Keynote Speakers

Over the past four decades there has been much greater recognition of the importance of parenting and parenting programs in policy and practice to promote better mental health outcomes in children and young people. However, this recognition does not occur everywhere and too few families access the kind of support they need in many countries. However, to reduce the global prevalence rates of social, emotional, and behavioural problems in children and adolescents, a population approach is required that employs an integrated multi-level, system of evidence-based parenting support. Several criteria need to be met for such a system to work in “shifting the needle” at a population level. Apart from having an empirically supported theory of change, clear goals and targets, multiple levels of intensity of intervention available (not a “one size fits all”), and the involvement of different disciplines, sectors, and service delivery systems, the interventions need to accommodate both flexibility and fidelity of delivery, have a well-trained and supported workforce to deliver programs. Programs need to be inclusive, gender-sensitive, culturally informed, and attuned to local ecological context including (culture, policies, funding, type of workforce and their availability). Taking a global perspective and using the Triple P-Positive Parenting Program as an example, Professor Sanders will reflect on progress, challenges encountered, learnings, solutions and future opportunities to advance the field of evidence-based parenting support.

Use of digital technologies to deliver training and support to parents is an attractive option. Widespread availability and uptake of both devices and fast connections have substantially reduced key impediments to user access, and large-scale dissemination of self-coached interventions at low unit cost can readily be achieved. Not only is there strong evidence for the efficacy and effectiveness of these interventions, but they potentially offer an unprecedented opportunity to automatically cue behaviours, deliver feedback and offer personalised support when they are most needed—capabilities that are rapidly increasing with advances in devices and software. However, digital interventions are not universally accepted, and their ongoing financial viability is hard to ensure. Obtaining sufficient user engagement can be challenging, and new risks to data security frequently emerge. Integration of digital interventions with face-to-face services has also proven difficult. Ways to address these issues are discussed, and emerging opportunities using robots, avatars and AI are canvassed. Digital strategies are not seen as a universal solution to delivery of training and support, but as a viable alternative means of access and as an important adjunct to other methods.

More than 1.5 billion children live in countries affected by armed conflict, and children comprise at least 40% of the world’s refugee population. The combination of prolonged exposure to the violence and destruction of political violence, and to the everyday stressors caused or worsened by war and displacement, represent serious threats to children’s mental health and psychosocial wellbeing. Among the most powerful stressors impacting the wellbeing of conflict-affected children is compromised parenting by caregivers who are both highly stressed and persistently distressed. Numerous studies have found that, under conditions of persistent stress and distress, caregivers in humanitarian settings (and other high adversity contexts) are more likely to engage in harsh parenting, and less likely to engage in warm and responsive parenting. This robust finding underscores the importance of strengthening parenting, at least partly by improving caregiver’s own mental health, as a means of safeguarding and improving the mental health of their children. Several parenting interventions have been developed or adapted that aim to strengthen parenting in conflict-affected and refugee settings. However, they have typically been focused on remedying presumed deficits in parenting knowledge and skills, while overlooking the negative influence of caregiver stress and distress on parenting. This deficit-focused approach underestimates the impact of chronic adversity of caregivers’ ability to make use of the knowledge and skills they already possess. It also risks lowering the receptiveness of caregivers to program participation, due to the unwelcome misperception of sub-optimal parenting as rooted solely or primarily in a lack of parenting knowledge and skills. War Child’s Caregiver Support Intervention (CSI), also known as Be There, combines mindfulness-based caregiver support and positive parenting in a nine-session preventive group intervention. In this presentation, the rationale for and development of the CSI is presented. Results from pilot and fully powered randomized controlled trials of the CSI with Syrian refugees in Lebanon are presented which demonstrate the positive impact of the intervention on caregiver mental health, parenting, and child psychosocial wellbeing. We also demonstrate that men can be fully engaged in parent-focused interventions by addressing traditional barriers to their participation. Conclusion: strengthening caregiver wellbeing and parenting represents a critical ecological or holistic approach to improving and protecting the psychosocial wellbeing of children and youth impacted by war and forced migration.

This presentation makes the case that the role of evolution has been rather neglected when it comes to contemporary thinking about child development, especially with respect to “nurture”, the effects of early-life experiences on development. So this talk emphasizes the need to keep in mind not just genetics, which are well studied, in terms of their developmental effects, but the fundamental evolutionary goal of all living things, the passing on of genes to future generations. This focus puts reproduction as central to what development is all about. In consequence, theoretical and, just as importantly, evidentiary cases are made for rethinking why, how, and for whom nurture early in life shapes later development. Specifically, two evolutionary hypotheses are advanced and research testing what might be regarded as long-shot and uncanny predictions are presented. The first predicts that early-life adversity should accelerate pubertal development, as this would increase the chances of passing on genes before one dies or becomes developmentally compromised. The second predicts that children should vary in their susceptibility to their early-life experiences, for better and for worse. This implies that some children will be more susceptible than others to both the negative effects of adversity AND the beneficial effects of support and enrichment. The evidence presented challenges the risk-resilience framework that is focused on vulnerability and resilience in the face of adversity, while failing to consider whether children are similarly susceptible to supportive life conditions and negative ones. Ultimately, two concluding claims are made. First, we have long and misguidedly, even if for humanitarian reasons, presumed that nature intended children to grow up to be secure, autonomous, achievement striving and capable of establishing and sustaining close relationships. While this is a likely outcome under favorable developmental conditions, it is less so under unfavorable ones. The resulting effects of adversity on psychological and biological development do not simply reflect dysfunction, dysregulation or even disorder, as so long presumed, but strategic—and evolved—developmental responses to the anticipated future based on childhood conditions. But because the future is uncertain, regulating development in response to early-life conditions will not always pay off when it comes to passing on genes, so children will vary in their tendency to be shaped by early-life experiences. In essence, nature has hedged its bets with respect to how susceptible children are to the effects of nurture: High susceptibility should prove reproductively strategic when childhood and later-life conditions are in line with each other, whereas it should not when a mismatch occurs, such that early life is not an accurate prognosticator of later life. Under these conditions, not being so developmentally plastic holds the promise of being more reproductively successful, or at least once did. Even if the evolved developmental processes no longer affect the passing on of genes in the modern, contracepting world as they did in the past, the machinery guiding development still functions as it once did.

Use of digital technologies to deliver training and support to parents is an attractive option. Widespread availability and uptake of both devices and fast connections have substantially reduced key impediments to user access, and large-scale dissemination of self-coached interventions at low unit cost can readily be achieved. Not only is there strong evidence for the efficacy and effectiveness of these interventions, but they potentially offer an unprecedented opportunity to automatically cue behaviours, deliver feedback and offer personalised support when they are most needed—capabilities that are rapidly increasing with advances in devices and software. However, digital interventions are not universally accepted, and their ongoing financial viability is hard to ensure. Obtaining sufficient user engagement can be challenging, and new risks to data security frequently emerge. Integration of digital interventions with face-to-face services has also proven difficult. Ways to address these issues are discussed, and emerging opportunities using robots, avatars and AI are canvassed. Digital strategies are not seen as a universal solution to delivery of training and support, but as a viable alternative means of access and as an important adjunct to other methods.