Preventing child mental health problems in southeastern Europe: Feasibility study (phase 1 of MOST framework).

The prevalence of child emotional and behavioral problems is an international problem but is higher in low- and middle-income countries (LMIC) where there are often less mental health supports for families. Parenting programs can be an effective means of prevention, but must be low-cost, scalable, and suitable for the local context. The RISE project aims to systematically adapt, implement, and evaluate a low-cost parenting program for preventing/reducing child mental health problems in three middle-income countries in Southeastern Europe. This small pre-post pilot study is informed by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework and tested the feasibility of the intervention, the implementation, and evaluation procedures: Phase 1 of the three-phase Multiphase Optimization Strategy (MOST) for program adaptation. Local facilitators delivered the Parenting for Lifelong Health (PLH) for Young Children program to parents of children aged 2-9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre- and post-program. Results demonstrated positive pre-post change for participating families (N = 140) on various outcomes including child externalizing and internalizing symptoms and parenting behavior, in all three countries, all in the expected direction. Program participation was associated with positive outcomes in participating families. Based on the experiences of this pilot study, we outline the practical implications for the successful implementation of parenting programs in the three countries that will inform our next study phases, factorial experiment, and RCT.

El predominio de los problemas emocionales y conductuales de los niños es un problema internacional, pero es mayor en los países de ingresos bajos y medios donde generalmente hay menos asistencia para la salud mental de las familias. Los programas de crianza pueden ser un medio de prevención eficaz, pero deben ser de bajo costo, escalables y adecuados para el contexto local. El proyecto RISE tiene como finalidad adaptar, implementar y evaluar sistemáticamente un programa de crianza de bajo costo para prevenir o reducir los problemas de salud mental infantil en tres países de ingresos medios del Sudeste de Europa. Este pequeño estudio piloto previo y posterior está fundamentado por el marco de Alcance, Eficacia, Adopción, Implementación y Mantenimiento (RE-AIM, por sus siglas en inglés) y evaluó la viabilidad de los procedimientos de intervención, de implementación y de evaluación: Fase 1 de la Estrategia de Optimización Multifase (MOST) de tres fases para la adaptación del programa. Un grupo de moderadores locales impartió el programa Crianza para la Salud Durante Toda la Vida (Parenting for Lifelong Health, PLH) para Niños Pequeños a padres de niños de entre 2 y 9 años en Macedonia del Norte, República de Moldavia, y Rumania en 2018. Los padres completaron evaluaciones antes y después del programa. Los resultados demostraron cambios positivos después del programa para las familias participantes (N = 140) en varias respuestas, entre ellas, los síntomas de exteriorización y de interiorización de los niños y la conducta de crianza, en los tres países, todos en la dirección esperada. La participación en el programa estuvo asociada con resultados positivos en las familias participantes. Sobre la base de las experiencias de este estudio piloto, describimos las consecuencias prácticas para la implementación satisfactoria de los programas de crianza en los tres países que servirán como base para las fases de nuestro próximo estudio, del experimento factorial y del ensayo controlado aleatorizado.

[Posttraumatic Stress and Depressive Symptoms amongst Asylum Seekers]. / Posttraumatische und depressive Symptomatik bei Asylsuchenden.

Background and Objectives: Currently, there is a large number of refugees that are coming to Germany from (civil) war zones. The aim of this study was to estimate the extent of posttraumatic stress and depressive symptoms amongst asylum seekers in Germany. Methods: In the summer of 2015, 280 adult refugees (88,2% men) were interviewed with the support of translators in the Lower Saxony State Refugee Reception Center, Brunswick. Data was categorized due to country of origin (Balkan States, Middle East, Northern Africa, Rest of Africa). The Posttraumatic Diagnostic Scale-8 (PDS-8) and the Patient-Health-Questionnaire (PHQ-8) were employed as screening measures. If the threshold values of 12 in the PDS-8 or 15 in the PHQ are exceeded, respectively, the diagnosis of PTSD or depression is highly likely. Results: Participants reported an overall high number of potentially traumatic experiences (72,5% war experiences; 67,9% violent attacks; 51,4% another very burdensome experience; 50,0% torture; 47,9% imprisonment; 11,1% sexual assault), whereby multiple answers were possible. The prevalence rates for possible PTSD were 16,1% (Balkan States), 20,5% (Middle East), 23,4% (Rest of Africa) and 28,1% (Northern Africa); rates for a possible depression varied between the countries of origin from 17,9, 35,9, 28,1 to 24,0%, respectively. Conclusions: Compared to the German population, the rates of traumatic experiences and the prevalence of a possible PTSD were significantly higher amongst asylum seekers of the present sample; this was not the case for depression. The integration of affected asylum seekers may be considerably complicated due to health impairments, e. g. with regard to learning the German language and admission to educational or occupational services.

Experiences in Disseminating Evidence-Based Prevention Programs in a Real-World Setting.

The primary aim of family-based prevention programs is to promote children's health. Unfortunately, it is difficult to reach families with such evidence-based prevention programs (EBP). Therefore, implementing EBP on a population level could be a promising approach to reach more families, including those faced with socioeconomic challenges who are usually less likely to participate in randomized controlled trials (RCT). Is a population rollout appropriate to reach more and different families than those participating in RCT, especially those representative of the target population? We implemented three EBP in a city in an uncontrolled trial. The effects of this population rollout were tracked on the level of the participating families and on the level of all families living in the city. More than 3480 families (30 % of the population) with children up to 12 years of age participated based on practitioner report. Analyses indicate that a greater percentage of low socioeconomic-status families attended a program compared with a randomly surveyed sample from the city's general population. The sizes of the within-subject effect for parental strategies, child behavior problems, and children's quality of life for a subsample of n = 411 families were similar to those of other uncontrolled EBP studies. The study contributes to highly needed type 2 translation research. The population-based dissemination of EBP could be a promising approach to reach families at risk. However, there are considerable barriers to the implementation process, which currently limit the effectiveness of this rollout in a community.

Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial.

BACKGROUND: Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children's future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs. METHODS/DESIGN: A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group. DISCUSSION: This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme. TRIAL REGISTRATION: ClinicalTrials.gov ., Registration number: NCT04721730 ( https://clinicaltrials.gov/ct2/show/NCT04721730 ). Registered 13.01.2021.

Prevention of child mental health problems in Southeastern Europe: a multicentre sequential study to adapt, optimise and test the parenting programme 'Parenting for Lifelong Health for Young Children', protocol for stage 1, the feasibility study.

INTRODUCTION: Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme. METHODS AND ANALYSIS: This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2-9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre-post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre-post differences using ANCOVA, χ2 tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied. ETHICS AND DISSEMINATION: The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study. TRIAL REGISTRATION NUMBER: NCT03552250.