Education Note No. 4 | November 2024 Guidance Note on Designing and Implementing Early Childhood Parenting Programs Manzuma Bozmamadova, Rayanatou Laouali, Pia Sosa Walder Intervention is a combination of elements and Glossary strategies designed to produce changes, where the aim is usually to improve behavior, practices, or attitudes. Beneficiaries refers to a person or group that receives Parenting programs are defined as a set of activities or money, advantages, help, etc. from something; can services aimed at improving how parents’ approach and often be considered as individuals, as groups of execute their role as parents, specifically their parenting people, or as entities designed to receive benefits or knowledge, attitudes, skills, behaviors, and practices advantages from something or someone. (Cambridge (Britto et al. 2017; UNICEF 2020). University Press). For this purpose, in this note parents and caregivers are considered as beneficiaries directly, Quality refers to «the minimum standards that and children as beneficiaries indirectly. managers and teams must maintain in what and Caregiver refers to “a person who is very closely how they do programs and the impact, effectiveness, attached to the child and responsible for their daily efficiency, sustainability, accountability and care and support. Primary caregivers include parents, transparency of outputs and processes achieved in all families and other people who are directly responsible phases of programming and in all sectors of program for the child at home. They also include carers outside implementation» (Manghani 2011). the home, such as people working in organized day care” (World Health Organization 2022). Parents traditionally refers to people who either beget or bring forth offspring or to those who bring Dosage refers to the combination of program duration up and care for them. In this guidance note, parents and intensity of activities. are defined not only by their familial relationship but also by their functional relationship with a child, and Duration refers to the total amount of time it takes therefore the term includes nonbiological caregivers to finish a project, task, or program, which can be such as grandparents, extended family, and kinship measured in hours, days, weeks, months or/and year. (Britto and Engle 2015). Intensity refers to the magnitude of a quantity per unit; in this note concerning elements of parenting programs, it refers to the number of program beneficiaries receiving the intervention. 02 • Partnerships with influencers within the community Parenting Programs: A Guidance Note and local organizations can help to enhance buy-in and effectiveness. Evidence-based parenting programs are interventions aimed at improving behaviors, parental practices, skills, and knowledge to promote healthy child development, through support and education from professionals Introduction or paraprofessionals working directly with the child’s caregiver. About three-quarters of children living in low-and middle- The objective of this guidance note is to provide income countries did not receive minimally adequate digestible information about parenting programs to nurturing care in their first three years of life (McCoy et World Bank teams and government partners so they may al. 2022). Lack of access to nurturing care for children in optimize the design and implementation of parenting the early years places them at risk of not reaching their programs. The main aim is to make this guidance note development potential (Daelmans et al. 2021). Research relevant to any sector, such as education, health, and shows that parenting interventions for children during social protection. Although the primary target audiences the first three years of life can be effective in improving are World Bank teams and government partners, we early childhood development (ECD) outcomes and hope other practitioners will find this guidance note enhancing parenting outcomes across low-, middle-, useful as well. and high-income countries (Jeong et al. 2021). In this sense, promoting evidence-based parenting programs • Parenting programs’ content is driven by both the is essential to enhance child development by improving objective and the local context. parental behavior, skills, and knowledge through training • Context analysis defines the targeted communities and support. and provides an understanding of their cultural norms and attitudes toward parenting. There is a considerable amount of research and evidence on parenting programs that has been produced over the • Parenting programs should target both parents and past decade. However, it is still necessary to summarize nonparental caregivers to bolster community- level and translate this information into actionable guidance. change. Thus, this guidance note aims to distill the extensive • Community members should be involved in deciding research on parenting programs into a guidance note the programs’ delivery modality. with practical recommendations for World Bank teams • It is best to combine different delivery modalities and government partners. based on need; while group-based programs are This document is divided into four sections. Following more cost effective, in-person and home-based this Introduction, the second section presents the quality modalities allow individualized support. framework while developing and implementing parenting • Parenting programs should be delivered over a programs, which is the core aspect of this guidance note. sufficient duration, with regular meetings (ideally The quality elements we propose, while they are neither weekly or biweekly) that last between 60 and 90 standardized nor universal, we regard as critical items: (1) minutes. content of parenting programs, (2) delivery modality, (3) • Workforce training should occur on a minimum of dosage, (4) workforce, and (5) monitoring and evaluation. two weeks (full time five day per week). Context analysis as well as policy and partnerships are • Provide delivery agents and supervisors with on-the- added as critical steps to support the key items in the job training and coaching by professionals. quality framework. Within each quality element of the framework, we illustrate common approaches or best • Monitoring and evaluation of parenting programs practices, as well as examples from evaluated parenting should be based on a clear program theory of programs in different contexts. We have consciously change and with indicators used at all levels (for activity, product, result, and outcome). excluded costs and resource maximization from the key elements, as further explained in the policy and • Strong government commitment through policy and partnership section. The final section of this guidance allocated resources is needed to support parenting note presents our conclusion and recommendations. programs. 03 Enabling Environments, which provide the foundation for Quality Framework for developing relevant, feasible, and sustainable programs, Parenting Programs include Context Analysis, discussed next as the first step, and Policies and Partnerships, which are discussed at the The proposed quality framework outlines best end of the paper as the last but not least consideration or commonly agreed practices for designing and for scaling up and sustainability. Key Elements implementing evidence-based parenting programs. There include practical considerations for the design and is not yet consensus on a standardized or universal set of implementation of parenting programs, such as Content, quality elements, but these are being considered as core Delivery Modality, Dosage, and Workforce. Lastly, Quality elements or critical steps to follow to ensure a quality Assurance encompasses the Monitoring and Evaluation program.1 component to ensure program efficacy (see Box 1). This section organizes key aspects into three categories: Enabling Environments, Key Elements, and Quality Assurance. Box 1. Summary of elements in the quality framework Enabling Environment Context analysis Policy and partnership Understanding and considering the specific context Strong government commitment through policy and within which parenting programs will be implemented allocated resources is needed to support parenting is crucial for their success. This involves tailoring the programs. Partnerships should be developed with content, delivery, and frequency of the programs to the influencers within the community. specific needs and constraints of the target population, considering cultural norms and attitudes toward parenting. Key Elements Content should be Delivery modality Dosage should be Workforce - adequate evidence-based, culturally should be carefully intensive and long enough training, supervision, and sensitive, and tailored considered and tailored to achieve the program's support are needed for to the identified issue to the specific context, goals, while also being community workers and and program objectives. resources and needs of the flexible and adaptable to volunteers. The different Content should also build target population. This is the needs and context types of workforces on the existing knowledge worthwhile to ensure that of the target population. needed should be and skills of parents, while it is accessible, culturally Weekly group meetings considered, as well as the also challenging them to relevant, and effectively lasting 60–90 minutes are various incentives and adopt new practices that supports the learning and recommended. workforce engagement are beneficial for child engagement of parents strategies, to ensure development. and caregivers. the effective delivery of parenting programs. Quality Assurance Monitoring and evaluation of parenting programs should be done based on a clear program theory of change and indicators used at all levels (activity, product, result, and outcome). To develop the quality framework, we applied the following steps: consultations, search, and screening. We consulted with different stakeholders and 1. experts including the Early Years Fellowship Coordination team, experts Dr. Jorge Cuartas and Dr. Joshua Jeong, World Bank staff working on parenting programs, and ECD experts. We searched and considered articles published from the year 2000 onward. We also considered other literature that was published in the 1990s based on its relevance to evidence-based parenting. 04 Quality Framework for Parenting Program Box 2. Summary of Essential Questions for Context Analysis Key questions within a context analysis may include these: • What are the primary objectives of the program in terms of childhood development outcomes? • Who are the primary beneficiaries of the program? Is the program designed to support individuals (such as mothers, fathers, or grandparents) or families, or is it aimed at an institutional level (e.g., government agencies)? • What is the geographic focus or location of the program? • How is the concept of parenting perceived within the community? What cultural beliefs and values shape the community’s definition of good parenting? • What are the main obstacles that hinder the practice of effective parenting within the community? Are there any social, economic, or cultural factors that contribute to these barriers? • What opportunities exist or could be created to promote positive parenting practices within the community? Are there any existing community resources or strengths that could be leveraged to support good parenting? Source: Bornstein et al. 2022 could underscore the need for a parenting program. Context Analysis While these indicators are significant, they may also be The quality framework should be implemented after symptomatic of broader issues. A comprehensive needs a comprehensive context analysis. This guidance note assessment can be undertaken by analyzing secondary defines context analysis as an in-depth assessment data pertinent to child development across various that employs a blend of quantitative and qualitative sectors, such as health, education, and social protection. methodologies to gain insights into the target Additionally, a formative study may be valuable to gather community’s needs, cultural norms, attitudes towards primary data on the determinants of parenting behaviors parenting, obstacles to embracing positive parenting within the targeted region (UNICEF 2021). practices, and potential opportunities for engagement. The following are steps to conduct a context analysis for a The note will later elaborate on policies and partnerships, parenting program: which are crucial for the effective execution of parenting programs. This section delves into the significance Define the scope: Clearly outline the objectives of the of performing a thorough context analysis, outlining parenting program and the specific needs it aims to methods to accurately assess the environment. address (Bornstein et al. 2022). Determine the geographic Subsequently, it emphasizes the necessity of embracing area and the population that will be served by the appropriate policies and forging alliances with key parenting program. individuals and entities in the community, all of which are Gather secondary data: Collect existing data from instrumental in driving positive change at the local level. reliable sources on child development, health, education, Several factors may warrant the implementation of and social protection within the targeted area. This a parenting program. For instance, elevated child includes reviewing previous studies, reports, and statistics malnutrition and rising infant mortality rates may prompt related to parenting practices and child well-being. a thorough investigation to identify underlying causes. Conduct a formative study: Carry out primary research Should such an inquiry reveal a pattern of inadequate to collect data directly from the target population. This parenting practices or a lack of parental engagement with could involve surveys, interviews, focus groups, or health services critical to child well-being, these findings observations to understand current parenting practices, 05 Quality Framework for Parenting Program challenges, and resources available. Engage with • Common objectives for parents include early stakeholders such as parents, caregivers, community stimulation, health/nutrition/WASH (water, sanitation, leaders, health professionals, educators, and social and hygiene), and safety. workers. Understanding cultural norms and attitudes • It is important to differentiate between community- towards parenting will help assess how community based programs that benefit children and parenting members view their roles as parents and inform what programs which support parents involve much more type of design is needed to help them achieve childhood than just providing information. Parenting programs development outcomes (Lansford et al. 2022). actively support parents and caregivers to strengthen their relationship with their children. Analyze data: Analyze both secondary and primary data to identify gaps in services, resources, and knowledge Content should be characterized by evidence-based among parents. Look for patterns and trends that could practices and designed to strengthen the parent-child inform the design of the parenting program. relationship and support a nurturing home environment for children’s emotional and social growth (Cuartas et Validate data and prioritize needs: Engage local al. 2022; Black et al. 2015; Bornstein et al. 2022; Jeong et childhood development experts within government and al. 2021; in-person non-structured interview with Jeong, local organizations to help validate findings and prioritize March 15, 2024). needs. Needs can be prioritized based on what is most critical to the target community and where the parenting • Even when using content from a successful and program can have the greatest impact. evaluated program, a context analysis and adaptation are needed to ensure that the content aligns with the Develop a program plan: Use the findings from the current community needs. needs assessment to define the parenting program’s theory of change and results framework (will be discussed Box 3 presents a list of common evidence-based topics in more detail in the monitoring and evaluation section). and themes in parenting programs. However, the content This should include specific goals, activities, resources is always driven by the objective and the contextualized required, and a plan for implementation and evaluation. challenge that needs to be improved. At this stage the quality framework can be implemented to define the content, delivery modality, dosage, Parenting programs should also give consideration workforce and monitoring and evaluation plan for the to caregivers’ specific well-being and the adversities parenting program. they face while parenting: • Parenting involves navigating various experiences Key Items: Quality Framework and adversities such as financial hardship, health crises, and relationship issues. CONTENT • Parenting programs aim to prepare parents to Understanding the concept of parenting is crucial manage adversities effectively by providing necessary for defining a program’s content, which must align tools and resources. with its objectives and the challenges identified in • Changing the practices of only one caregiver may not the context analysis. While there are numerous early suffice for altering household-wide practices. childhood development (ECD) domains and topics, not • Support is crucial for nonparental caregivers when all interactions or activities between a parent and child parents are absent due to work, migration, divorce, qualify as parenting. violence, death, war, or displacement. The following should be considered when designing the • Parenting programs should target both parents content of parenting programs: and other caregivers, as childcare often involves • Parenting involves specific activities that support child grandparents or other family members (Evans and development, requiring interaction between parent Stansbery 1998; Arriagada et al. 2018). and child (via play, communication, relationship building). • Content should encompass activities that foster parent-child relationships and involve other caregivers. 06 Quality Framework for Parenting Program Box 3. List of Evidence-Based Content in Parenting Programs 1. Child development : Education on age-appropriate developmental milestones and how to support children’s cognitive, emotional, and social growth 2. Effective communication: Techniques for improving communication with children, including how to listen actively and express love and expectations clearly 3. Responsive caregiving : Modelling and encouraging caregivers to make eye contact, smile, cuddle, and praise 4. Positive discipline: Strategies for guiding behavior in a constructive way, focusing on encouragement and setting limits rather than punishment 5. Play and learning : The role of play in child development and strategies for engaging children in educational and developmentally appropriate activities 6. Parental self-care: The importance of parents’ well-being, including managing stress and maintaining a healthy lifestyle to better support their children 7. Health and nutrition: Guidance on providing a balanced diet, ensuring proper sleep, and promoting physical activity for children. Essential newborn care including kangaroo care for small babies, immunization of mother and child 8. Safety *: Information on creating a safe environment for children both inside and outside the home, including accident prevention and emergency preparedness 9. Building self-esteem*: Approaches to help children develop a positive self-image and confidence in their abilities 10. School readiness*: Preparing children for the academic and social aspects of school and supporting their learning at home 11. Managing transitions and change*: Helping children adapt to significant life changes such as starting school, moving to a new home, or adjusting to a new sibling 12. Substance abuse prevention*: Educating parents on how to discuss substance use with their children and how to set a positive example 13. Conflict resolution*: Skills for resolving family conflicts in a healthy way and fostering an environment of cooperation and respect 14. Family-based parenting training *: To improve parenting skills and reduce behavior patterns in children that are associated with violence later in life, such as aggression and antisocial disorders *Topics 8 through 14 are aimed at supporting parents and caregivers in managing adversity and promoting positive outcomes for children. 07 Quality Framework for Objective(s) Parenting Program In-person support and home visits for parenting DELIVERY MODALITY programs include the following activities carried out by Following the context analysis that helped prioritize the frontline worker: needs and define key content in parenting programs, • Individualized support: Providing support to the the next crucial step is to determine the most effective specific needs and circumstances of each family delivery modality. There are key points to consider that • Discussion: Having discussions with the parent should help one decide which delivery modality to use, focusing on the messages shared during the which include existing community resources and systems, parenting sessions; reminding the parent/caregiver community needs, population risk profiles, and cultural about the messages and practicing them with context (Jeong 2024). This underscores the importance gestures and role play of aligning the chosen modality with the specific • Problem-solving: Using the opportunity to help requirements and circumstances of the target audience parents/caregivers and share best practices on (see Box 4.) specific challenges and issues they face in parenting The following are some characteristics of delivery that are • Goal setting: Assisting parents in setting realistic and contingent upon the target population and the parenting achievable goals for themselves and their children issues the program aims to address. • Resource sharing: Providing materials and resources that parents can use to support their child’s In-Person Support and Home visits development • Linking to and facilitating referrals to existing services: In-person support: This face-to-face modality, held in Referring the parent/caregiver to other community various local settings, provides parents with direct, resources as needed interactive, and personalized support, enabling them • Follow-up: Scheduling subsequent visits to track to better understand and confidently apply parenting progress and provide ongoing support strategies in their home environments. Settings can • Feedback collection: Gathering input from parents include community centers, waiting rooms in mother-and- about the visit and the support provided to improve child clinics, ECD centers, schools, or other local venues. the program Home visiting: Parenting programs with home visits • Documentation: Keeping detailed records of visits, provide personalized guidance and enable parents to progress, and any concerns receive individualized support according to their specific circumstances and family dynamic. In comparison to group sessions, they are cost-intensive and challenging to scale. This is a significant consideration for program implementers and policymakers (in-person non- structured interview with Jeong, March 15, 2024). Box 4. Summary of Best Practices for Delivery Modality of Parenting Programs • Combine and diversify delivery modalities based on community needs. • In-person delivery works best. • Group-based sessions are more cost-effective when relevant to the objective of the parenting program. • Sessions should have a clear goal and be structured. • Sessions should be instructed with continuous feedback and modeling between peers. • Providing printed materials for parents, such as flip books and material kits, is effective. 08 Quality Framework for Objective(s) Parenting Program Group Meetings Telephone or mobile-based support features include2 : Another approach commonly used in parenting programs • Hotlines for immediate parenting advice and crisis is group meetings, held in community centers, schools, or intervention other local venues. Small group delivery is more effective • Scheduled phone sessions with trained parenting for program scale up (Jervis et al. 2023). It helps to bring counselors together multiple parents to participate in interactive • Text messaging services for tips and reminders sessions led by trained facilitators. This also mobilizes • Apps with tools for tracking child development and peer support and problem solving among parents within milestones the community. • Access to resources and support networks via mobile Group-based delivery for parenting programs typically devices includes: Online Programs for parenting support often include: • Structured sessions in community settings like health • Web-based modules accessible from home or any centers or schools location • Facilitation by experts in parenting and child • Interactive content such as videos, articles, and development quizzes • Regularly scheduled meetings to maintain group • Virtual support groups or forums for sharing cohesion experiences • Curriculum focused on key parenting issues and child • Live webinars or workshops led by parenting experts growth • Personalized feedback and advice through online • Group activities, discussions, and sometimes guest platforms speakers • Peer support and shared learning among parents • Role-playing and hands-on exercises to practice Box 5. Example of a Delivery Modality parenting skills in Bangladesh: Inserting Early Stimulation • Information on accessing further family support Messages into a National Nutrition Program services locally The National Nutritional Services Program in • Materials for parents such as flip books and material Bangladesh distributes nutritional supplements and kits provides information to pregnant and lactating women, young mothers, and caregivers about stimulating their Online Programs, Telephone or Mobile- children. Community workers are trained to incorporate Based Support these messages into their routine counseling sessions and distribute picture books for children and Parenting support can be efficiently provided through information to caregivers during clinic visits for wellness technology like hotlines, texts, or apps. For instance, a or sick visits. Additionally, these community health Serbian virtual program used text messaging to effectively workers are expected to conduct home visits to provide deliver parenting tips and encouragement, offering a cost- the same information and distribute the books. effective and convenient method for busy parents (Arnold et al. 2022). However, it should be noted that there is not Impact evaluation conducted on the program found enough evidence on use of media, telephone, or mobile that the program had modest impact on children’s phone-based sessions. cognitive, linguistic, social-emotional, and physical development (Holla and Breeding 2021). 2 There is still little evidence on these approaches, but they o er promise for the future. 09 Quality Framework for Objective(s) Parenting Program DOSAGE Despite that, Jeong’s et al. (2021) meta-analysis and WHO parenting guidelines (2023), both indicate that shorter Dosage is the combination of program intensity and parenting programs with more frequent meetings frequency and length of each session. The duration is the may yield greater effectiveness. Therefore, it would overall length of the parenting program from its start to be advantageous to thoroughly review the evidence end. Intensity in this paper refers to the number of times supporting this assertion. program beneficiaries receive the intervention. Intensity Duration The intervention’s intensity must be tailored to the Research has not yet found evidence of cut-off points target population’s needs, determined by a thorough on the duration of parenting programs to yield effective needs assessment. This informs the design of effective results on child development outcomes. Nevertheless, parenting programs, with intensity and duration set Dulal et al. (2021) conducted trials on the effectiveness according to resources. Involving the community in of integrating nutrition and psychosocial stimulation scheduling increases participation and local commitment. in parenting programs. Among these trials, 11 were implemented in less than 12 months, while 11 others went over 12 months in duration. It was concluded that the length of implementation was not significant to determine the effectiveness of the program. Box 6. Summary of Best Practices for Dosage of Parenting Programs • Intensity and duration depend on available resources and context. • Weekly group meetings lasting between 60–90 minutes are recommended. Box 7. An Example of Dosage in Colombia: Embedding Stimulation and Micronutrient Supplementation in a Conditional Cash Transfer Program Familias en Acciónis a home-based early-childhood stimulation program in Colombia based on the Jamaica program. The intervention in Colombia involved weekly home visits by local women, known as Madres Líderes (MLs), who were drawn from a network of local women and were beneficiaries of the conditional cash transfer program. The women were trained to deliver psychosocial stimulation to mothers and children, promoting play, maternal-child interactions, and improved parenting practices. The program also involved mentors with backgrounds in psychology or social work who provided training and support to the home visitors. The program was evaluated twice: first after 18 months of implementation with children 2.5 and 3.5 years old, and then two years later when those children were 4.5 and 5.5 years old. The first evaluation found “significant impact on cognitive and language development and on the amount of time and effort parents put into interacting with their children.” The second evaluation found that those gains were not sustained two years later. For this program, 18 months of delivery already had a positive impact on the program. But sustainability of the intervention was a major issue (Holla and Breeding 2021). 010 Quality Framework for Objective(s) Parenting Program WORKFORCE This workforce, depending on context, can be made of: • Health professionals: These are people who have university degrees and are paid to deliver medical Box 8. Best Practices with Frontline Workers in services and health education (Aboud et al. 2023). Parenting Programs • Community health workers: The term has been used • Frontline worker training should balance in diverse ways in the literature studied. In some facilitation skills and understanding of child contexts, “community health workers” has been used to represent various levels of paraprofessionals development. (level one paraprofessionals as people with some • Continuous learning through ongoing secondary education and informal training, level two professional development sessions, workshops, paraprofessionals as people with some secondary education and formal training of few months and up or seminars is essential for frontline workers to one year) and lay health workers (Olaniran et al. to stay updated with the latest research, 2017). In other literature, community health workers interventions, and best practices in parenting are individuals who are not professionally trained support. health workers but received some training and are paid a salary (Mohajer and Singh 2018). • Training content should cover essential parenting skills such as effective • Teachers: Strengthening educator–parent partnerships demonstrate that facilitating communication, positive discipline techniques, communication and collaboration between parents child development stages, and fostering healthy and educators can boost children’s academic and parent-child relationships. social-emotional skill development (Lang et al. 2016). For instance, in early childhood education and • Cultural sensitivity and competence are crucial care (ECEC) services, educators communicate with aspects of training to ensure interventions parents about a range of matters related to children’s are tailored to the cultural backgrounds of the development and learning. families being served. • Social workers: These are essential in child protection, • Frontline workers should be equipped with where there is also evidence (Munro 2011) on the strategies for handling common parenting effectiveness of their early interventions with children and families. challenges, recognizing signs of parental stress or mental health issues, and providing • Paraprofessionals: (See community health workers.) appropriate referrals. • Volunteers: These individuals typically have a specialized training in health campaigns and child • Training duration should exceed a minimum of protection. They are often involved in community two weeks. service and may receive modest financial incentives for their efforts (Aboud et al. 2023; Mohajer and Singh 2018). Type The difference between those categories of frontline workers is the level of training each has received, which The “frontline workers” of parenting programs, meaning tasks they are each to accomplish, and how they are the people delivering the parenting intervention directly remunerated. to the parents, are key to the success and achievement of childhood development outcomes. They are the community-known individuals who deliver interventions, leveraging their cultural and linguistic familiarity to foster trust and encourage community engagement. 011 Quality Framework for Objective(s) Parenting Program Content and training of workforce • Problem-solving: Training should include problem-solving exercises that allow trainees to work through real-world Enhancing the capacity of frontline workers in parenting scenarios. This helps develop critical thinking skills and the programs involves bolstering their knowledge, skills, and ability to apply knowledge in practical situations. capabilities to effectively support families in fostering healthy child development and positive parenting practices. • Referrals for training: Sometimes, additional training or This endeavor is pivotal for improving outcomes for children resources may be necessary for trainees to fully grasp and families, addressing challenges, and enhancing overall complex topics or to further their learning. Providing community well-being (Sanders 2008). referrals to additional training resources or advanced courses can be beneficial. The content and length of training for frontline workers in parenting programs can vary depending on numerous factors, Training should include cultural sensitivity and competence such as the program’s objectives, target population, and to ensure that interventions are tailored to the cultural available resources. However, there are some commonalities backgrounds of the families. Workers should have a good and best practices that can guide the development of such understanding of child development principles and milestones training programs. For example, a 2-week training program to provide appropriate support and guidance to parents. with daily sessions having a duration of 90 minutes each Frontline workers should be equipped with strategies for can be more effective in delivering the content. However, handling common parenting challenges and crisis situations the 2-week training parenting program should consider the effectively. minimum hours over minimum time required, taking into consideration transportation, people mobilization, and so on. Training should also include information on recognizing signs of parental stress, depression, or other mental health issues Training should cover essential parenting skills, such as and providing appropriate referrals and support. Workers effective communication, positive discipline techniques, should be familiar with available community resources such child development stages, building resilience in children, and as support groups, counseling services, childcare facilities, fostering healthy parent-child relationships. It is also crucial and educational programs to help parents access additional for frontline workers to understand and respect the cultural support when needed. While robust initial training lays a solid diversity among families they serve. foundation, ongoing supervision is equally indispensable for monitoring program implementation and ensuring the When designing quality training for workforce development, provision of necessary resources. there are several key components that should be included to ensure the training is effective and comprehensive. Here is a brief overview of each component: Motivation of frontline workers: Financial and non- • Modeling: This involves demonstrating the skills or financial incentives behaviors that trainees are expected to learn. It provides a Parenting programs differ in their recruitment and clear example for learners to emulate and sets a standard compensation strategies, ranging from unpaid volunteers of performance. to waged workers, impacting staff quality, retention, and program costs. While paid positions may draw more qualified • Hands-on practice: Providing opportunities for trainees to individuals, volunteers often offer a higher motivation to practice what they have learned is crucial. This helps to improve the lives of children in the community motivation reinforce learning and allows trainees to apply new skills but may lack skills. Attrition is frequently high due to low in a controlled environment. compensation and job demands (time consuming and high • Mastering the curriculum: Ensuring that the training independent mobility) (Tomlinson et al. 2015; Arriagada et al. curriculum is thoroughly understood and mastered by 2018). trainers is essential. Trainers should be well-versed in the material so they can effectively teach and respond to trainee questions. 012 Quality Framework for Objective(s) Parenting Program The following are strategies to motivate frontline workers: • Professional development opportunities: Offering opportunities for professional development and career • Recognition and rewards: Providing recognition and advancement can motivate frontline workers to enhance rewards for frontline workers’ efforts can boost motivation their skills and knowledge. This could include access and morale. This could include verbal praise, certificates of to training programs, workshops, and conferences, appreciation, or small incentives such as gift cards or extra as well as opportunities for advancement within the time off. Research suggests that recognition and rewards organization. Research suggests that investing in can increase job satisfaction and performance among employees’ professional development can lead to higher frontline workers (Smith 2019). job satisfaction and motivation. • Relationships and feedback: Effective communication • Intrinsic motivation: Fostering intrinsic motivation, or from supervisors and organizational leaders is essential motivation that comes from within, can be achieved by for motivating frontline workers. Research indicates that providing opportunities for autonomy, mastery, and communication plays a key role in fostering employee purpose in frontline workers’ roles. Allowing frontline motivation and commitment (Locke and Latham 2013). workers to have a degree of autonomy in decision- • Clear roles and responsibilities: Providing clear expectations, making, facilitating opportunities for skill development regular feedback, and opportunities for input can help and mastery, and connecting their work to a sense of frontline workers feel valued and engaged in their work purpose can enhance intrinsic motivation. (Locke and Latham 2013). Box 9. Example of Strategies: The Triple P Program Adopted to Train Frontline Workers The Triple P Positive Parenting Program has been effective in providing frontline workers with essential skills (Sanders 2008; Prinz et al. 2009), highlighting the importance of continuous training and support for enhancing program impact and longevity. Training for the program includes modules on its principles, strategies, assessment, and implementation. Frontline workers undergo didactic instruction, engage in role- play for skill enhancement, study case examples for practical application, and receive ongoing supervision and coaching to maintain program fidelity. Additionally, they are encouraged to pursue continuing education to keep abreast of the latest developments in parenting support. 013 Quality Framework for Objective(s) Parenting Program Box 10. Examples of Program Aspects to Measure per Content Type* Child development: Education on age-appropriate developmental milestones and how to support children’s cognitive, emotional, and social growth. • Measure caregiver’s understanding of the different age-appropriate milestones by asking caregivers to list important milestones for a given age in an interview. The interview questions could be developed using the training material on child development. • Measure caregiver’s understanding on support they can provide to children at the distinct stages. • Use one of the caregiver’s children as an example, collect data on the child’s age and ask the caregiver to describe the stage at which the child is in his development. Ask the caregiver to report on the type of activities they conducted with the child over the last week to support his cognitive, emotional, and social growth. Positive discipline: Strategies for guiding behavior in a constructive way, focusing on encouragement and setting limits rather than punishment. • Collect caregiver’s report on the number of times they used harsh discipline over the last seven days. • Collect caregiver’s perceptions about using harsh discipline. • Measure the percentage of caregivers that could list at least three positive discipline techniques. Play and learning: The role of play in child development and strategies for engaging children in educational and developmentally appropriate activities. • Collect caregiver’s report on time spent playing with children. • Other specific list of indicators can be found in Table 3 (p. 20), of the following resource: Indicators for Measuring Responsive Care and Early Learning Activities (Hentschel, Yousafzai, and Aboud 2021) Parental self-care: The importance of parents’ well-being, including managing stress and maintaining a healthy lifestyle to better support their children. • Collect caregiver’s report on self-care initiatives they conducted over the last week or month. • Administer the Parental Stress Scale to the caregivers and set a reasonable target to achieve (Kotsis et al. 2023). *Note: The list is not exhaustive; it is illustrative of what could be measured. A detailed monitoring and evaluation plan should be developed based on the program’s objectives and activities. Process monitoring involves ensuring that activities are MONITORING AND EVALUATION executed properly and effectively, while performance Monitoring and continuous learning are essential to monitoring entails the assessment of project indicators’ ensure that parenting addresses the needs of the target status. Both types are conducted regularly throughout population, and that the implementation is taking place the project’s implementation. In contrast, evaluations in conformity with program design (Britto et al. 2022). are carried out at predetermined intervals to appraise Parenting program monitoring encompasses two distinct performance indicators and to explore additional types: process monitoring and performance monitoring. questions related to the program’s objectives. 014 Quality Framework for Objective(s) Parenting Program These are common tools used for the monitoring and Record keeping for sessions: evaluation of any type of program, though they are often • For group sessions, create an attendance sheet overlooked for parenting programs: to document the number of participants in each • A program theory of change: to explain in detail how session. This also applies to the online sessions. the expected change of the parenting program will Additionally, the frontline worker should record any occur, while providing a detailed causal pathway commitments made by participants to implement between the activities all the way to the outcomes the session’s teachings. The attendance sheet should and impact. Insights from context analysis can be also include a section for any notable observations or integrated into the theory of change, enriching its comments that may arise during the session. relevance and applicability. • For home visits, a detailed registry is necessary • A results framework: constructed to illustrate the to capture the nuances of each encounter. The interconnections among various outcomes, thereby frontline worker should note the identities of all providing a structured approach to achieving the individuals met during the visit, such as the mother, parenting program’s goals. grandmother, and children. It is also important to document any referrals made to the local health • A logical model: to depict in a simple and visual center, particularly for children or pregnant and manner the theory of change, connecting the lactating women. This information is crucial for parenting program’s inputs, outputs, results, and ensuring continuity of care and allows for effective outcomes with indicators to measure each level. The follow-up on subsequent visits. model also presents the assumptions that need to hold true for the program to achieve its goals. Supervision for delivery fidelity: • Data storage system: a central and informatized The program should be underpinned by a well-defined system to store project data is essential to secure plan that outlines the key aspects to be monitored: project information. The project implementation unit • Ensure fidelity of activity delivery according to should avoid keeping reports and beneficiary data on curriculum and project workplan. staff computers only without a backup system. When it comes to beneficiary records, the project should • Address issues encountered by frontline worker in align, when possible, with the national data system. activity delivery. • Provide coaching/mentorship to the frontline worker Process monitoring after observing the frontline worker deliver messages Testing training quality: in a session. • Assess understanding of training participants • Verify registry of frontline workers to check if it is through pre- and post-training tests focused on being filed accordingly, if not provide coaching. key curriculum concepts. Participants failing to Discuss with community leaders and group of achieve the satisfactory grade threshold—set by the caregivers to get their appreciation of the parenting program team—must be provided with additional program implementation and address any issues training opportunities before they can start delivering identified. messages to the target community. Community accountability system: • Monitor training attendance and ensure that each • Set up a hotline or suggestion box for individuals to training session’s duration adheres to the planned submit feedback about the program. schedule. • Establish a committee made of respected men and • Evaluate participants’ satisfaction with the training women within the community to receive and address delivery methodology, venue, and duration at the end complaints. of training. Participants are asked to reflect on what they liked and what could be done differently in the • Share status of performance indicators with future. community members in general assembly regularly after any major evaluations (mid-term and impact evaluation). 015 Quality Framework for Objective(s) Parenting Program Performance monitoring • Develop minimum standards on parenting programs. Effective monitoring of performance indicators for • Allocate sufficient resources for parenting programs. parenting programs encompasses several key strategies: • Get parenting facilitator role recognized among the • Indicators must be specific, measurable, achievable, official roles in the workforce. relevant, and time-bound (SMART), while • Connect the data collection system for parenting simultaneously capturing the specific components programs with the national data system. that the parenting program aims to influence. • Establish indicators at every level of the program. While activity or output level indicators are commonly PARTNERSHIPS articulated, it is equally important to define indicators Community change agents/influencers for results and outcomes. Within every community, there exist pivotal agents of • All stakeholders involved in the program’s change who possess the capacity to shape the behaviors implementation, including the target communities, of others: are well-informed about the performance indicators. This ensures a shared understanding of the metrics • Identify and engage influential community figures used to gauge the program’s impact and progress. (respected authorities, religious leaders, etc.) for fostering widespread adoption of positive parenting Evaluation techniques. One notable consideration to make is that impact • Develop a strategy to engage those key influencers assessments should be conducted only after the program to effectively integrate them into the program for its has been operating for a sufficient period, ensuring that enhanced success. communities have had many opportunities to participate in the full range of activities. Moreover, ongoing Public private partnerships monitoring data should guide the decision-making process, helping to ascertain whether the impact is at a Public-private partnerships (PPPs) can play a significant stage where it can be reliably observed. role in the implementation and sustainability of parenting programs by leveraging the strengths and resources of In all, it should be noted that monitoring and evaluation both sectors: are meant to help the program assess and adapt implementation. Regular reports produced out of • They include partnerships with corporations, monitoring data and evaluation reports should be foundations, and philanthropic organizations that can discussed by program management to make the contribute financial resources to support parenting necessary adaptation to the implementation. programs. • Partnership funding can reduce reliance on government resources alone. Funding can be used Policies and Partnerships for to develop program materials, provide training for Parenting Programs frontline workers, conduct outreach and awareness campaigns, or establish community-based support POLICIES services. Implementing effective parenting programs requires a • Partnerships can help expand the scale and reach supportive enabling environment and a set of well-crafted of parenting programs by tapping into the private policies: sector’s networks, distribution channels, and • Develop a national curriculum for parenting marketing capabilities. programs (a curriculum addressed for training caregivers and for the frontline workers). 016 Quality Framework for Objective(s) Parenting Program Partnerships with other programs/organizations achieving the desired outcomes—services that the program itself may not provide. Parenting programs often operate with constrained • Develop partnerships with these stakeholder resources, making it impossible to tackle every issue organizations to enable the parenting program to that may impact child development. To minimize this direct beneficiaries toward their services, thereby constraint: ensuring that all available resources are leveraged to • Identify key stakeholders operating within the enhance the prospects of attaining the anticipated program’s geographic area who offer services child development goals. deemed essential in the theory of change for Box 11. The Cuna Mas Program in Peru: A Program that Encompasses the Components of the Quality Framework The Cuna Más program in Peru is a comprehensive early childhood development (ECD) program that aims to provide support to families with children aged 0-3 years (Araujo et al. 2021; Arriagada et al. 2018; Guerrero and León 2017; Datla 2021). • Objectives: The primary objective of the Cuna Más program is to promote early childhood development through a combination of parenting interventions, including nutrition, health, hygiene, child stimulation, and positive parenting. The program aims to provide comprehensive support to families to ensure the healthy development of young children. • Audience: The program targets pregnant women and caregivers of children aged 0-3 years, with a focus on reaching and communicating with families throughout the country. The program is designed to cater to the needs of families in different geographic areas and socio-economic backgrounds. • Content: The parenting curriculum of the Cuna Más program is adapted from the Reach UP model and previous country experiences. It covers a range of topics including nutrition, health, hygiene, child stimulation, and positive parenting. The program also incorporates social, and behavior change strategies such as play and feedback to parents. • Delivery Modality: The parenting interventions are delivered through a combination of home visits, community- based group sessions, and day care services. This approach allows for personalized and targeted engagement with families based on their specific needs. Additionally, the program is designed to complement face-to- face activities within childcare and home visiting services with a permanent remote modality, allowing for a combination of schemes depending on the family’s needs. • Duration: The parenting dosage involves weekly sessions, with up to about 144 sessions. This consistent and long-term engagement with families is aimed at providing sustained support for early childhood development. • Training: Front-line workers involved in delivering the parenting interventions receive 9 days of pre-service training, other 9 in-service training, and are part of a monitoring and evaluation system. The workers are employed by the national government and receive a paid stipend, with no minimum level of education required. • Outcomes: The Cuna Más program has demonstrated interest from other country programs, such as Criança Feliz in Brazil, in learning how technology-based strategies can complement in-person individual and group parenting interventions. The program’s lessons learned and adapted approaches are expected to be reflected in Peru’s national ECD policy, which is currently under revision. This indicates the potential for the program to influence broader policy and programmatic approaches to early childhood development in Peru and beyond. 017 Objective(s) While partnerships and policies were somewhat Conclusion and discussed in this guidance note and are not components Recommendations of the quality framework, they are instrumental elements in enhancing the attainment of high-quality outcomes in parenting programs. This Guidance Note outlines quality elements that are common practices while designing and implementing The quality framework’s recommended practices and evidence-based parenting programs across various common strategies for evidence-based parenting domains, such as health, education, and social program development are informed by research, field protection. Evidence-based parenting programs experience, and expert consultations. Nonetheless, there should commence with an in-depth context analysis to is a pressing need for more data on the implementation comprehend the community’s perception of parenting, of evidence-based parenting programs across diverse identify needs, and establish priorities. Subsequently, settings. Further research is also important to explore a quality framework can be utilized to delineate the the use of technology, especially any form of media, as a program’s content, delivery methods, frequency, and delivery channel for such programs and to examine the workforce considerations—including type, training, and training and compensation of the workforce involved in compensation. Additionally, monitoring and evaluation delivering parenting programs. processes are crucial for improvement and expansion of programs. Acknowledgements This note is a joint work by Manzuma Bozmamadova (Early Years Fellow, Tajikistan and Uzbekistan), Rayanatou Laouali (Early Years Fellow, Niger), and Pia Sosa Walder (Early Years Fellow, Paraguay) made possible by the Early Learning Partnership (ELP) multi-donor trust fund’s Early Years Fellowship. It was prepared under the guidance of the Parenting & Adversity capstone coach, Dr. Jorge Cuartas (Consultant) and the Capstone Coordination Team, namely Melissa Diane Kelly (Education Specialist), Alisa Currimjee (Consultant), and Catalina Quintero (Consultant). Their guidance and support were instrumental in completing this project. We also extend our gratitude to our peer reviewers, Amer Hasan (Senior Economist), Fitsum Zewdu Mulugeta (Economist), Ibrahima Samba (Education Specialist), Marguerite Marlow (Senior Researcher, Stellenbosch University), and Joshua Jeong (Assistant Professor, Rollins School of Public Health), for their critical insights and constructive feedback. Suggested Citation: Bozmamadova, M., Laouali, R., and Sosa Walder, P. 2025. Guidance Note on Designing and Implementing Early Childhood Parenting Programs. Washington, DC : World Bank This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. RIGHTS AND PERMISSIONS The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. 018 Objective(s) References Aboud, F., K. Choden, M. Tusiimi, R. Contreras Gomez, R. Hatch, S. Dang, T. Betancourt, K. Dyenka, G. Umulisa, & C. Omoeva. 2023. A tale of two programs for parents of young children: Independently conducted case studies of workforce contributions to scale in Bhutan and Rwanda. Children 10(8): 1413. Araujo, M.C., M. Rubio-Codina, & M. Dormal. 2018. Quality of Parenting Programs and Child Development Outcomes: The Case of Peru’s Cuna Mas. Working Paper no. 9205, IDB Publications, Inter-American Development Bank. Arriagada, A., J. Perry, L.B. Rawlings, J.M. Trias, & M. Zumaeta. 2018. Promoting Early Childhood Development Through Combining Cash Transfers and Parenting Programs. Washington, D.C.: World Bank Group. https://documentsinternal. worldbank.org/search/30607172 Attanasio, O., H. Baker-Henningham, R. Bernal, C. Meghir, D. Pineda, & M. Rubio-Codina. 2022. Early stimulation and nutrition: The impacts of a scalable intervention. Journal of the European Economic Association 20(4), 1395-1432. https:// academic.oup.com/jeea/article/20/4/1395/6516938 (last accessed on August 1st, 2023) Baldwin, T. T., & Ford, J. K. 1988. Transfer of training: A review and directions for future research. Personnel psychology, 41(1), 63-105. https://gwern.net/doc/psychology/1988-baldwin.pdf Beidas, R. S., Paciotti, B., Barg, F., Branas, A. R., Brown, J. C., Glanz, K., ... & Schmitz, K. H. 2014. A hybrid effectiveness- implementation trial of an evidence-based exercise intervention for breast cancer survivors. Journal of the National Cancer Institute Monographs, 2014(50), 338-345. . Black, M.M., R. Pérez-Escamilla, & S. Fernandez-Rao. 2015. Integrating nutrition and child development interventions: Scientific basis, evidence of impact, and implementation considerations. Advances in Nutrition 6(6): 852–859. https://doi. org/10.3945/an.115.010348 Black, M.M., S.P. Walker, O. Attanasio, M. Rubio-Codina, C. Meghir, J.D. Hamadani, L.C.H. Fernald, A. Kowalski, & S. Grantham-McGregor. 2023. Promoting childhood development globally through caregiving interventions. Pediatrics 151(Suppl 2). https://doi.org/10.1542/peds.2023-060221B Bornstein, M., J. Kotler, & J. Lansford. 2022. The Future of Parenting Programs: An Introduction, Parenting 22(3): 189-200, DOI: 10.1080/15295192.2022.2086808 Borrelli, B., D. Sepinwall, D. Ernst, A. Bellg, A. J. Czajkowski, R. Breger, ... & D. Orwig, D. 2005. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of Consulting and Clinical Psychology 73(5): 852. https://www.researchgate.net/publication/7481810_A_new_tool_to_assess_treatment_fidelity_and_ evaluation_of_treatment_fidelity_across_10_years_of_health_behavior_research (last accessed on 06/06/2023) Britto, P. R., & Engle, P. 2015. Parenting education and support: Maximizing the most critical enabling environment. Investing against evidence, 157. https://books.google.com/ Britto, P. R., Bradley, R. H., Yoshikawa, H., Ponguta, L. A., Richter, L., & Kotler, J. A. 2022. The future of parenting programs: III uptake and scale. Parenting, 22(3), 258-275.https://doi.org/10.1080/15295192.2022.2086809 (Last accessed November 5, 2023) Cambridge University Press. n.d.. Upcycling. In Cambridge dictionary. Retrieved in September 13, 2024 from https:// dictionary.cambridge.org/us/dictionary/english/beneficiary#google_vignette. Tomlinson, M., Hunt, X., Watt, K., Naicker, S., & Richter, L. (2020). Programmatic guidance for interventions to improve early childhood development in high HIV burden countries: a narrative review. Vulnerable Children and Youth Studies, 15(4), 289–306. https://doi.org/10.1080/17450128.2020.1786204 (Last accessed June 20, 2024). Cuartas, J., H. Baker-Henningham, A. Cepeda, C. Rey-Guerra, & the Instituto Colombiano de Bienestar Familiar Icbf Early Childhood Team. 2022. The Apapacho Violence Prevention Parenting Program: Conceptual foundations and pathways to scale. International Journal of Environment Research and Public Health 19(14): 8582. doi: 10.3390/ijerph19148582. PMID: 35886432; PMCID: PMC9325014. (https://pubmed.ncbi.nlm.nih.gov/35886432/ (last accessed on 6/6/2023) Daelmans, B., S.A. Manji, & N. Raina. 2021. Nurturing care for early childhood development: Global perspective and guidance. Indian Pediatrics 58(Suppl 1), 11-15. Daly, M., R. Bray, Z. Bruckhauf, J. Byrne, A. Margaria, N. Pecnik, & M. SammsVaughan. 2015. Family and parenting support: Policy and provision in a global context. Innocenti Insight, UNICEF Office of Research, Florence, Italy. 019 Objective(s) Dulal, S., A. Prost, S. Karki, N. Saville, & D. Merom. 2021. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: A systematic review and meta-analysis. BMJ Global Health 6(7): e003872. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319976/ (Last accessed on July 31st, 2023) Evans, J. 2006. Parenting Programs: An Important ECD Intervention Strategy. UNESCO. https://unesdoc.unesco.org/ark:/48223/ pf0000147461. Evans, J.L., & P.A. Stansbery. 1998. Parenting in the Early Years: A Review of Programs for Parents of Children from Birth to Three Years of Age. Washington, DC: World Bank. https://documentsinternal.worldbank.org/search/442397 Galvin, L., Verissimo, C. K., Ambikapathi, R., Gunaratna, N. S., Rudnicka, P., Sunseri, A., ... & Kieffer, M. P. 2023. Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women’s empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial. Social Science & Medicine, 324, 115869. Gertler, P., Heckman, J. J., Pinto, R., Chang, S. M., Grantham-McGregor, S., Vermeersch, C., ... & Wright, A. 2021. Effect of the Jamaica early childhood stimulation intervention on labor market outcomes at age 31 (No. w29292). National Bureau of Economic Research. Gomby, D. S., Culross, P. L., & Behrman, R. E. 1999. Home-Visiting: Recent Program Evaluations-Analysis and Recommendations. The Future of Children, 9, 4-26. https://doi.org/10.2307/1602719. Holla, A., & M. Breeding. 2021. Lessons from Parenting Programs in Early Childhood. Washington, DC: World Bank Group. https://documentsinternal.worldbank.org/search/33146889 Hentschel, E., K.A. Yousafzai, E.F. Aboud. 2021. Indicators for measuring responsive care and early learning activities. Nurturing Care for Early Childhood Development. https://nurturing-care.org/wp-content/uploads/2021/03/Proposed_ indicators.pdf Galvin, L., Verissimo, C. K., Ambikapathi, R., Gunaratna, N. S., Rudnicka, P., Sunseri, A., ... & Kieffer, M. P. 2023. Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women’s empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial. Social Science & Medicine, 324, 115869. Jeong. 2024. cited p 11, 13 Jeong, J., E. Franchett, C. Ramos de Oliveira, K. Rehmani, & A. Yousafzai. 2021. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS medicine 18, e1003602 Jervis, P., J.O. Coore-Hall, H. Pitchik, C. Arnold, S. Grantham-McGregor, M. Rubio-Codina, H. Baker-Henningha et al. 2023. The Reach Up parenting program, child development, and maternal Josephson, K., G. Guerrero, & C. Coddington. 2017. Supporting the early childhood workforce at scale: The Cuna Más home visiting program in Peru. Results for Development. Washington, DC: World Bank. http://repositorio.minedu.gob.pe/ handle/20.500.12799/5528 Kotsis, K., M. Boukouvala, A. Serdari, I. Koullourou, V. Siafaka, T. Hyphantis. 2023. Parental stress scale: Psychometric properties in parents of preschool children with developmental language disorder. Healthcare (Basel) (May 5) 11(9): 1332. doi: 10.3390/healthcare11091332. PMID: 37174874; PMCID: PMC10178680. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC10178680/ Lang, S. N., Tolbert, A. R., Schoppe-Sullivan, S. J., & Bonomi, A. E. (2016). A cocaring framework for infants and toddlers: Applying a model of coparenting to parent–teacher relationships. Early Childhood Research Quarterly, 34, 40-52. https://doi. org/10.1016/j.ecresq.2015.08.004 Lansford, J. E., Betancourt, T. S., Boller, K., Popp, J., Pisani Altafim, E. R., Attanasio, O., & Raghavan, C. (2022). The future of parenting programs: II implementation. Parenting, 22(3), 235-257. Leer, J. & F. Lopez-Boo. 2019. Assessing the quality of home visit parenting programs in Latin America and the Caribbean. Early Child Development and Care 189(13): 2183-2196, DOI: 10.1080/03004430.2018.1443922. Locke, E.A., & Latham, G.P. (Eds.). (2012). New Developments in Goal Setting and Task Performance (1st ed.). Routledge. https://doi.org/10.4324/9780203082744. 020 Objective(s) Manghani, K. 2011. Quality assurance: Importance of systems and standard operating procedures. Perspectives in clinical research, 2(1), 34-37. https://journals.lww.com/picp/fulltext/2011/02010/Quality_assurance__Importance_of_systems_ and.7.aspx (Last accessed on July 31, 2023) McCoy, D.C., J. Seiden, J. Cuartas, L. Pisani, & M. Waldman. 2022. Estimates of a multidimensional index of nurturing care in the next 1000 days of life for children in low-income and middle-income countries: A modelling study. The Lancet Child & Adolescent Health 6(5): 324-334. Mohajer, N., & D. Singh. 2018. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: Meta-synthesis using the concept of social capital. Human Resource Health 16(63). https://doi. org/10.1186/s12960-018-0331-7 Munro, E. 2011. The munro review of child protection: Final report a child centred system. https://assets.publishing.service. gov.uk/media/5a7b455ee5274a34770ea939/Munro-Review.pdf Olaniran, A., H. Smith, R. Unkels, S. Bar-Zeev, & N. van den Broek. 2017. Who is a community health worker? - A systematic review of definitions. Global Health Action 10(1): 1272223. doi: 10.1080/16549716.2017.1272223. PMID: 28222653; PMCID: PMC5328349. Prime, H., K. Andrews, A. Markwell, A. Gonzalez, M. Janus, A.C. Tricco, A. C., ... & L. Atkinson, L. 2023. Positive parenting and early childhood cognition: A systematic review and meta-analysis of randomized controlled trials. Clinical Child and Family Psychology Review, 1-39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10123053/ (Last accessed August 2nd, 2023) Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The US Triple P system population trial. Prevention science, 10, 1-12. https://link.springer.com/article/10.1007/ s11121-009-0123-3 (Last accessed, July 31, 2023) Sanders, M. R. 2008. Triple P-Positive Parenting Program as a public health approach to strengthening parenting. Journal of Family Psychology, 22(4), 506–517. https://doi.org/10.1037/0893-3200.22.3.506Scannell, C. 2021. Parental self-efficacy and parenting through adversity: Parenting-studies by an ecocultural and transactional perspective. IntechOpen. doi:10.5772/ intechopen.91735. Smith, C.S. 2019. Employee recognition: A strategic approach. In Human Resource Management Review (pp. 193-202). Routledge. DOI: 10.4324/9780429056329-14 Tomlinson, H. B., & Andina, S. 2015. Parenting education in Indonesia: Review and recommendations to strengthen programs and systems. UIS (United Nations Educational, Scientific and Cultural Organization Institute for Statistics). 2012. A Place to Learn: Lessons from Research on Learning Environments. Montreal. UNICEF. 2020. Designing Parenting Programs for Violence Prevention: A Guidance Note. https://www.unicef.org/media/77866/ file/Parenting-Guidance-Note.pdf (Last accessed May 15, 2023) WHO, UNICEF. 2021. Nurturing Care Handbook. https://nurturing-care.org/handbook/ (Last accessed March 28, 2024). Yousafzai, A.K., & F. Aboud. 2014. Review of implementation processes for integrated nutrition and psychosocial stimulation interventions. Annals of the New York Academy of Sciences 1308(1): 33-45. https://nyaspubs.onlinelibrary.wiley.com/ doi/10.1111/nyas.12313 (Last accessed August 2nd, 2023) Yousafzai, A.K., M.A. Rasheed, & S. Siyal. 2018. Integration of parenting and nutrition interventions in a community health program in Pakistan: An implementation evaluation. Annals of the New York Academy of Sciences 1419(1): 160-178. https:// nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.13649 (Last accessed July 31, 2023) World Health Organization. 2022. WHO guidelines on parenting interventions to prevent maltreatment and enhance parent– child relationships with children aged 0–17 years. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. World Bank. 2017. Rwanda—Strengthening Social Protection Project. Washington, DC: World Bank Group. https:// documentsinternal.worldbank.org/search/2894085 World Bank. 2022. ELP Grants and Country Work - Thematic Round: Playful Parenting (2020-2022). Washington, DC: World Bank Group. https://documentsinternal.worldbank.org/search/33876005