.
Panel 2. Desc ip ion o Implemen a ion, P ima y, and Seconda y Ou comes and Quali a i e
E alua ion
Ou come Va iables
Measu es Used
Implemen a ion
Ou comes
Ca egi e a endance
Measu ed weekly h ough a endance logs
P eschool eache
compliance
Teache compliance wi h conduc ing sessions was measu ed weekly using p ojec logs.
Compliance wi h sending ou Wha sApp messages o pa icipa ing pa en s was documen ed
h ough mobile phone eco ds.
Session quali y
Measu ed h ough obse a ion by a membe o he esea ch eam using a s uc u ed
ques ionnai e ha includes a ing eache p epa a ion, skills in session deli e y, skills in
building posi i e ela ionships wi h ca egi e s, and skills in helping pa icipan s lea n.
Ra ings we e conduc ed on a i e-poin scale: 1=poo , 2=pass
, 3=a e age, 4=good,
5=excellen .
15
P ima y Ou come
Ca egi e s use o
iolence agains hei
child (VAC)
Measu ed using i ems om he co po al punishmen and psychological agg ession subscales
o he Con lic Tac ics Scale Pa en Child (S auss e al., 1998). The scale had en ques ions,
i e ques ions measu e physical iolence and i e measu e psychological agg ession: 1)
shake, 2) hi on he bo om wi h ba e hand, 3) pinch, 4) hi on he bo om wi h some hing
ha d (e.g., bel , s ick), 5) slap on he a ms, hand o leg, 6) shou , yell o sc eam, 7) h ea en
o hi , 8) call names like idio , dummy, 9) h ea en o send he child away, 10) swea a child.
Ca egi e s epo on he las wo weeks and esponses a e gi en on a se en-poin equency
scale om 1=ne e o 7=mo e han once a day. Highe sco es indica e highe ca egi e use
o VAC. Tes e es o e wo weeks (n=20) was in a-co ela ion coe icien (ICC)=0.88.
In e nal eliabili y using C onbach’s alpha (α)=0.71.
Seconda y Ou comes
Ca egi e
in ol emen wi h
hei child
The scale consis s o wel e ques ions answe ed on a se en-poin equency scale ( om
1=ne e o 7=mo e han once a day): 1) eading s o ybooks, 2) helping wi h homewo k, 3)
playing games inside he home, 4) playing ou side, 5) play wi h oys, 6) si wi h child as
hey w i e, d aw o colo , 7) cha wi h child abou school and/o iends, 8) in ol e child in
cho es, 9) cha wi h child du ing daily ou ines (e.g., d essing, ba hing), 10) each child
household ules, 11) p aise child, 12) spend 10-15 minu es wi h child doing some hing un.
Highe sco es indica e highe ca egi e in ol emen . Tes e es o e wo weeks (n=20):
ICC=0.96. In e nal eliabili y: α=0.76.
Ca egi e a i ude o
VAC
Measu ed using an adap ed e sion o he UNICEF Mul iple Indica o Clus e Su ey
(MICS) ques ionnai e used p e iously in Jamaica (Dina e-Diaz e al., 2023). The scale
consis ed o i e ques ions answe ed on a ou -poin scale om 1=disag ee comple ely o
4=ag ee comple ely: h ee ques ions measu ed a i udes o physical iolence and wo
measu ed a i udes o psychological agg ession. Highe sco es indica e mo e a o able
a i udes o VAC. Tes e es o e wo weeks (n=21): ICC=0.71. In e nal eliabili y: α=0.63.
Ca egi e p e e ences
o ha sh punishmen
The scale consis s o nine pic o ial scena ios o child en misbeha ing: ou scena ios in a
public place (bank, ma ke , supe ma ke , school) and i e scena ios a home. The child
misbeha io s include non-compliance, gi ing a i ude, empe an um, hi ing a younge
child, doing some hing dange ous, being o e ly ac i e, and making a mess. We selec ed
hese beha io s as in p e ious quali a i e esea ch, ca egi e s epo ed ha hey o en
esponded o hese beha io s wi h physical iolence (F ancis e al., 2023). Fo i e o he
ques ions, i he ca egi e s’ esponse(s) do no include physical punishmen , we ask wha
hey would do i he beha io con inued. A pic o ial esponse scale is p o ided, and mul iple
esponses a e accep ed. The sco e includes he numbe o esponses ha include VAC (e.g.,
hi , shou o yell, h ea en o hi ). Highe sco es indica e highe p e e ences o ha sh
punishmen . Tes e es o e wo weeks (n=30): ICC=0.80. In e nal eliabili y: α=0.57.
16
Seconda y Ou comes
(con inued)
Child conduc
p oblems
Measu ed using he Eybe g Child Beha io In en o y (ECBI) equency scale (Eybe g and
Ross, 1978). The ECBI consis s o 36 ques ions and ca egi e s epo on hei child’s
beha io using a 7-poin scale om 1=ne e o 7=Always. Highe sco es indica e highe
le els o conduc p oblems. Tes e es o e wo weeks (n=20): ICC=0.99. In e nal
eliabili y: α=0.81
Pa en ing sel -
e icacy
Measu ed using he B ie Pa en ing Sel -E icacy Scale (Woolga e al., 2023). The scale
consis s o i e ques ions and ca egi e s answe ed on a ou -poin scale om 1=disag ee
comple ely o 4=ag ee comple ely. Highe sco es indica e highe pa en ing sel -e icacy.
Tes e es o e wo weeks (n=30): ICC=0.58. In e nal eliabili y: α=0.69.
Quali a i e da a
Teache pe cep ions
A e eache s had comple ed all IHT sessions, we conduc ed in-dep h in e iews wi h
eache s who conduc ed he sessions wi hin each school. In e iewe s used a opic guide o
explo e eache s’ pe cep ions o he enable s and ba ie s o in e en ion implemen a ion
( ela ing o he con en , p ocess, s uc u e, and ma e ials used in he p og am) and eache s’
sugges ions o imp o emen and o p omo e sus ainmen wi hin he p eschool sys em.
Resea ch eam
pe cep ions
The esea ch eam kep an ongoing log o he enable s and ba ie s o in e en ion
implemen a ion and sugges ions o imp o emen based on hei in e ac ions wi h he
p eschool eache s and pa en s and hei obse a ions o he sessions.
3.5 P ocedu e o Measu es
Implemen a ion Ou comes. Implemen a ion ou comes we e collec ed h oughou in e en ion
implemen a ion by wo membe s o he I ie Toolbox Team (TF and MB). Each eam membe was
esponsible o collec ing implemen a ion da a in six p eschools.
Impac E alua ion. The ques ionnai es ela ed o ca egi e s’ use o VAC, ca egi e in ol emen
wi h hei child, a i udes o VAC, p e e ences o ha sh punishmen , sel -e icacy, and child
conduc p oblems we e adminis e ed in ace- o- ace in e iews by wo esea ch assis an s, masked
o s udy design and g oup alloca ion. In e iews we e usually conduc ed a he s udy p eschools
wi h a mino i y o in e iews conduc ed a he pa icipan s’ homes. All pa icipa ing ca egi e s (in
bo h in e en ion and con ol schools) ecei ed a small gi o hei child (e.g., colo ing book and
c ayons) and US$2.50 phone c edi a e baseline and again a e pos - es measu emen s. Resea ch
17
assis an s we e o a ed ac oss schools and in e iewed equal numbe s o ca egi e s in each g oup
a bo h ime poin s. Resea ch assis an s we e ained o e a wo-week pe iod including 0.5 weeks
in o ice and 1.5 weeks o ield aining. Ongoing quali y con ol was main ained by he aine
accompanying each esea ch assis an once a week h oughou da a collec ion. Comple ed
ques ionnai es we e checked on a weekly basis o comple eness by he p ojec manage .
Quali a i e Da a. Teache in e iews we e conduc ed wi hin wo mon hs a e he end o he
in e en ion. Teache s we e con ac ed by phone and a con enien ime a anged o in e iew.
In e iews we e conduc ed a he p eschool by he I ie Team membe who was esponsible o
suppo ing he eache s. In e iewe s used a s uc u ed opic guide, and he in e iew las ed
app oxima ely one hou .
3.6 De ia ions om P o ocol
In he p o ocol, he in e en ion was desc ibed as a wel e-week in e en ion. We ound ha when
in eg a ing in o he exis ing p eschool sys em, we had o ollow he pace o he schools. Teache s
had esponsibili y o iden i ying he pa icipan pa en s and se ing up hei pa en ing g oups
(including se ing he da e and ime and c ea ing a Wha sApp g oup o pa icipan s). These
ac i i ies ook mo e ime han we an icipa ed. Hence he in e en ion was sho ened o a maximum
o ele en weeks. We added a measu e o ca egi e sel -e icacy o he measu emen s a pos - es .
This measu e was added a e eedback om he ad iso y boa d o e seeing he esea ch.
3.7 Analysis
This is a easibili y pilo s udy, and i s powe is limi ed by he small numbe o clus e s. Wi h a
clus e size o 10 (10 pa en /child dyads pe school), and assuming an in aclus e co ela ion
coe icien o 0.02 on ou p ima y ou come o ca egi e s’ use o VAC, (based on ou p e ious
da a), 120 pa icipan s pe g oup a e su icien o de ec an e ec o 0.35 SD wi h 80% powe a a
signi icance o p<0.1.
All analyses we e p especi ied wi h de ails gi en in a p e iously published p o ocol
(F ancis e al., 2025). Ou come a iables we e assessed o no mali y and ans o med whe e
necessa y. Ca egi e s’ use o VAC, ca egi e s’ a i ude o VAC, and ca egi e p e e ences o
ha sh punishmen we e nega i ely skewed, and we e no malized wi h a squa e oo ans o ma ion.
18
The e ec o in e en ion was analyzed using MLWin 3.04 (Rasbash e al., 2009), on an
in en ion o ea basis, using mul ile el linea eg ession models o ake in o accoun he
hie a chical na u e o he da a (ca egi e s nes ed in schools). Fixed e ec s in he model included
a cons an , baseline sco e (whe e a ailable), in e iewe , child age and sex, in e en ion s a us and
a iables ha we e di e en be ween he g oups a baseline, o ha we e di e en be ween hose
los o analysis and hose who con inued, a a signi icance le el o p<0.1. P eschool was en e ed
as a andom e ec . As he e was only one p ima y ou come (ca egi e - epo ed equency o
iolence agains hei child), we did no con ol o mul iple hypo hesis es ing. Seconda y
ou comes a e conside ed explo a o y. E ec sizes we e calcula ed by di iding he eg ession co-
e icien by he s anda d de ia ion o he con ol g oup a pos - es o each ou come.
As he ou come measu es a e assessed h ough ca egi e sel - epo , hey a e suscep ible
o expe imen e demand e ec s especially o ou comes ela ed o ca egi e s’ use o and a i udes
o VAC. We assessed expe imen e demand e ec s using h ee se s o mul ile el eg ession
analyses. In all analyses, child age, sex, in e iewe , ca egi e age, and baseline ca egi e
in ol emen we e en e ed as ixed e ec s and p eschool as a andom e ec . Fi s , we in es iga ed
he e ec o he in e en ion on a social desi abili y index using mul ile el eg ession analysis.
Second, we epea ed all he mul ile el eg ession analyses on p ima y and seconda y ou comes
desc ibed abo e, wi h he social desi abili y index added as a co a ia e in he model. Finally, we
in es iga ed he e ogenei y o expe imen e demand e ec s by e- unning he mul ile el eg ession
analyses o each p ima y and seconda y ou come wi h he social desi abili y index (SDI) and an
in e ac ion e m (SDI x s udy g oup) as ixed e ec s in he model.
Fo all mul ile el eg ession analyses, we used he es ic ed maximum likelihood
es ima o a ailable in MLWin o ake in o accoun he small numbe o clus e s (El e al., 2021).
The in-dep h in e iews wi h eache s we e audio- eco ded. Due o esou ce cons ain s,
we made no es om he audio- eco ding o each eache in e iew a he han ansc ibe he
in e iews in ull. The quali a i e da a, including he no es om he eache s in e iews and he
ongoing logs om he esea ch eam du ing he IHT implemen a ion, we e analyzed manually
using hema ic analysis (B aun and Cla ke, 2006). We de eloped a lis o key hemes using a
deduc i e app oach sepa a ely o each se o quali a i e da a ( eache in e iews and esea che
logs). One o he I ie Team membe s (TF) c ea ed a hema ic ma ix linking each heme and
19
sub heme wi h co esponding ex ac s om he quali a i e da a. The analyses we e conduc ed wi h
ongoing inpu and consul a ion wi h HBH.
4. Resul s
4.1 Sample Cha ac e is ics
Sample cha ac e is ics a e shown in Table 1. Child en had a mean (SD) age o 4.1 (1.1) yea s, 118
(49.2%) we e boys, and 49 (20.4%) we e in he clinical ange o conduc p oblems by ca egi e -
epo , wi h no signi ican di e ences by s udy g oup. In e ms o ca egi e s and household
cha ac e is ics, 172 (71.7%) had comple ed high school, 176 (73.3%) we e employed, 227 (94.6%)
we e emale, 205 (85.4%) we e mo he s, 91 (37.9%) a he s li ed wi h hei child and he e was a
mean (SD) o 2.2 (0.98) child en pe household. The only signi ican di e ences be ween he
g oups, (a p<0.1), we e o ca egi e age (p=0.07) and ca egi e in ol emen wi h hei child
(p=0.07). Se en ca egi e /child dyads we e los o ollow up: ou om he in e en ion g oup and
h ee om he con ol g oup: easons o loss a e shown in Figu e 1. The e we e no di e ences
be ween hose los and ollowed up, (a a signi icance o p<0.1), o any p ima y o seconda y
ou come o o any ca egi e cha ac e is ics (See Appendix). Howe e , child en los o ollow-up
we e signi ican ly olde han hose who con inued (Mean (SD): 5.0 (1.2) e sus 4.1 (1.1)
espec i ely, p=0.03). Ca egi e age, ca egi e in ol emen and child age we e en e ed as ixed
e ec s in all mul i-le el eg ession analyses.
20
Table 1 Child, Ca egi e and Household Cha ac e is ics by S udy G oup
In e en ion
(n= 120)
Con ol
(n= 120) p alue
Child age (in yea s) 4.07 (1.12) 4.08 (1.08) 0.91
Child sex (n (%) boys)) 56 (46.7) 62 (51.7) 0.44
Clinical ange o conduc p oblems by pa en
epo 1 n (%) 23 (19.3) 26 (22.0) 0.61
Ca egi e age (in yea s) 33.92 (9.99) 31.79 (8.13) 0.07
Ca egi e sex (n (%) emale) 115 (95.8) 112 (93.3) 0.39
High school comple ed n (%) 86 (71.7) 86 (71.7) 1.00
Ca egi e cu en ly employed n (%) 89 (74.2) 87 (72.5) 0.77
Mo he li es wi h child n (%) 108 (90.0) 113 (94.2) 0.69
Fa he li es wi h child n (%) 41 (34.2) 50 (41.7) 0.31
Numbe o child en < 18 yea s in household 2.13 (1.18) 2.33 (1.18) 0.19
Household possessions 2 9.44 (2.22) 9.30 (2.42) 0.64
Household sani a ion (median (IQR)) 3 12.00 (8-12) 12.00 (8-12) 0.98
C owding median ( ange)4 1.33 (0-5) 1.50 (0-8) 0.64
No es: Sco es a e mean (SD) unless o he wise s a ed. 1Abo e cu o (>130) on Eybe g Child Beha io In en o y
by pa en epo . 2Numbe o possessions om a lis o 16 i ems. 3Wa e supply and oile . 4Numbe o people
pe oom.
4.2 Cha ac e is ics o In e en ion Teache s
Twen y- ou p eschool eache s (n=2 om each p eschool) pa icipa ed in p og am
implemen a ion. Teache cha ac e is ics a e shown in Table 2. All eache s we e emale, 6 (25%)
we e also he school p incipal, in addi ion o being a class oom eache , and 11 (45.8%) had a
o mal eache - aining quali ica ion (Diploma o B.Ed.).
21
Table 2. Cha ac e is ics o Teache s Implemen ing he I ie Homes Toolbox P og am
n=24
Teache sex: n (%) emale
24 (100%)
Teache age:
•
25-34
8 (33.3%)
•
35-44
8 (33.3%)
•
45-54
4 (16.7%)
•
55-64
4 (16.7%)
Teache ole: n (%)
•
Teache
18 (75%)
•
Teache & P incipal
6 (25%)
Numbe o yea s eaching: median (IQR)
8 (5-16)
Numbe o yea s eaching a his school: median (IQR) 5 (1.5-10)
Recei ed aining in ea ly childhood educa ion: n (%)
22 (95.7%)
Ha e a Diploma in Educa ion: n (%)
1 (4.2%)
Ha e a Bachelo ’s in Educa ion: n (%)
10 (41.7%)
4.3 In e en ion Implemen a ion
Teache Pa icipa ion in T aining. Teache s we e ained in wo ounds o implemen a ion: one
g oup (n=12 eache s) was ained in ea ly Janua y 2024, and one g oup (n=12 eache s) was
ained in he Feb ua y hal e m. In he Janua y coho , 8/12 eache s (66.7%) a ended wo days
o aining, 4/12 (33.3%) a ended one day. In he Feb ua y coho , eache s we e only a ailable
o one day o aining: 10/12 eache s (83.3%) a ended he aining. So, o e all, (8/24 (33.3%)
a ended wo days, 14/24 a ended 1 day (58.3%) and 2/24 (8.3%) a ended no aining. Schools
we e isi ed by an I ie Toolbox eam membe he day be o e each session o app oxima ely 30
minu es o e iew he sc ip and o e 90% o sessions we e a ended by a membe o he eam.
Numbe o Sessions Deli e ed and Teache Compliance. Fi e schools comple ed all 11 sessions,
i e schools comple ed 10 sessions, one school comple ed 9 sessions, and one school only
comple ed 7 sessions. The eason why some schools comple ed ewe han 11 sessions was due o
a delay in se ing up he p og am. This occu ed because o delays in pa icipan ec ui men and/o
in o ganizing he ime and da e o he i s session. Teache compliance wi h implemen ing he
sessions was high and sessions we e only missed due o poo wea he , he session alling on a
28
4.5 Quali a i e In es iga ion
Fo he quali a i e in es iga ion, we selec ed eache s who had been ac i ely in ol ed in
conduc ing he IHT session o pa icipa e in he in-dep h in e iew. In six schools, bo h eache s
implemen ed he sessions, while in six schools one eache ook p ima y esponsibili y o
conduc ing he sessions. Hence we in i ed wo eache s om six schools and one eache om he
o he six schools o pa icipa e. In e iews we e conduc ed du ing he ime ha Hu icane Be yl
impac ed Jamaica in July 2024, and one eache was una ailable o in e iew. We he e o e
in e iewed se en een eache s om ele en p eschools.
Teache s’ Pe spec i es o he Enable s o Implemen a ion. Teache s epo ed bene i s o
hemsel es om hei in ol emen in he IHT deli e y including building be e ela ionships wi h
pa en s, unde s anding pa en s mo e, inc eased skills in managing child en’s beha io in he
class oom, and inc eased job sa is ac ion (Table 7). Enable s a he le el o he ca egi e s included
ca egi e s’ pa icipa ing in he sessions, seeing bene i s o pa icipan s pa en ing skills and hei
in ol emen in school, and ca egi e s suppo ing each o he wi h hei pa en ing. In e ms o
enable s ela ed o ma e ials, mos eache s liked using he sc ip s o each session and epo ed
ha i made he session easie o deli e . They epo ed ha he bulle ins and Wha sApp messages
gene a ed in e es among ca egi e s who we e no en olled in he g oup sessions and ha he
ideos we e easy o unde s and and in e es ing. Teache s highly alued he aining and he
ongoing suppo .
Teache s’ Pe spec i es o he Ba ie s o Implemen a ion. Teache s epo ed some di icul ies in
acili a ing he sessions including di icul y in doing he oleplays due o shyness and eeling
uncom o able o because i was di icul o play he ole equi ed (Table 8). A mino i y o eache s
would ha e p e e ed o he sessions o be less sc ip ed. O he di icul ies included poo
a endance o ca egi e s and some ca egi e s being unwilling o pa icipa e in he sessions and/o
inding i di icul o unde s and and p ac ice he s a egies. Se e al eache s el ha he e we e
oo many p ac ice ac i i ies wi hin each session which led o disengagemen o ca egi e s.
Teache s’ Sugges ions o Imp o emen . Teache s ga e sugges ions o ca egi e ec ui men ha
included he ollowing: i) in o ming he ca egi e s abou he p og am in ace- o- ace mee ings,
29
ei he in g oups du ing pa en o ien a ion, o indi idually o allow eache s o add ess indi idual
ca egi e s’ needs; ii) using Wha sApp messages and ideos; iii) ad e ising he p og am using
pos e s a ound he school, and i ) asking ca egi e s who ha e pa icipa ed in he p og am o
encou age o he ca egi e s o join he g oups by sha ing hei expe iences and how hey ha e
bene i ed (Table 9). To p omo e a endance, hey sugges ed ongoing encou agemen du ing ace-
o- ace mee ings, phone calls, and Wha sApp messages. Some eache s ecommended using
incen i es o mo i a e ca egi e s. The majo i y o eache s wan ed mo e suppo om o he
eache s in he school in unning he p og am. This suppo could in ol e all eache s being ained
o conduc he sessions and/o suppo wi h o he aspec s o he p og am such as wi h p epa a ion
and wi h ec ui ing, mobilizing, and engaging ca egi e s. Some eache s epo ed ha o nigh ly
o mon hly sessions would be mo e easible o eache s and/o ca egi e s and ha he p og am
should be sho ened o i be e in o he school e m. They also ga e sugges ions o engaging
ca egi e s wi h he ideos, messages and bulle ins by, o example, making hem mo e in e ac i e
and mo e salien .
30
Table 7. P eschool Teache s’ Pe cep ions o he Enable s o Implemen a ion o he I ie Homes Toolbox P og am
Theme
Quo e
Enable s a he le el o he eache s
Teache s build be e
ela ionships wi h pa en s
• “I b ings us close oge he , we in e ac mo e, hey will ask ce ain ques ions.” T16
• “The pa en s a e communica ing mo e.” T3
• “We a e close . We ha e chi cha s, alk abou hei child’s de elopmen when hey d op o o pick up hei child.” T4
Teache s unde s and
pa en s mo e
• “I go o unde s and hem mo e. They we e willing o open up and con ide in me, and ha was a bene i o me.” T5
• “The e was one mommy who I hough was a oiding me, bu I lea n ha she is shy. So, I know how o in e ac wi h he now.” T3
• “I ge o see hem in a di e en ligh and how hey in e ac wi h hei child.” T15
Pa icipa ing in he IHT
p og am helped eache s
o manage child beha io
in he class oom
• “Going h ough his p og am, I’ e lea ned many di e en ways o how o deal wi h child en a he han hi ing and shou ing a
hem.” T3
• “I helped me o know how o deal wi h he child en be e and how o manage my ange .” T2
• “I helps me a lo , I am calme wi h he child en ... du ing he sessions you lea n s a egies ha you can use.”T15
Teache s epo inc eased
job sa is ac ion
• “I hink she ( he pa en ) looks o me mo e. When she comes, she asks o me, i makes me eel good ha I was able o impac
someone’s li e, o he han a child.” T1
• “I makes me eel accomplished because hey can us me o come and alk. …They now know ha hey can alk o me.” T3
Enable s a he le el o he pa icipan s
Ca egi e s pa icipa ed in
he sessions
• “I was easy because he pa en s we e ecep i e. I lo ed ha he pa en s encou aged each o he . We also chee ed on he pa en s.” T11
• “Suppo ing hem as hey p ac iced was com o able because hey lis ened and esponded acco dingly.” T10
• “I was easy, because pa en s we e willing o pa icipa e.” T12
Ca egi e s bene i om
he IHT: (e.g., unde s and
child beha io , skills in
posi i e discipline
s a egies)
• “I helped … pa en s o be able o manage he beha io o hei child en.” T2
• “They ( he pa en s) exp essed ha he sessions helped hem in hei e e yday li e, dealing wi h hei child en, managing beha io .”
T4
• “They ge o unde s and mo e abou child en’s beha io and wha causes hem o beha e a ce ain way, and how o deal wi h i .” T1
Ca egi e s we e mo e
in ol ed in school • “They a e a bi mo e a ached o he ins i u ion. You a e seeing hose pa en s mo e o en.” T17
Ca egi e s suppo ed each
o he
• “… hey spoke abou pe sonal iumphs and issues in hei pe sonal li es. In he Wha sApp g oup, pa en s we e p aising each o he ;
hey sen ideos in he g oups, and he pa en s would commen on hose because i was abou hem, hei li es, and hei
accomplishmen s.” T4
31
Table 7 (con inued)
Theme
Quo e
Enable s ela ing o ma e ials
Ha ing a sc ip o ollow
helped
• “The sc ip ells you wha o do, gi es he possible answe s. I makes i less s ess ul and easie .” T1
• “So, when you ha e a s uc u ed hing, you a e able o do i he igh way and don’ spoil i .” T11
• “The expe ience o using a sc ip is exci ing. I p e e o use a sc ip because i is a guideline o he session, so no hing is le ou .” T6
Bulle ins spa ked
ca egi e s’ in e es in
p og am
• " When he bulle ins a e up, ..we had pa en s who we e no in he wo kshop come and say, ‘Miss, me y some o hese hings you
know.’" T9
• "Pa en s asked wha is was abou . The pa en s asked me o le hem know when i was going o happen again." T2
• “I saw hem ake pic u es o i , hey s opped, and hey ead i , and hey asked us abou i .” T12
Wha sApp messages
spa ked in e es om
ca egi e s who a e no
pa icipa ing in sessions
• “O he pa en s wan ed o be a pa o he g oup, hey asked ‘When is he o he one going o s a ?’” T4
• “A pa en asked abou he message ha encou ages pa en s o p aise child en. So e en hough she wasn’ awa e o he g oup, he
message made he wonde , so she asked me abou i .” T8
Videos we e
in e es ing/ ela able,
use ul and easy o
unde s and
• “I liked ha he ideos showed eal pa en s in e ac ing wi h hei eal child en. I also liked ha a he s we e in he ideos.” T5
• “The ideos cla i y e e y hing a li le mo e. They we e in e es ing and help ul.” T9
• “I go eedback om pa en s saying how i has helped hem, and hey a e be e able o connec wi h hei child en.” T1
Enable s ela ed o aining
T aining and p ac ice
p epa ed eache s o
deli e he sessions
• “The p ac ice he day be o e helped because you knew wha o do, whe e o s and, and how o app oach he pa en .” T4
• “I was com o able enough because I did he aining al eady. I had he unde s anding o wha o do. I was awa e o wha o say and
he eac ion I would p obably ge .” T3
• “The ac ha I wen h ough i be o e, i wasn’ new. So, when i was ime o do i in he wo kshop, i was clea e and good.” T5
Suppo om he
esea ch eam was
alued by eache s
• “The ac ha a pe son om he esea ch eam was he e as a guide, in case he key poin s we e no being highligh ed, o i was no
being done as i should be done.” T5
• “The suppo was e y help ul. I we made a mis ake o i we we en’ clea abou some hing, a membe o he esea ch eam would help
us. I el mo e com o able ha ing he he e.” T12
32
Table 8. P eschool Teache s’ Pe cep ions o he Ba ie s o Implemen a ion o he I ie Homes Toolbox P og am
Theme Quo es
Ba ie s a he le el o he acili a o
Teache s epo
discom o in doing
oleplays
• “Fo he i s wo sessions i was di icul bu as ime wen on i became easy, and mo e com o able. You eel silly some imes because mos
o he ac ions a e o a child, and I wonde ed how hey would see me, bu hey saw me as wha i was in ended o do: a child.” T4
• “Some hings I had o check mysel on. So, i he child is doing some hing ha you don’ wan hem o do, you ha e o eally es ain you sel
om saying ‘S op do ha ’ o ‘Don’ do ha ’. Because i has o be posi i e, so ha pa was di icul .” T9
• “I emembe he i s aining whe e I had o play he ole o a ‘bad mommy’ I el a way because i is some hing ha I don’ do. I was ha d
o me o play he bad mommy.” T11
Teache s p e e mo e
au onomy wi h
deli e y
• “…i eache s we e allowed o adlib, maybe i would be a bi mo e in e es ing. No changing he sc ip bu say i in my own way.” T9
• " I would a he use my own wo ds. I eel mo e com o able using my own wo ds.” T12
Ba ie s a he le el o he pa icipan s
Poo a endance o
ca egi e s
• “Some imes i was ha d because hey didn’ show up.” T3
Ca egi e s’ lack o
pa icipa ion in
sessions
• “I made i di icul when he pa en s didn’ wan o pa icipa e.” T3
• “Some imes some pe sons didn’ wan o alk because hey a e e y shy, so ha migh be a li le di icul y.” T6
• “Some pa en s a e imid, so hey don’ wan o speak ou , so you ha e o … encou age hem along he way.” T14
Ca egi e s ind
aspec s o he IHT
p og am di icul
• “Some imes you a e no ge ing wha you wan om he pa en s, so you ha e o wo k mo e o ge he in o ma ion.” T5
• “Some o hem canno ead, ha ’s why some o hem don’ ill ou he home assignmen .” T2
Ba ie s ela ing o ma e ials
Few eache s wa ched
all he ideos
• “I wa ched a ew. I hink I wa ched he one abou wi hd awing a en ion.” T14
• “I didn’ pay any in-dep h a en ion because I jus igu ed he ideos we e o pa en s who we e no a he sessions o o hose who don’
unde s and.” T15
Ba ie s ela ed o in e en ion
Teache s epo ed ha
he e we e oo many
p ac ice ac i i ies
• “I hink ha we can minimize he amoun o p ac ice in each session ... We don’ need so many ac i i ies on he pape .” T12
• “Only hing is mos o he demons a ions i we did wo o h ee i is enough a he han doing all he examples.” T13
33
Table 9. P eschool Teache s’ Sugges ions Rela ing o Implemen a ion o he I ie Homes Toolbox P og am
Theme
Quo es
Sugges ions ela ing o p omo ing pa icipan ec ui men and a endance
Teache s can ec ui
pa icipan s ace- o- ace
• “Talk abou i du ing o ien a ion in Sep embe . We can also ell hem abou i in pa en s’ mon h (No embe ).” T5
• “Face o ace because you would ha e a mo e meaning ul con e sa ion a he han on Wha sApp. Face o ace hey know ha you eally
ca e.” T4
• “Fo he pa en s who eally need i , I would ec ui hem ace- o- ace because hen I can ge hei eedback and know which app oach o
ake.” T3
• “I would app oach hem abou he sessions indi idually, we wan hem o eel impo an .” T15
Teache s can ec ui
pa icipan s i ually
• “I could also ell hem abou i ia he Wha sApp g oup ( he school g oup). Whoe e indica es in e es is old o come in and sign up.” T9
• “Flye , ideo ad e isemen , some hing li ely. The ideo ads could be sen o he school, and i could be pos ed in he Wha sApp g oup o
he school’s social media page, o websi e.” T5
• “Highligh i mo e. Ha e a billboa d in he schoolya d. Ad e isemen ideo sen in he g oup.” T7
Teache s can engage
pas pa icipan s in
ec ui ing new
ca egi e s o he IHT
• “Le he o he pa en s who ha e been h ough he p og am ell hem how hey bene i ed.” T10
• “Ha e pas pa en s speak abou hei expe ience and how i helps hem and hei child en.” T16
Teache s’ sugges ions
o p omo ing ca egi e
a endance
• “Encou age hem when we see hem in he mo nings, o Wha sApp message, o phone call. We could say, ‘ emembe we a e ha ing he I ie
mee ing his a e noon. This will help you o be an I ie pa en .” T8
• “You ha e o gi e incen i es.” T13
• “Con inue sending ou he bulle ins, messages on he phone.” T14
Sugges ions ela ing o he school
T ain all eache s in he
school o conduc he
pa en ing sessions
• “We wan hem o come on boa d o help us o do he sessions. We ha e 5 eache s so we could all ake a u n in doing he sessions.” T14
• “Fi s ly, I wan o in oduce he p og am o he eache s a he school du ing he holiday so hey can do sessions. Then all hands would be
on deck o engaging new pa en s and o ge e e ybody on boa d wi h I ie pa en ing.” T12
• “Do a os e whe e each eache does a session, so i is no bu densome on one eache .” T13
Ask o he eache s in he
school o p o ide
suppo o he eache s
conduc ing he pa en ing
sessions
• “Helping o se up he oom, ge ing e eshmen s p epa ed, helping o do a week, no lea ing i on one pe son.” T5
• “Be engaged and communica e he in o ma ion sen ou o pa en s so ha he e is a wide audience ange, because we can’ ha e mo e
han 10 pa en s in a session.” T4
34
4.6 Ongoing Resea che Logs
The wo membe s o he I ie Toolbox eam who we e aining and suppo ing he eache s o
implemen he in e en ion kep an ongoing log o he enable s and ba ie s o implemen a ion and
sugges ions o imp o emen . These logs included no es kep a e each session hey isi ed,
combined wi h no es ela ed o ongoing in e ac ions wi h eache s.
Resea ch Team’s Pe spec i es o he Enable s o Implemen a ion. All eache s we e epo ed o
be highly complian wi h in e en ion p o ocols, enjoyed deli e ing he sessions, and u ilized he
s a egies om he IHT in hei pe sonal and p o essional li es (Table 10). The majo i y o eache s
had good ela ionships wi h he ca egi e s in hei pa en ing g oups, engaged ca egi e s well, and
sha ed pe sonal expe iences o how hey used he s a egies hemsel es and he di icul ies hey
aced. Some eache s showed good unde s anding o he con en , demons a ed he skills well,
we e compe en a using he sc ip , and deli e ed he sessions en husias ically and wi h a li ely
pace.
Resea ch Team’s Pe spec i es o he Ba ie s o Implemen a ion. Key ba ie s o he quali y o
session deli e y, included lack o p epa a ion and insu icien suppo o ca egi e s du ing
p ac ice ac i i ies (Table 11). Some eache s ound i di icul o main ain a li ely demeano , and
hei sessions we e no engaging o ca egi e s. An impo an ba ie was ha many eache s ound
i di icul o add ess ca egi e s’ ques ions and conce ns ela ing o hei child’s misbeha io and
lacked skills in dealing wi h esis ance om ca egi e s. Fu he mo e, some eache s had posi i e
a i udes o using ha sh punishmen . We aced ongoing challenges wi h ca egi e a endance. In
some ins ances, hese challenges we e due o ca egi e s’ wo k schedules and o he esponsibili ies.
Howe e , i was also e iden ha in many schools, eache s had no checked ca egi e s’
willingness and a ailabili y p io o ec ui men .
Resea ch Teams’ Sugges ions o Imp o emen . The esea ch eam iden i ied a need o mo e
ini ial aining o p epa e eache s o acili a e he sessions. Op imally, he aining would include
he eache s pa icipa ing in he aining as hough hey a e ca egi e s, p io o being ained o
conduc he sessions (Table 12). This would ensu e hey a e ully con e san wi h he s a egies
and ha e a ho ough knowledge and unde s anding o he co e con en o he p og am.
35
Expe iencing he IHT p og am as a pa icipan would also help eache s o unde s and he a ionale
o he beha io change echniques used. Fo he school-wide elemen o be e ec i e, we need o
o ien all eache s in he school o he IHT and p o ide guidelines o how schools can alloca e
asks so ha all eache s a e in es ed and in ol ed in he p og am. Ano he ecommenda ion was
o de elop a school eadiness index o iden i y schools ha a e eady o implemen he p og am
e sus schools ha may need o be s eng hened p io o implemen a ion.
36
Table 10. Resea ch Team Pe spec i es o P eschool Teache s’ S eng hs in Implemen ing he I ie Homes Toolbox P og am
Theme Ex ac om Resea ch Logs
No es om Obse a ions o Sessions
Clea and Engaging Sc ip Deli e y: Teache s
ead he sc ip en husias ically, na u ally, wi h
cla i y and a a good pace.
• “Clea and engaging deli e y, wi h app op ia e emphasis on key poin s.”
• “Reads he sc ip as i ha ing a con e sa ion, e y na u al and kep a good pace.”
Good Rela ionship wi h Ca egi e s: Teache s
show wa m h and os e open communica ion and
ca egi e s sha e openly
• “She has a good ela ionship wi h he pa en s – hey sha e pe sonal expe iences, and she makes hem laugh.”
• “I is clea ha she has a good ela ionship wi h he pa en s and ha hey like alking o he .”
Unde s and Con en : Teache s ha e a solid g asp
o session con en which helps hem e ec i ely
guide discussions and cla i y concep s.
• “Unde s ood he con en ega ding eason o child misbeha io .”
• “Unde s ands he impo ance o p aise and can e ec i ely demons a e i ."
• “Unde s ood he s eps o each he skill and could ecognize i when he pa en s did i .”
Rela abili y and Pe sonal Expe ience: Teache s
sha e pe sonal s o ies o acknowledge hei own
lea ning jou ney ha end o build us and appo
wi h pa en s.
• “Sha ed pe sonal expe iences wi h he 1- and 3-yea -old child en.”
• “Sha ed how he p og am has helped he in he class oom, pa icula ly managing emo ions.”
• “Sha ed pe sonal ins ances whe e she almos los he cool and exploded.”
Engagemen and Li eliness: Teache s in e ac
wi h pa en s wa mly and main ain an engaging
session a mosphe e h ough eye con ac , smiling,
humo , o li eliness.
• “Was en husias ic and encou aged pa en pa icipa ion."
• “Demons a ed he s a egies well and kep i un.”
• “Encou aged quie e pa en s o sha e hei pe spec i es.”
Clea Demons a ion: Teache s demons a e he
use o he s a egies clea ly
• “Good job demons a ing how o p aise.”
• “Good job helping hem o use many concep wo ds in I ie Time.”
No es om Ongoing Logs
Teache compliance was high
• “The eache s we e willing o deli e he sessions each week. They made ime o mee wi h us o go h ough he
sc ip and hen ac ually held he sessions. They sen ou he messages o he pa en s and pu up he bulle ins.
They e en called pa en s o ask whe e hey we e i he session is abou o s a , and hey we e no ye p esen .”
Teache s enjoyed conduc ing sessions
• “Mos eache s seemed o enjoy doing he sessions and ge ing o know he pa en s. They laughed and sha ed
hei pe sonal s o ies; A e sessions we e inished, hey some imes hung a ound cha ing wi h he pa en s.”
Teache s used he p og am in hei p o essional
and pe sonal li e
• “Some eache s we e lea ning alongside he pa en s. They lea n s a egies ha hey would hen use in hei
class ooms as well as wi h hei own child en a home. They sha ed he ideos on hei pe sonal social media
pages, sen ideos o amily membe s and encou aged hem o y he s a egies. One eache inqui ed abou
unning sessions a he chu ch.”
37
Table 11. Resea ch Team Pe spec i es o Facili a o s’ Needs in Implemen ing he I ie Homes Toolbox P og am
Theme Ex ac om Resea che Logs
No es om Obse a ions o Sessions
Lack o P epa edness & O ganiza ion: Teache s we e o en
unp epa ed wi h ma e ials and didn’ se up he oom in ad ance.
• “Did no ake ou ma e ials be o ehand.”
• “Chai s se up bu s ill needed a bi o ea anging and ma e ials no se ou .”
Managing and O ganizing Session Ma e ials: Teache s s uggle
wi h o ganizing and handling ma e ials, including cha s and sc ip s
simul aneously, and ensu ing ma e ials a e isible o pa en s.
• “Needs o wo k ou how o hold he sc ip and cha s a he same ime."
• “Tu ned body away om he g oup."
• “Needs o handle cha s so pa en s can see he pic u e and/o ex .”
Lack o Sc ip Familia i y and Engagemen : Teache s had issues
wi h s icking o he sc ip , o en a emp ing o deli e om memo y
o in hei own wo ds. This led o hem changing he meaning a
imes o led o hem missing ce ain sec ions/poin s.
• “Needs o ead wi h mo e en husiasm and keep he head up om he sc ip .”
• “T ied o do i om memo y ins ead o ollowing he sc ip ."
• “T ied o pu he sc ip in he own wo ds, which changed he meaning."
Poo Pacing, Low Ene gy and Engagemen : Teache s spoke in a
slow o mono onous one, we e low-ene gy and lacked en husiasm
which a ec ed he pacing o he session and led o ca egi e s
disengaging.
• “Read in a la one, which made he session eel longe ."
• “Is oo laid back. Reads e y la , mono one and all in one. No ib an .”
• “…s uggles wi h pacing and ene gy.”
Does no P omp , Sca old o Suppo Ca egi e s: Teache s don’
always ecognize when pa en s need help and don’ suppo
ca egi e s when hey p ac ice he s a egies.
• “O en missed oppo uni ies o p omp pa en s and o gi e speci ic eedback when pa en s
needed encou agemen .”
• “O e all, she has di icul y o is uncom o able wi h suppo ing pa en s o make su e hey ge
i igh .”
Dealing wi h Sensi i e Topics and Misconcep ions: Teache s
some imes s uggle o guide ca egi e s in unde s anding and
add essing common misconcep ions abou child beha io and
discipline. They also need help wi h dealing wi h esis ance om
pa icipan s.
• “Pa en s and eache s belie e ha hi ing wo ks and some imes he child en need a good
slap.”
• “The eache did no belie e in changing nega i e hough s o posi i e, and she said she would
s ill be ang y.”
No es om Ongoing Logs
Poo and Inconsis en Pa en A endance: A endance a he
sessions was low in some schools. In o he s he a endance was
inconsis en wi h di e en pa en s a ending each week.
• “Only h ee pa en s a end consis en ly, he majo i y o he pa en s in he g oup wo k.”
• “A endance was low his week a he school due a wa e issue in he communi y”
• “Mul iple pa en s we e busy his week aking hei child en o egis e a he p ima y school.”
Una ailable Pa en s Rec ui ed and En olled: In mul iple schools
he pa en s en olled in he s udy we e una ailable o a end he
sessions
• ” In some schools, he eache s do no know he pa en s well, so hey ec ui ed pa en s who
did no ha e ime o a end.”
• “P eschool eache s ec ui ed ca egi e s who hey hough needed he p og am a he han
ca egi e s who we e willing and able o a end."
44
om he ou se o in eg a ion in o he exis ing ea ly childhood educa ion sys em, ongoing
adap a ion and lexibili y is equi ed as go e nmen sys ems a e no s a ic (He li z e al., 2020).
5.1 S eng hs and Limi a ions
The s eng hs o he s udy a e he use o a clus e - andomized design, ou come measu es wi h good
psychome ic p ope ies, assesso s masked o he s udy design, hypo hesis, and g oup alloca ion,
low le els o a i ion wi h only 2.9% los o ollow-up, and he mixed-me hod app oach including
quali a i e da a om he p eschool eache s who a e implemen ing he p og am. The limi a ions
o he s udy a e ha all ou come measu es a e by ca egi e sel - epo and pa en s a e awa e o
hei g oup alloca ion, so his may esul in biased esponses. Using a social desi abili y index
(SDI), we ound no e idence ha ca egi e s assigned o he in e en ion we e mo e likely o
espond in a socially desi able way han ca egi e s assigned o he wai -lis con ol and con olling
o SDI in he analyses did no al e he magni ude o signi icance o he e ec s on ca egi e
ou comes. The use o pa en ques ionnai es o measu e use o ha sh punishmen , in ol emen and
child beha io has he ad an age o assessing pa en and child beha io ac oss all con ex s.
Ano he limi a ion is ha his is a easibili y s udy, and he sample size was small. We had
insu icien powe o he e ogenei y analyses and hence we did no examine he e ogenei y by child
age and sex, o by ca egi e age, educa ion, and socio-economic s a us. We we e unable o ec ui
all ca egi e s p io o andomiza ion, due o he need o conduc eache aining wo kshops in he
school holidays. As p eschool s a led he ec ui men o ca egi e s in o he s udy, his could lead
o eache s in in e en ion schools in i ing highe - isk pa en s o a end he pa en ing sessions
(F ancis and Bake -Henningham, 2023). Howe e , he g oups we e balanced on he p ima y
ou come o ca egi e s’ use o iolence agains hei child and on o he seconda y ou comes o
ca egi e a i udes o iolence, p e e ences o ha sh punishmen , and child beha io di icul ies.
We ound a signi ican di e ence be ween he g oups in ca egi e in ol emen wi h hei child
and ca egi e age and we con olled o hese di e ences in all analyses. Ca egi e s we e ec ui ed
in o his s udy based on hei in e es and willingness o pa icipa e, while p eschools we e selec ed
based on hei willingness and easibili y o implemen he p og am. Hence, he pa icipan s a e
no ep esen a i e o he wide popula ion o ca egi e s and p eschools. The decision o ec ui by
in e es and willingness was based on he di usion o inno a ion heo y which desc ibes how
inno a ions a e sp ead h ough a popula ion, s a ing wi h he ea ly adop e s, hen sp eading o he
45
ea ly majo i y, hen he la e majo i y, and inally he lagga ds (Roge s, 2003). Implemen ing he
p og am wi h in e es ed pa icipan s maximizes he likelihood ha he p og am will be success ul,
leading o he p og am gaining momen um, hus a ac ing o he p eschools and o he ca egi e s
( he ea ly majo i y).
5.2 Summa y
This s udy demons a ed ha he IHT can main ain e ec i eness when deli e ed by p eschool
eache s as pa o hei ou ine du ies. The nex s eps a e o u he adap he IHT p og am based
on lessons lea n . The e is a need o es a sho e e sion o he IHT ha may be mo e accep able
o eache s and ca egi e s. We also need o es he e ec o school-wide messaging on ca egi e s’
a i ude o and use o VAC. To main ain he quali y o he IHT implemen a ion as he p og am
scales, i is impo an o de ise s a egies o adequa e aining and supe ision o p eschool
eache s. Finally, i is impo an o inc ease he a ailabili y o e idence-based p og ams o educe
ca egi e s’ use o VAC. This in ol es designing lexible p og ams ha a e deli e ed h ough
di e en modali ies, and ha ca e o ca egi e s wi h di e en needs.
46
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Table A. Child, Ca egi e , Household Cha ac e is ics and Baseline Ou comes
by Los and Found
Los
(n= 7)
Found
(n= 233) P- alue
Child age (in yea s)
5.0 (1.2)
4.1 (1.1)
0.03
Child sex (n (%) boys))
5 (71.4%)
113 (48.5%)
0.23
Ca egi e age (in yea s)
30.4 (6.7)
32.9 (9.2)
0.48
Ca egi e sex (n (%) emale)
7 (100%)
220 (94.4%)
0.52
High school comple ed n (%)
3 (42.9%)
65 (27.9%)
0.39
Ca egi e cu en ly employed n (%)
3 (42.9%)
61 (26.2%)
0.33
Mo he li es wi h child n (%)
7 (100%)
214 (91.8%)
0.96
Fa he li es wi h child n (%)
4 (57.1%)
87 (37.3%)
0.29
Numbe o child en < 18 yea s in household
1.9 (0.9)
2.2 (1.0)
0.42
Household possessions
8.0 (2.4)
9.4 (2.3)
0.11
Household sani a ion (median (IQR))
12.0 (8.0-12.0)
12.0 (8.0-12.0)
0.68
C owding median ( ange)
1.3 (0.8-2.5)
1.4 (1.0-2.0)
0.91
Ca egi e s’ use o iolence agains hei child
(median (IQR)) 11.0 (4.0-17.0) 12.0 (7.0-17.0) 0.63
Ca egi e in ol emen
31.3 (14.7)
35.3 (11.0)
0.12
Ca egi e a i ude o iolence agains child en
(median (IQR)) 6.0 (2.0-10.0) 5.0 (3.0-7.0) 0.67
Ca egi e p e e ences o ha sh punishmen
(median (IQR)) 4.0 (4.0-7.0) 5.0 (3.0-6.0) 0.89
Child conduc p oblems
106.3 (11.3)
114.2 (22.9)
0.37
No es: Sco es a e mean (SD) unless o he wise s a ed.
