IntroductionFamilies 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 analysisThis 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, χ2tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied.Ethics and disseminationThe ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study.Trial registration numberNCT03552250.
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. 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. 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. 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.
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 to 9 in North Macedonia, the Republic of Moldova, and Romania in 2018. Parents completed assessments pre-and post-program. Results demonstrated positive prepost 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.
Hintergrund: Seit 2014 ist Psychotherapie bei psychotischen Störungen uneingeschränkt indiziert. Patienten mit psychotischen Störungen erhalten jedoch weiterhin selten eine ambulante Psychotherapie. Unklar ist, ob eine höhere Ablehnungsquote durch ambulante Psychotherapeuten dazu beiträgt. In einem Feldexperiment prüften wir, ob Patienten mit psychotischen Störungen auf Therapieplatzsuche häufiger von Therapeuten abgelehnt werden als andere Patientengruppen. Methode: Die Experimentatorin kontaktierte niedergelassene Psychotherapeuten mit dem Schwerpunkt «Verhaltenstherapie» (N = 60) und gab sich entweder als Patientin mit Schizophrenie oder als Patientin mit Depression aus. Wir erfassten die Zu- oder Absage der Therapeuten zu einem Erstgespräch, die voraussichtliche Wartezeit und Vorerfahrungen mit Schizophrenie sowie erwartete Herausforderungen bei der Schizophreniebehandlung. Ergebnisse: Dabei zeigten sich keine statistisch signifikanten Unterschiede hinsichtlich der Zusagen zu einem Erstgespräch (Schizophrenie: 60%; Depression: 53%) und der durchschnittlichen Wartezeit (Schizophrenie: M = 1,6 Monate; Depression: M = 0,8 Monate). Therapeuten, die im Nachgespräch angaben, grundsätzlich keine Patienten mit Schizophrenie zu behandeln, beklagten häufiger das Fehlen spezialisierter Supervisionsangebote und waren eher der Ansicht, Patienten mit psychotischen Störungen seien unzureichend zu rationalem Denken befähigt. Schlussfolgerung: Patienten mit psychotischen Störungen scheinen auf Therapieplatzsuche ebenso häufig ein Erstgesprächsangebot zu erhalten wie andere Patientengruppen. Mögliche Unterschiede in der Wartezeit sollten mit größeren Stichproben getestet werden. Eine spezialisierte Weiterbildung und Supervision könnten das Engagement in der Versorgung dieser Patientengruppe steigern.
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