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.