Implementing low-cost Learning through Play (LTP) Plus group Cognitive Behaviour Therapy (CBT) for mothers of young children (0-3 years) in Gadap Town Karachi (Roshni-2)

The early experience of life makes impact on later development. This impact is responsible for individual differences in different aspects, as in cognition, behaviour, emotional responses, and social skills. The LTP plus programme promotes child health by supporting attuned interaction between mother and child, increasing maternal awareness of the physical and emotional needs of young children, and encouraging nurture and attachment. Interventions which are targeted at disadvantaged groups can have wider benefits in terms of improving health and tackling the social detriments of health such as education and employment. Therefore, the LTP Plus intervention can contribute significantly to the evidence base of addressing this great global public health problem.

The objective of the study is to: “Determine if supported implementation of the LTP plus programme improves infant development compared to standard implementation of the LTP plus programme” The proposed project is based in Gadap Town, Karachi. We have also engaged with the local health services of HANDS Pakistan who have committed to support the implementation of LTP program. It is a Cluster RCT of culturally adapted intervention LTP Plus. In our previous trial of GCC seed grant we have randomized 120 villages in two groups. In this trial we are proposing to give intervention to the control group of previous 60 villages including 30 in each treatment arm i.e. LTP plus and LTP plus supported implementation. It is planned to recruit of 898 mothers between the age of 18-44 years and having a baby between 0-3 years. Each cluster will be comprised of up to 15 mothers. All eligible participants will receive 10 sessions of LTP plus intervention, including weekly sessions till 2 months and fortnightly in 3rd month. All participants will be assessed after completion of intervention (3 months after baseline).  

The planned interventions:

Learning Through Play Plus (LTP Plus) Parenting Intervention:

LTP Plus is comprised of two components; Learning through play (LTP) and Cognitive Behavior Therapy (CBT). The central feature of the LTP intervention is a pictorial calendar devised for parents which depicts eight successive stages of child development from birth to 3 years along with illustrations of parent-child play and other activities that promote parental involvement, learning, and attachment. The CBT sections include step-by-step instructions for each session organized into modules. The modules focus on the following three areas: the mother‘s personal health, the mother-infant relationship, and the psychosocial support of significant others.