Adaptation of the Communities That Care Youth Survey for Use in Estonia: A Pilot Study.

The Communities That Care Youth Survey (CTCYS) assesses risk and protective factors, predicting a range of behavioural health problems, including substance use, violence, and delinquency. Although the survey has been adapted to other contexts and languages, further studies on cross-cultural adaptations, particularly in non-English speaking countries, are needed. In 2022, CTCYS was adapted for Estonia, incorporating 38 risk and protective factors, along with measures of substance use, antisocial behaviour, mental health problems, and self-harm. This study investigated the psychometric properties and applicability of the CTCYS in Estonia. The adaptation process involved translating and refining the US CTCYS, followed by focus group discussions with students and specialists and a pilot study in two municipalities, with data obtained from 265 students. A focus group with municipality members explored the measure's feasibility. Results indicate that the original CTC framework largely captures key issues within the Estonian context. Overall, the survey showed good validity, as evidenced by its ability to predict problem outcomes through both risk and protective factors. Regarding reliability, with the removal of one item, internal consistency reached acceptable levels for all but eight risk and protective factor subscales. The most problematic scales in the Estonian context were Prosocial Involvement, Social Skills, and Belief in the Moral Order. Municipality members perceived the measure as useful but highlighted some challenges regarding its practicality and comprehensibility. It became clear that other elements are needed to effectively support communities in using the CTCYS results for preventive efforts.

Effectiveness of a Universal, Classroom-Based Preventive Intervention (PAX GBG) in Estonia: a Cluster-Randomized Controlled Trial.

The PAX Good Behavior Game (PAX GBG) is a behavior management strategy that has demonstrated positive effects on children's behavior and well-being in trials conducted mainly in the USA. This study assessed the impact of the PAX GBG on students' mental health and behavior 7 and 19 months post-baseline in Estonia. This matched-pair, cluster-randomized, waitlist-controlled, open-label trial included 42 Estonian elementary schools with 708 first-grade students. The primary outcome was children's overall mental health rated by teachers, while secondary objectives were to examine whether the effects of the intervention extended to the home context. Teachers also rated their self-efficacy and overall classroom behavior. Intervention adherence and children's exposure to the intervention were also measured. Modified intention to treat analysis involved 696 students on first post-baseline and 647 on second post-baseline. Intervention had positive effects on children's mental health at the end of the first academic year, which lasted and strengthened during the second academic year. Moderation analysis demonstrated positive effects on mental health and prosocial behavior for high-risk students during the first year. A few positive effects extended to the home environment during the second academic year. Implementation fidelity was satisfactory. The intervention also had a positive lasting effect on teacher's self-efficacy and overall classroom behavior. This study shows the positive effects of the PAX GBG in Estonian schools and supports broader implementation of the intervention in Estonian elementary schools. TRIAL REGISTRATION: ClinicalTrials.gov No. NCT02865603.

Effectiveness of a universal classroom-based preventive intervention (PAX GBG): A research protocol for a matched-pair cluster-randomized controlled trial.

INTRODUCTION: The PAX Good Behavior Game (PAX GBG) is a universal classroom-based program that promotes children's mental health. In Estonia, the intervention is delivered to first grade students (aged seven to eight) within the regular school curriculum. The current work describes a protocol for a cluster-randomized controlled trial (RCT) of the PAX GBG conducted in Estonia. DESIGN AND METHODS: This is an ongoing, pragmatic, two-year, matched-pair, cluster-RCT conducted in Estonian elementary schools. Schools were matched to pairs based on their geographical location and number of students per classroom. One school in each pair was randomly selected to receive the intervention and the other placed on a wait-list as a control. 42 schools provided baseline data during the autumn of 2016. Data is collected at two more points in time - seven months and 19 months post-baseline. Outcomes of children's mental health and behavior are measured by the teacher- and parent-rated Strengths and Difficulties Questionnaire, parent-rated Swanson, Nolan, and Pelham - IV Questionnaire and the Go/No-Go task completed by children. Teachers also rate their self-efficacy and overall classroom behavior. DISCUSSION: This study aims to test the effectiveness of the intervention in Estonian classrooms with a newer version of the rigorously tested GBG program. To our knowledge, this study is the first to measure the effects of the intervention on children's inhibitory control, which has been associated with externalizing problems in the literature. The results from this trial will provide further understanding into how the program influences children's well-being and self-control. TRIAL REGISTRATION: ClinicalTrials.gov registry (NCT02865603).