Masayang Pamilya Feasibility Study

Physical abuse (including abusive discipline) will be measured using 16 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Parent version (ICAST-TP). The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-Parent version (ICAST-P), and has been used successfully in low and middle-income countries, including recently in the Philippines. The ICAST-TP measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did you discipline [Child Nickname] by pushing, grabbing, or kicking him/her?").

Emotional abuse will be measured using 10 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Parent version (ICAST-TP). The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-Parent version (ICAST-P), and has been used successfully in low and middle-income countries, including recently in the Philippines. The ICAST-TP measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times.

Physical abuse (including abusive discipline) will be measured using 14 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Parent version (ICAST-TP). The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-Parent version (ICAST-P), and has been used successfully in low and middle-income countries, including recently in the Philippines. The ICAST-TP measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did you discipline [Child Nickname] by pushing, grabbing, or kicking him/her?").

Emotional abuse will be measured using 10 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Parent version (ICAST-TP). The ICAST-T is an adaptation of the multi-national and consensus-based survey instrument ICAST-Parent version (ICAST-P), and has been used successfully in low and middle-income countries, including recently in the Philippines. The ICAST-TP measures parental reports of the incidence of abuse perpetrated against their child over the past month using a frequency score on a scale of 0 to 7, or 8 or more times.

Physical abuse (including abusive discipline) will be measured using 10 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Adolescent version (ICAST-TA). The ICAST-TA measures child reports of the incidence of abuse perpetrated against them over the past month using a frequency score on a scale of 0 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did your caregiver push, grab, or kick you?"). This study will assess incidence of child maltreatment for physical (11 items).

Emotional abuse will be measured using 10 items from an adapted and expanded version of the ISPCAN Child Abuse Screening Tool-Trial Adolescent version (ICAST-TA). The ICAST-TA measures child reports of the incidence of abuse perpetrated against them over the past month using a frequency score on a scale of 0 to 7, or 8 or more times.

Child neglect will be assessed using an adapted version of the ICAST-T Caregiver (mentioned above) Neglect subscale. This subscale has three items for assessing medical, physical, and educational neglect, including "In the past month, how often was [Child Nickname] not taken care of when sick or injured, even when you or another caregiver were able to do so and could afford it?" and "In the past month, how often was [Child Nickname] not given a meal that he or she needed, even when you or another caregiver was able to afford it?"

Child neglect will be assessed using an adapted version of the ICAST-T Caregiver (mentioned above) Neglect subscale. This subscale has five items for assessing medical, physical, and educational neglect, including "In the past month, how often was [Child Nickname] not taken care of when sick or injured, even when you or another caregiver were able to do so and could afford it?" and "In the past month, how often was [Child Nickname] not given a meal that he or she needed, even when you or another caregiver was able to afford it?"

Parental monitoring and supervision practices will be measured using an adapted parental monitoring scale (11 items) which scale measures parents' solicitation of information (5 items, i.e., "How much do you try to know…") concerning their child's activities and friendships (e.g., who your child spends time with) using a 3-point scale (0 = I don't try; 2 = I try a lot); rule-setting, or how often parents set rules or limits about the same items using a 4-point scale (0 = Never; 3 = Always). Three items on monitoring online activities were added to the solicitation of information subscale (e.g., "How much do you try to know the websites your child visits?) and two items were added to the rule-setting subscale (e.g., "How much do you set rules or limits on how long your child uses his or her device?), derived from the Global Kids Online survey. Mean scores on the subscales are standardized and summed to create a parental monitoring score.

Parental monitoring and supervision practices will be measured using an adapted parental monitoring scale (20 items). The scale measures parents' solicitation of information (7 items, i.e., "How much do you try to know…") concerning their child's activities and friendships (e.g., who your child spends time with) using a 3-point scale (0 = I don't try; 2 = I try a lot); rule-setting, or how often parents set rules or limits about the same items using a 4-point scale (0 = Never; 3 = Always). Four items on monitoring of online activities were added to the solicitation of information subscale (e.g., "How much do you try to know the websites your child visits?) and nine items were added to the rule-setting subscale (e.g., "How much do you set rules or limits on how long your child uses his or her device?), derived from the Global Kids Online survey. Mean scores on the two subscales are standardized and summed to create a total parental monitoring score.

Child behavior problems will be measured using the Child and Adolescent Behavior Inventory (CABI) (14 items). The CABI assesses a wide range of internalizing and externalizing symptoms in children and adolescents and is relatively shorter than the Child Behavior Check List (CBCL), making it a practical and reliable tool for measuring behavior problems. Parents report on their child's behavior during the past month (0 = Not True, 1 = Somewhat or Sometimes True, 1 = Very True). The irritability subscale (4 items, e.g., "has frequent mood changes") and the externalizing subscale (10 items, e.g., often lies or cheats) will be used to measure problem behaviors. Items on both subscales are summed to create a total score of child behavior problems.

Child behavior problems will be measured using the Child and Adolescent Behavior Inventory (CABI). The CABI assesses a wide range of internalizing and externalizing symptoms in children and adolescents and is relatively shorter than the Child Behavior Check List (CBCL), making it a practical and reliable tool for measuring behavior problems. Children report on their own behavior during the past month (0 = Not True, 1 = Somewhat or Sometimes True, 1 = Very True). The irritability subscale (4 items, e.g., "has frequent mood changes") and the externalizing subscale (10 items, e.g., often lies or cheats) will be used to measure problem behaviors. Items on both subscales are summed to create a total score of child behavior problems.

The Three Problem Scale-Child Report (6 items) specific concerns or issues parents are having with their children change during an intervention. Parent-defined concerns from the Three Problem Scale that is consistent or larger than other measurements such as the Strengths and Difficulties Questionnaire or Child Behavior Check List. This study adapted the parent-report scale for children to report on specific issues or problems they are having with their parents. Children are asked to identify up to 3 areas of conflict with their parents that are causing them the most distress and to rate each problem area from 1 to 10 (1 = "not a problem," 10 = "couldn't be worse"). The same problem areas are then asked at post-assessment to assess whether these problems have changed. Each single item will be analysed separately as well as a total problem rating score for the 3 issues.

The Three Problem Scale-Parent Report (9 items) was adapted from developed by Scott to assess whether specific concerns or issues parents are having with their children change during an intervention. Parent-defined concerns from the Three Problem Scale that is consistent or larger than other measurements such as the Strengths and Difficulties Questionnaire or Child Behavior Check List. Parents are asked to identify up to 3 areas of concern with their children that are causing them the most distress and to rate each problem area from 1 to 10 (1 = "not a problem," 10 = "couldn't be worse"). The same problem areas are then asked at post-assessment to assess whether these problems have changed. Each single item will be analysed separately as well as a total problem rating score for the 3 issues.

Parenting efficacy will be assessed using the Efficacy Subscale of the Parenting Sense of Competence Scale (8 items; PSOC-ES). The PSOC has been widely used in studies to evaluate parenting self-esteem, efficacy, or competence. The PSOC Efficacy Subscale measures parental perception of competence, problem-solving ability, and capability in the parenting role (e.g., "I honestly believe I have all the skills necessary to be a good mother/father to my child"). Each item is rated on a 6-point scale that ranges from 1 (strongly disagree) to 6 (strongly agree). Items are summed to create a total score of parental self-efficacy.

Parenting stress will be assessed using the Parental Stress Scale (PSS; 18 items). PSS has been widely used to measure parenting stress, including in LMIC, such as Pakistan and China. The scale has also been used with non-parent caregivers such as grandparents. Caregivers report current positive attitudes (n = 8, e.g., "I feel close to my child") and negative attitudes (n = 10, e.g., "I feel overwhelmed by the responsibility of being a parent") related to parenting stress based on a five-point Likert scale (0 = strongly disagree; 4 = strongly agree). Positive items are reversed and then all items are summed to create a total parenting stress score (range 0 to 90).

Self-efficacy in managing emotions is measured using an adapted version of the Regulatory Emotional Self-Efficacy Scale (8 items). The anger-irritation subscale includes four items. Parents indicate how well they think they can control their emotions (e.g., How well can you manage negative feelings when reprimanded by significant others?) using a 5-point scale (1 = Not well at all to 5 = Very well). Scores are averaged to create a total score for self-efficacy in managing emotions.

Parental depressive symptoms will be measured using the adult version of Moods and Feelings Questionnaire (MFQ). The scale includes 13 items indicating depressive symptoms (e.g., I didn't enjoy anything at all). Parents indicate how they have been feeling or acting in the past two weeks using a 3-point Likert scale (0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total parental depression score.

Child depressive symptoms will be measured using the short parent report version of Moods and Feelings Questionnaire (MFQ). The scale includes 13 items indicating depressive symptoms (e.g., I didn't enjoy anything at all). Parents indicate how their child has been feeling or acting in the past two weeks using a 3-point Likert scale (0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total child depressive symptoms score.

Child depressive symptoms will be measured using the short child report version of Moods and Feelings Questionnaire (MFQ). The scale includes 13 items indicating depressive symptoms (e.g., I didn't enjoy anything at all). Children indicate how they have been feeling or acting in the past two weeks using a 3-point Likert scale (0 = Not true, 1 = Sometimes True, 2 = True). Items are summed to create a total child depressive symptoms score.

Adult self-report of experiencing intimate partner violence over the past month will be assessed using an adapted version of the Revised Conflict Tactics Scale Short Form (CTS2S, 8 items). The CTS2S includes 2 items on the frequency of negotiation (e.g., "partner suggested a compromise for a disagreement"), 5 items on physical assault (e.g., "partner pushed, shoved, or slapped me"), and 1 item on psychological aggression (e.g., "partner insulted, shouted, yelled, or swore at me").

Adult self-report of experiencing intimate partner violence over the past month will be assessed using adapted items from the WHO Multi-Country Study Questionnaire on Women's Health and Life and Domestic Violence against Women (WHO, 10 items). The adapted WHO questionnaire includes 7 items on coercion and emotional violence (e.g., "my partner tried to keep me from seeing my friends" and "my partner insisted on knowing where I was at all times"), and 3 items on restriction of financial autonomy (e.g., "my partner took my earnings or savings from me against my will.") All answers are coded on a frequency scale of 0 to 3 (0 = never happened; 1 = once or twice; 2 = 3-5 times; 3 = more than 5 times). Both the CTS2S and the WHO will determine an overall indication of intimate partner violence on a level of severity (sum of items across both scales) and prevalence (dichotomous variable indicating experience of conflict or not), as well as for each subscale.

Family functioning will be measured using the Burmese Family Functioning Scale. It includes subscales on family cohesion (12 items, e.g., having understanding towards one another), family communication (7 items, e.g., expressing love through words or actions), and negative family interactions (4 items, e.g., having a lot of bad feelings in the family). Parents indicate how much they agree with statements regarding their family in the last four weeks on a 4-points Likert scale (1 = Almost Never True; 4 = Almost Always True). Items are summed to create total frequency score as well as for each subscale.

Family functioning will be measured using the Burmese Family Functioning Scale. It includes subscales on family cohesion (12 items, e.g., having understanding towards one another), family communication (7 items, e.g., expressing love through words or actions), and negative family interactions (4 items, e.g., having a lot of bad feelings in the family). Children indicate how much they agree with statements regarding their family in the last four weeks on a 4-points Likert scale (1 = Almost Never True; 4 = Almost Always True). Items are summed to create total frequency score as well as for each subscale.

Exposure to community violence will be measured using 6 items from each of the subscales of the Violence Exposure Scale: Witnessing Community Violence and Experiencing Community Violence (12 items total). Parents report on whether they witnessed or experienced community violence in the past month based on 4-point Likert scale (0 = never; 4 = Often, more than 5 times). They also have the option to report that the incident has occurred before but not in the past month. Items from each subscale are summed to create a total subscale score as well as to create an incidence rating of exposure to community violence.

Exposure to community violence will be measured using 6 items from each of the subscales of the Violence Exposure Scale: Witnessing Community Violence and Experiencing Community Violence (12 items total. Children report on whether they witnessed or experienced community violence in the past month based on 4-point Likert scale (0 = never; 4 = Often, more than 5 times). They also have the option to report that the incident has occurred before but not in the past month. Items from each subscale are summed to create a total subscale score as well as to create an incidence rating of exposure to community violence.

Positive parenting behavior will be assessed using the Parenting of Young Children Scale (PARYC, 21 items). The PARYC measures the frequency of parent behavior over the previous month. Items are summed to create total frequency scores for positive parenting (7 items, e.g., "how often do you play with your child"), setting limits (7 items, e.g., "how often do you stick to your rules and not change your mind") and proactive parenting (7 items, e.g., "how often do you explain what you want your child to do in clear and simple ways"). It has been used with strong reliability in previous studies on the program adapted in this study.

Dysfunctional parenting behavior will be assessed using the Parenting Scale (PS, 30 items). This scale examines parent attitudes and beliefs regarding discipline practice. Responses are based on a 7-point Likert scale in which parents are presented with a situation and then are asked to choose between two alternative responses to a situation (1 = most effective; 7 = most ineffective; i.e., situation: "When I say my child can't do something;" response, score = 1: "I stick to what I said;" or response score = 7: "I let my child do it anyway"). Items are summed to create an overall score as well as for three subscales: Laxness, Over-reactivity, and Verbosity. The PS has been used widely to assess the effectiveness of parenting programs, including in low-resource settings such as Panama.

Parent-child interaction, will be measured using two subscales from the Alabama Parenting Questionnaire - Adult Report: Positive Parenting (8 items, e.g., "you praise your child if s/he behaves well") and Parent Involvement (8 items, e.g., "you take your child to a special activity"). The APQ has been shown to have moderate to strong internal reliability for both parent and child reports (Cronbach's alpha = 0.50 to 0.89). It has been used widely including in LMIC such as South Africa and Mexico. Caregivers report on the frequency of parenting behavior based on a 4-point Likert scale (0 = never; 3 = Often, more than 5 times). Items are summed to create total frequency score (range 0 to 24) as well as for each subscale.

Parent-child interaction, will be measured using two subscales from the Alabama Parenting Questionnaire - Child Report: Positive Parenting (8 items, e.g., "your parent/caregiver praises you when you behave well") and Parent Involvement (9 items, e.g., "your parent/caregiver takes you child to a special activity"). The APQ has been shown to have moderate to strong internal reliability for both parent and child reports (Cronbach's alpha = 0.50 to 0.89). It has been used widely including in LMIC such as South Africa and Mexico [31-36]. Caregivers report on the frequency of parenting behavior based on a 4-point Likert scale (0 = never; 3 = Often, more than 5 times). Items are summed to create total frequency score (range 0 to 24) as well as for each subscale.

Attitudes toward punishment will be assessed using one item from the UNICEF Multiple Indicator Cluster Survey (MICS) 5 Child Discipline module. The MICS item asks the parent/primary caregiver: "In order to bring up, raise up, or educate a child properly, the child needs to be physically punished." Parents/primary caregivers will report whether they disagree or agree with the statement based on a 5-point Likert scale of 0 to 4 (0 = Disagree strongly; 4 = Agree strongly).

Attitudes toward punishment will be assessed using one item from the UNICEF Multiple Indicator Cluster Survey (MICS) 5 Child Discipline module

Attitudes toward punishment will be assessed using items from each of the ISPCAN Child Abuse Screening Tool-Intervention Efficacy and Attitudes sub-scales (ICAST-I). The two ICAST-I Efficacy items asks how often parents/primary caregivers reacted to child misbehavior over the past month using a frequency score on a scale of 1 to 7, or 8 or more times (e.g., "In the past 4 weeks, how often did physical discipline seem like the only option for stopping [Child Nickname's] bad behavior?". Four of the ICAST-T Attitudes sub-scale items assess parent/primary caregiver refer to a scenario in which a child is "always getting into trouble," and asks about the level of effectiveness of various disciplinary responses based on a 5-point Likert scale of 1 to 5 (1 = Very ineffective; 5 = Very effective). The fifth item on this sub-scale then asks "Which of the above approaches do you feel is most effective for disciplining children?" and permits a single select response.

Attitudes toward punishment will be assessed items from the ISPCAN Child Abuse Screening Tool-Intervention Efficacy and Attitudes sub-scales (ICAST-I). Four of the ICAST-T Attitudes sub-scale items refers to a scenario in which a child is "always getting into trouble," and asks about the level of effectiveness of various disciplinary responses based on a 5-point Likert scale of 1 to 5 (1 = Very ineffective; 5 = Very effective). The fifth item on this sub-scale then asks "Which of the above approaches do you feel is most effective for disciplining children?" and permits a single select response.

Child prosocial behavior will be measured using a Prosocial Behavior Scale. Children report how often they engage in prosocial behaviors (16 items, e.g., "I share things I have with my friends") using a 5-point Likert Scale (0 = Never/Almost Never; 5 = Almost Always/Always True). Items are averaged to create a total score for child prosocial behavior.

Child risk behavior will be measured using a Risk Behavior Scale. Children report how many times they have engaged in risky behaviors in the past month (8 items, e.g., "drinking beer or wine") using a using a frequency score on a scale of 0 to 7, or 8 or more times. Items are summed to create a total score for child risk behavior. This measure will be administered using audio-CASI to increase response rate.

The incidence and frequency of witnessing family violence will be assessed by using two items from the ICAST-T Child (e.g., "How many days in the past month were there arguments with adults shouting in your home?"). Items will be summed to create a total frequency of witnessing family violence as well as dichotomized to create an incidence variable.

Parental support for school will be measured by asking how often the parent engages in behaviours that support learning (6 items) using a 5-point Likert scale. Higher scores reflect more parental support and value for school.

Parental support for school will be measured by asking how often the parent engages the child in behaviours that support learning (6 items) using a 5-point Likert scale. Higher scores reflect more parental support and value for school.

Educational aspirations will be measured one item asking the parent "How far would like your child to go in school?" rated on a 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).

Educational Aspirations will be measured one item asking the child "How far would you to go in school?" rated on a 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).

Educational Expectations will be measured using one item asking the parent how far they think their child will actually go in school rated on the same 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).

Educational Expectations will be measured using one item asking the child how far they think they will actually go in school rated on the same 5-point scale (1 = finish some high school, 2 = graduate from high school, 3 = graduate from a 2-year college, 4 = graduate from a 4-year college, 5 = graduate from law, medical or graduate school).