Innovation summary

In the last two decades, the Department of Mental Health and Substance Abuse started to conduct research to investigate the prevalence and magnitude of the issue of child maltreatment, neglect and abuse in Iran.  One study showed 12% (347 children) of 3019 children less than 18 years of age, who attended the emergency department of three children hospitals in Tehran had been physically abused1. ​This evidence necessitated action by the Ministry of Health and the Department to put systems in place for the implementation of preventive programs in the field of child mental health.

One of the preventive measures found to mitigate child abuse was to improve the communication between parents and their children. This programme introduced a Parenting Skills Training through the Ministry of Health, in recognition of the importance of parenting to promote positive mental health and early childhood development.

Goals of the intervention included:

  • Improving the mental health literacy of parents with children aged between 2-17 years
  • Improving child-parent interaction
  • Preventing child maltreatment
  • Preventing mental health problems, specifically behavioural problems in children and adolescents

“Your kids require you most of all to love them for who they are, not to spend your whole time trying to correct them.” 

  -Bill Ayers

Innovation details

The Iran Multiple Indicator Demographic and Health Survey (2010) shed light on the issue of child discipline. The findings showed that 18% of parents believed in using physical punishment on their children, only 13% use non-aggressive punishment methods, and 2.5% don’t use have any parenting strategy at all2-3. These statistics prompted policy makers to take notice and implement policies and implementing plans of action.

This program has been integrated into the public health care system ever since 2003, after standard training guidelines and manuals were developed and tailored to the needs of the general population based on national evidence. In 2013 a major modification of the training processes took place in the context of a significant recruitment of human resources within the health system. This significant recruitment was the hiring and placement of clinical psychologists as mental health workers in health centers for delivering this service based on a cascade training plan. The whole process has been coordinated by the Ministry of Health and Medical Education (MOHME) and based on results of expert panels and focused group discussions with skilled child psychiatrists and psychologists with experience in this field.


The training process started with conducting a 5-day national training of trainers (TOT) workshops for the mental health managers in all Iran provinces. The subsequently trained mental health managers of these provinces are required to conduct their own training workshops for all mental health workers working in the public health care system of their province periodically. Their responsibilities also include supervising and monitoring them on a regular basis afterwards.


The main entry point for receiving parenting skills in the public healthcare setting is after the individual goes through the initial screening for mental health problems performed by the general health workers, and the result of screening is negative. This individual is then referred to the mental health worker if he or she is a parent of a child aged between 2-12 or 12-17 years old. The mental health worker introduces the parenting skills package to them and registers them for the routine group training sessions.

The package is based on Parent Management Training (PMT) principles including effective communication, adopting proper reward, punishment, reinforcement strategies and the management of difficult situations. Each group training session is held for 15-20 individuals registered in the center. This group training session can also be delivered in settings other than the health centers for addressing larger audiences (maximum of 20-25 individuals that are parents of children aged between 2-12 or 12-17 years old.) Each session takes around two hours, which can be broken down into two parts with a short break. Sessions are generally delivered once a week, although this does vary according to the local context.

If parents feel that they need more training in this field or report a problem regarding interaction with his/her child, they can be registered to receive individual sessions according to their problem. A parent can also register for participating in group sessions or individual sessions according to the same protocol, out of the initial screening process. A screen positive individual can come back for this type of training after receiving treatment for their mental health condition and are in recovery.

Key drivers

Strong leadership and legislation

Iran has a law that supports preventive educational interventions such as the one described here, and there is a clearly assigned lead organization (the Ministry of Health and Medical Education). There also exist senior authority documents to support the implementation of such programs. These include:

  • The Constitution of the Islamic Republic of Iran (stating the leadership role of the MOHME)
  • The Sixth National Development Plan (supporting the necessity of promotion of mental health)
  • The Family Protection Law of the Islamic Republic of Iran
  • The United Nations Convention on the Rights of a child (UNCRC)
  • The Health Transformation Plan in the Ministry of Health (supporting the recruitment of infrastructure and resources)

Other key drivers include:

  • Technical support from professional NGOs such as the Iranian Child and Adolescent Psychiatry Association and the Iranian Child Psychology Association
  • The Government Bill for the support of children and adolescents’ rights


  • Weak relationship with policy stakeholders such as the Ministry of Education which is in direct contact with main target groups (parents of school children)
  • Sessions are only delivered during the clinic’s working hours, making it hard for the majority of fathers to attend the sessions.
  • Weaknesses of a cascade training process, especially at end-points leading to some gaps in the skills and knowledge of the trainers
  • Weakness in coverage of the target group compared to their number, by face-to-face method and due to the large number of target group, the training coverage is slow and gradual.


The National Parenting Skills Training Program has been integrated into the Public Health Care system with national level implementation. The Health transformation plan lead to improvement in the coverage rates of mental health services of urban areas, and we have planned by implementing the program in rural areas after modifying training models appropriately.


  1. The National Welfare Organization (Supervising the preschools)
  2. The Ministry of Education (Supervising the elementary, middle and high-schools)
  3. The Ministry of Youth Affairs (Working on programs for young couples)
  4. The Literacy Movement Organization (Detection of illiterate individual in the need of more training)
  5. The Municipalities (supervising community centers)
  6. WHO (Technical and Financial Support)
  7. UNICEF (Technical and Financial Support)


The programme is funded from the Ministry of Health’s annual budget. UNICEF has been also supporting the Ministry to revise existing educational and communication materials and develop additional materials, to support capacity building in parenting skills training, conducting ToT workshops, and supporting an assessment and evaluation of the project.

Evaluation methods

The first evaluation of this program was performed in 2011, evaluating the efficacy of different levels of training by comparing pre- and post- test scores for knowledge and attitude of trainers and trainees as well as evaluating the self-report of children. This evaluation showed significant change in knowledge and attitude of parents and also significant change in their interaction with children. Following this evaluation, interventions have taken place to revise the training package.

The New Evaluation of the Parenting Skills Training Program is currently in progreess. This evaluation consists of a preliminary phase, phase 1, and gap analysis:

Preliminary phase:

This phase involved the identification of beneficiaries and administrative staff for interviewing and inquiry, designing the evaluation plan, determining the assessors, selecting sites for programming and related health centers and detailed plan of evaluation.

Phase 1 (data collection):

  • Stage 1: Field visits, using checklists in health centers
  • Stage 2: Developing tools and checklists for assessing the knowledge, attitude and practices (KAP) of service providers
  • Stage 3: Qualitative research through in-depth interview and FGDs
  • Stage 4: Quantitative research which assesses input, process, output outcome and impact indicators

Gap Analysis: 

Incorporates a systematic and data-driven approach to identifying needs within the system.

Cost of implementation

The Ministry of Health and Medical Education reported a total spend of approximately USD 1,583,000 (IR Rials 66,500,000,000) to implement this national integrated programme.

Impact details


  • A total number of 2,164,858 parents were trained in group sessions throughout the period of March '18 - March '19 (Annual Report 2018)

Outcome (based on the results of the 2011 evaluation project):

  • Among 404 parents with mean age of 38 years. (89% female, 11% male), a significant increase in knowledge of parents to an extent of 65% in 67% of parents (p-value<0.00) was seen.
  • Among 404 children with mean age of 9 years. (53% female, 47% male), a significant positive change in interaction reported by 55% of the children (p-value<0.00) was seen.


  1. Sayyari AA et al., 2002, Physical child abuse in Tehran, Iran. J. Rehab. ; 6(6-7): 7-13.,[]=citjournalarticle_65053_24
  2. Rashidian A et al., 2014, Iran's Multiple Indicator Demographic and Health Survey - 2010: Study Protocol. Int J Prev Med.; 5 (5): 632-42.
  3. The Iran Multiple Indicator Demographic and Health Survey (2010)
  4. Nasserbakht M, 2011, Evaluation of Communication Tools on Enhancing Parent-Child Relationship: Consultant’s Final Report 
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Iran (Islamic Republic of)


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