Table 4.

Decisions made to improve the effectiveness of the intervention.

Effectiveness	Decisions made to increase effectiveness
Logistic of session: group size	• The group size is small (6 participants) so that each participant gets an opportunity to practice skills with individual support. • Groups include an even number of participants to facilitate practicing in pairs as this maximizes engagement.
Parent understanding of skills and using the strategies	• Facilitators model the use of the strategies throughout the sessions. • Facilitators demonstrate clearly what parents are expected to do. • Picture cards depicting the strategies are shown and discussed. • Simple guidelines outlining the steps used in each strategy are drafted to help parents understand and remember the content. • Hand-held charts are used with the steps listed in a clear, succinct manner to reinforce these guidelines. However, the numbers of charts per session were kept to a minimum to ensure sessions didn't become didactic.
Parents are motivated to use the strategies	• Parents are given positive feedback when they use the strategies in the group and when they share how they used the strategies at home. • Benefits of the strategies are discussed. • Parents asked to share how they feel when the strategies are used with them in the role of the ‘child’ and asked how they think their child would feel.
Parents use strategies at home	• Home assignments are given that encourage parents to use the strategies at home. • To add a level of accountability, simple record forms, requiring little reading and writing, were designed for parents to record their use of the strategies at home. • Each session starts with parents sharing how they used the strategies in the previous week. • A take-home card for parents was developed for each session. The card included the key points from the session, written in a succinct, simple, reader-friendly style to act as a prompt for parents to use the strategies.
Parents can generalize to a variety of situations	• Parents set individual goals of how they will use the strategies across different context and situations. This encourages parents to consider how the strategies can be integrated into their daily lives and increases the chances of them using it.
Collaborative, supportive/non-critical	• Parents are encouraged to openly share their struggles with parenting and to engage in group problem-solving. • Parents are encouraged to use their own phrases, expressions, and display their own personality during role-plays. • Facilitator demonstrates the use of the strategy before parents are required to practice. • Facilitator models the use of the strategies throughout the sessions. • Facilitator prompts parents to use strategies. • Facilitator gives parent positive feedback when they use or practice the strategies. • Parents are encouraged to praise each other.
Session structure	• In addition to discussions, demonstrations, practice, and rehearsal with the parents, we decided to include the opportunity for parents to also practice the child-led play activities with their child as an integral part of each session. During this practice activity, parents receive support, and feedback from the facilitators. • Children are brought out for the play session for 15 min and then return to class. Debriefing of the activity and recap of the session then occurs.