EXAMPLES OF VIOLENCE PREVENTION PROGRAMMES IN SOUTH AFRICA

The Community Psychological Empowerment Services (COPES) project

COPES was an initiative implemented at preschool level in Lavender Hill, a working-class community in Cape Town. Lavender Hill is characterised by high levels of social adversity, gangsterism, domestic violence and unemployment (Petersen & Carolissen, 2000). The project was initiated in order to address behavioural problems identified in a number of preschools in the area. Behaviours included aggression, enuresis, sexually provocative behaviour and excessive fearfulness. COPES used the intervention model developed by Webster-Stratton and Hammond (1997) to intervene at a number of different levels (Roles 1 and 3). COPES aimed to reduce the levels of aggressive behaviour among preschool children by increasing their positive behaviour, assisting educators to set limits non-punitively, and in so doing, improve their subjective feeling of competency, and to increase the competency of parents in setting limits and encouraging positive behaviour.

The COPES intervention comprised a two-week assessment phase, an intervention and a follow-up evaluation two weeks later. Groups of parents, educators and children met in parallel over the course of eight weeks. The parent training group used video material as in the parenting programme of Webster-Stratton, as well as locally developed materials aimed at teaching parenting skills, helping parents be more empathic towards their children, and in so doing, also helping them understand their child’s behaviour (Petersen & Carolissen, 2000). The educators’ groups aimed to teach educators behaviour modification principles in order to set limits non-punitively, to assist educators in thinking critically in order to better understand the factors underlying disruptive behaviour and to help educators to lower their levels

of stress. As a result of the very different developmental level of children in the Lavender Hill community as compared to the American counterparts, Petersen and Carolissen (2000) make the point that the Webster-Stratton material had to be substantially adapted for the children’s groups (although it remained relevant for the parent groups). Children’s groups attempted to introduce preschool children to rules and consequences, including rewards for positive behaviour, the teaching of social and behavioural skills, teaching anger management skills and helping children to identify feelings in themselves and others (Petersen & Carolissen, 2000).

COPES was a laudable attempt at implementing a multimodal intervention (school, parent and child) in a context of high adversity. Its community-based nature coupled with careful planning, assessment and implementation are considerable strengths. Unfortunately, the nature of its design and evaluation makes any conclusion about efficacy or effectiveness difficult. There are no independent measures of child aggressive behaviour, and the only outcome measures at the level of educators and parents are by parents and educators themselves, the actual recipients of the intervention.

Feeling more competent at child management is not indicative of any change in child behaviour management in practice, and even if it were, without any independent measures of improved child behaviour in school, we are not in a position to come to any definitive conclusion about intervention efficacy.

There are also no details about baseline differences between the matched schools in the intervention and the comparison groups. In the absence of any randomisation there is no way of determining whether reported differences are due to the intervention or to pre-existing differences between schools.

As a case study, the COPES intervention does provide some insight into the process of implementing a multimodal intervention in a context of high adversity, and may provide some useful guidelines for future interventions.

However, without any independent observations, objective measures, or any data to suggest that the findings were not simply due to reporting bias or pre-existing differences between schools, it is not possible to draw any meaningful conclusions about programme efficacy.

Nonetheless, it points to the very real possibility of testing and imple-menting violence prevention initiatives with young children in South Africa.

The Khayelitsha mother-infant intervention

This intervention, while not primarily directed at violence prevention, is the first, intensive, early home-visiting programme using a randomised

controlled trial design in South Africa. It targets early interaction behaviours including coercive parenting that has been found to relate to later antisocial behaviour (Granic & Patterson, 2006). Several trials of early interventions aimed at improving maternal sensitivity (Role 3 on the matrix), and reducing infant attachment insecurity have been conducted. A meta-analysis of 70 intervention studies shows that both maternal sensitivity and infant attachment security were improved (Bakermans-Kranenburg, Van Izendoorn & Juffer, 2003).

A pilot intervention in Khayelitsha found that compared to women not receiving an intervention, those who had home visits from trained mothers from the community were found at six months postpartum to be more sensitive in engagement with their infants and to express more positive affect (Cooper et al., 2002). Thereafter, a randomised controlled trial was undertaken in the same area to test an intervention designed to encourage mothers to engage in sensitive, responsive interactions with their infants.

The intervention was delivered by women resident in Khayelitsha with no formal specialist qualifications. They were trained in basic parenting and counselling skills, as well as in the specific mother-infant intervention to be tested. The intervention was delivered in participants’ homes in hour-long sessions and comprised 16 sessions in total, ending at six months postpartum. The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared to control mothers, mothers in the intervention group were significantly more sensitive and less intrusive in their interactions with their infants (Cooper et al., 2009). The intervention was also associated with a higher rate of secure infant attachments at 18 months. The intervention also reduced maternal intrusive and coercive behaviour (Cooper et al., 2009), one of the aspects of maternal and child behaviour related to early-onset externalising behaviour (Moffitt, 1993).

The attachment finding is crucial in that, as Fonagy (2004) argues, socialisation to inhibit natural aggression occurs through the development of self-control. Self-control in turn requires the development of symbolisation, which itself develops as a function of the mother-child relationship (Role 3).

For Fonagy (2004), a poorly functioning attachment system is therefore likely to be instrumental in the development of later aggression and violence.

Negative attachment experiences are centrally implicated in the development of a sense of self and the processing of social interactions (Bradshaw &

Garbarino, 2004). Other investigators (Dodge et al., 1990) have proposed that social information-processing biases may lead to an increase in violent

behaviour that is congruent with the attachment research. Aggressive children are hypersensitive to threat, falsely attributing hostility to the action of others, and overlooking other more benign contextual factors (an accidental collision for instance) that may more readily explain the behaviour of another (Crick & Dodge, 1994).

Bradshaw and Garbarino (2004) argue that successful prevention initiatives such as the Olds programme that target early maternal sensitivity and the early caregiver-child relationship, influence social-cognitive processes. It is the intention to follow these children to establish whether the improvements in the mother-infant relationship do indeed result in reduced levels of aggression at age seven to eight years.

The Khayelitsha study demonstrates that trained lay persons can be effective change agents, that a programme of relatively limited intensity (compared, for example, to the Olds programme) can produce gains in a key aspect of early development. Also, that a rigorous test of a community-based intervention is entirely possible in a South African context.

GUIDING PRINCIPLES FOR EVIDENCE-BASED INTERVENTION