Preventing Punitive Violence: Implementing Positive Discipline in Everyday Parenting (PDEP) with Marginalized Populations in Bangladesh.

Physical and other types of punishment remain common in Bangladesh, despite overwhelming evidence of their harm and worldwide efforts to decrease their use. One of the strategic priorities of Save the Children in Bangladesh's Child Protection Program is to protect children from physical and humiliating punishment in homes, schools, and other settings. Save the Children in Bangladesh selected the Positive Discipline in Everyday Parenting (PDEP) Program to provide parents with alternatives to physical punishment that comply with human rights standards while strengthening relationships and understanding of child development. High-risk communities where children are particularly vulnerable were selected for this project. The PDEP program was delivered to 857 parents living in lower socioeconomic areas of Bangladesh, including ethnic minority groups, and parents living in urban slums of Dhaka and rural brothel areas. Due to the low levels of education of the participants (almost two-thirds of participants had not completed elementary school), simplified pre and posttests were utilized. Following program completion, parents' approval of both physical punishment and punishment in general declined; they were less likely to view typical parent-child conflicts as intentional misbehavior and were less reactive to frustration. In addition, parents indicated an increased understanding of the positive discipline and more confidence in their parenting skills. Before taking PDEP, 64% of the parents often felt like they just did not know what to do as a parent, compared to 34% following program completion. PDEP demonstrated the potential to decrease the use of physical and humiliating punishments by parents living in high-risk communities in Bangladesh.

The Complexities of Intimate Partner Violence: Mental Health, Disabilities, and Child Abuse History for White, Indigenous, and Other Visible Minority Canadian Women.

This research examines how mental health issues associated with intimate partner violence (IPV) relate to women's intersecting identities of race/ethnicity, disability status, and child abuse history. Data (N = 595) from a Canadian triprovincial study included women who were White (n = 263, 44.8%), Indigenous (n = 292, 49.7%), or visible minority (n = 32, 5.5%). Few demographic differences were found. None of the mental health measures (Symptom Checklist-Short Form [SCL-10], Centre for Epidemiological Studies-Depression [CES-D-10], Posttraumatic Stress Disorder [PTSD] Checklist) were in the clinical ranges. In a MANCOVA on the mental health scales, with IPV severity, racial group, disability status, and child abuse history as variables, only disability was significantly associated with more mental health symptoms.

The Mental Health and Well-Being of Canadian Indigenous and Non-Indigenous Women Abused by Intimate Partners.

Intimate partner violence (IPV), mental health, disabilities, and child abuse history were examined for 292 Indigenous compared with 295 non-Indigenous Canadian women. IPV was assessed by the Composite Abuse Scale and mental health by the Symptom Checklist-10, Center for Epidemiological Studies-Depression 10, the Posttraumatic Stress Disorder (PTSD) Checklist, and Quality of Life Questionnaire. Scores did not differ nor were they in the clinical ranges for the two groups. In a MANCOVA on the mental health/well-being scales, with IPV severity as a covariate, only disability was significantly associated with more severe mental health symptoms. Suggestions for service providers are presented.

Mothering, Guiding, and Responding to Children: A Comparison of Women Abused and Not Abused by Intimate Partners.

Intimate partner violence (IPV) has many negative outcomes for women, children, and families. However, researchers have opposing perspectives and findings with respect to the effects on mothering for abused women. The assumption by some service providers that abused mothers are compromised in their parenting generally ignores the larger issue of male violence and women's and children's safety. The question examined in this study was whether there were differences in reported positive parenting responses with children between women who have experienced IPV and those who have not experienced IPV. The sample consisted of 1,211 mothers and came from two studies: The National Longitudinal Survey of Children and Youth, and The Healing Journey: A Longitudinal Study of Mothers Affected by Intimate Partner Violence. The Positive Interaction and Rational Parenting scales, adapted from Strayhorn and Weidman's Parenting Practices Scale, were used to measure parenting interactions. Bivariate correlations between the outcome variables and maternal age, maternal education, child age, and child sex were calculated to determine whether any of these variables were significantly related to the Positive Interaction Scale or Rational Parenting Scale. This was followed by ANCOVA to determine whether mothers who had experienced IPV differed in their scores on the two parenting scales from mothers who had not experienced IPV. Findings did not support the notion that abused women are compromised in their parenting responses with their children in regard to positive interactions and behavior management. Recommendations include a greater focus on the prevention of IPV, addressing the source of violence and providing appropriate support for mothers who experience IPV.

Protective Strategies of Mothers Abused by Intimate Partners: Rethinking the Deficit Model.

Exposure to intimate partner violence is detrimental to children, but can abused mothers protect them, and, if so, what can they do? This study of 350 Canadian abused women represents the first quantitative examination of such protective strategies. The actions that mothers most commonly used and perceived as effective include showing affection and being nurturing to their children. The strategies often suggested by professionals, such as contacting police and obtaining protection orders, were used less and considered less effective than informal strategies. Professionals are urged to ask mothers what strategies they use, especially those who do not involve formal systems.

Report of an equity-focused health impact assessment of a proposed universal parenting program in Manitoba.

OBJECTIVES: To assess potential inequitable impacts of a proposed Teen Triple P Positive Parenting Program (Teen PPP) in Manitoba to achieve equity of access and outcomes for families of diverse backgrounds; recommend (if required) alternative actions to promote greater equity of access and outcomes for families participating in Teen PPP; and evaluate the influence of recommendations on implementation of the proposed program. INTERVENTION: An equity-focused health impact assessment (EfHIA) of the proposed Teen PPP was conducted, using a standard EfHIA framework. Methods used to assess potential Teen PPP impacts included: a literature review, key informant interviews and 14 community consultations. Evidence was analyzed, summarized and presented to the project Steering Committee (SC), along with draft recommendations for ensuring that equity is considered in Teen PPP planning and rollout. OUTCOMES: The SC prioritized 12 possible inequitable impacts of Teen PPP with potential to prevent certain parents/caregivers either from accessing the proposed program or benefitting adequately from the program, causing them to drop out prematurely. Recommendations for avoiding these impacts were finalized by the SC and presented to provincial government officials responsible for the proposed program. Follow-up interviews with these individuals indicated that the recommendations were well received and raised equity-related issues that will be considered in future program planning decisions. CONCLUSION: EfHIA is a proven planning tool for ensuring that health equity is considered in all policies, which is one of the necessary conditions for reducing inequities and closing the health equity gap throughout Canada within a generation.

Prenatal parent education for first-time expectant parents: "making it through labor is just the beginning ".

INTRODUCTION: The purpose of this pilot project was to determine first-time expectant parents' perceptions of a parent education intervention, their education needs, and preferred sources and modes of such education. METHOD: The intervention was carried out during the last class of a public health prenatal education series. A total of 31 first-time expectant parents participated and included both women (N = 16) and men (N = 15; mean, 29 years). The intervention was an in-person session on the topics of a safe sleeping environment, shaken baby syndrome, physical punishment risks and positive parenting, and expected development and safety. Participants completed the Infant Safety Education Project Questionnaire after the intervention. RESULTS: Overall, most participants in this study found the content useful, planned to use it in caring for their infant, and indicated that this information should be shared with all expectant parents. DISCUSSION: Findings support a larger scale study to determine parent education needs of expectant parents and the development, implementation, and evaluation of programming. Pediatric nurse practitioners and other primary care practitioners should be aware of the education needs of expectant parents and be prepared to provide anticipatory guidance and resources as appropriate.

Stereotyping as a barrier to collaboration: Does interprofessional education make a difference?

This research was part of a Health Canada funded initiative developed to provide evidence about the effectiveness of interprofessional education (IPE) interventions to promote collaborative patient-centred care. Health professional students' ratings of health professions and the effect of IPE on those ratings were examined. Participants were divided into three groups (N=51); control, education, and practice site immersion. Utilizing the Student Stereotypes Rating Questionnaire (SSRQ) which consists of a five point Likert-type scale each group rated health professionals on nine characteristics: academic ability, interpersonal skills, professional competence, leadership, practical skills, independence, confidence, decision-making, and being a team player (Hean, Macleod-Clark, Adams, and Humphris, 2006). Data were collected at four time points; prior to an IPE classroom intervention, following an IPE classroom intervention, following the IPE immersion experience, and four months post IPE immersion experience. Overall, perceptions of other health professions were more positive following the 2.5day interprofessional education session and immersion experience. Student ratings of the seven professions among the nine characteristics will be presented, highlighting similarities and differences across professional groups. Findings support the incorporation of IPE curricula that address the role and functions of other health care professions to facilitate the development collaborative patient-centred care health care teams.

Maternal bedsharing practices, experiences, and awareness of risks.

OBJECTIVES: The objectives of this study were to determine mothers' practices and experiences of bedsharing with their infants and also to determine their knowledge of the risks. DESIGN: A self-report questionnaire was mailed to 1,122 mothers of infants. SETTING: Manitoba, Canada. PARTICIPANTS: The participants in this study were the mothers of infants aged 3 months whose contact information was obtained through the Manitoba Health Information Privacy Committee. MAIN OUTCOME MEASURE: Maternal-infant bedsharing practices and maternal knowledge of risks. RESULTS: There were 293 completed questionnaires received (26% return rate). Key findings suggest that although 89% of participants agreed that sleeping with one's baby has some risks associated with it, 72% reported that they bedshared with their baby on either a regular or an occasional basis. Mothers who breastfed were twice as likely to have bedshared. Approximately 13% of respondents who had bedshared reported an experience(s) with bedsharing in which they had rolled onto or partway onto their infant. CONCLUSIONS: Although the majority of participants agreed that bedsharing had risks for infants, almost three quarters of respondents reported bedsharing on a regular or an occasional basis. Reports by respondents of rolling onto or partway onto their infants support the conclusion that health care professionals should promote safe sleeping environments that include a separate sleep surface for infants.

Maternal use of physical punishment in response to child misbehavior: implications for child abuse prevention.

OBJECTIVE: The objective was to examine the roles of cognition and affect in maternal use of physical punishment. METHOD: Through a review of the literature, distal and proximal predictors (cognitive and affective) of physical punishment use were identified. One hundred and ten mothers of 3-year-old children were interviewed regarding two disciplinary situations that occurred during the previous 2-week period that elicited their strongest reactions: one which resulted in the use of physical punishment (if this occurred) and one which did not. The individual and combined contributions of the predictors of physical punishment use were analyzed through logistic regression. RESULTS: The predictors of physical punishment following individual analyses were: maternal attitude toward physical punishment, maternal perception of the seriousness and intent of the child misbehavior, and maternal anger in response to the child misbehavior. Through multivariate analysis 54% of the variance in physical punishment use was explained. CONCLUSIONS: Both cognitive and affective factors affect the decision to use physical punishment with children. These findings can be useful in establishing parenting educational programming that is directed at decreasing the rates of physical punishment and subsequently child physical abuse.

Disciplinary practices with children: parental sources of information, attitudes, and educational needs.

Although parenting is one of the most important roles undertaken during an individual's lifetime, the amount of information and education that parents receive for this role is variable and often minimal. Parenting behaviors are influenced by a variety of factors and conditions such as knowledge levels, and parenting abilities vary with parents' own childhood experiences, value systems, education levels, and other life experiences. One ongoing parenting issue is the management of and appropriate response to child misbehavior. A review of the topics of discipline and physical punishment are discussed in this article in relation to definitions, practice, and outcomes. A study of parents' attitudes regarding physical punishment and their sources and needs for related parenting education are presented. Findings from this study (N = 170) indicate that parents receive parenting information from a variety of sources, most frequently through discussions with other parents, books on parenting, and their own experiences. The topics identified most frequently by respondents are age-appropriate disciplinary responses and expected child development and behaviors. These areas of information should be made available on a wide basis to parents of young children.

The risks and alternatives to physical punishment use with children.

Despite strong evidence of negative developmental outcomes resulting from the use of physical (or corporal) punishment with children, its use by parents and other caregivers is common. Such negative outcomes include child aggression, mental health issues, and physical abuse. Health care providers have a responsibility to promote disciplinary strategies that facilitate positive parent-children relationships and keep children's self-esteem and bodies healthy and intact. The incidence, factors, and outcomes associated with parental use of physical punishment are reviewed and useful advice for parents and age-appropriate disciplinary strategies and resources are outlined for the various stages of child development from infancy to school age.

Childhood experiences with, and current attitudes toward, corporal punishment.

The purpose of the present study was to determine, in a Canadian sample, the extent to which corporal or physical punishment use continues, personal experiences, and current attitudes. Of the 436 participants, 75% reported receiving physical punishment as children. Approximately 40% of participants agreed that corporal punishment is necessary as a means of discipline. Since parental attitude toward physical punishment has been determined to be an important predictor in its use with children, the authors recommend that parent education programming must include information related to its risks.