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

Abstract

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.

Exploring Factors Associated with Parent Engagement in A Parenting Program in Southeastern Europe

“…Demographics are displayed in Table 1. There were no significant demographic differences between those allocated to a group and those who dropped out before allocation (for details see Jansen et al, 2021). A total of 110 parents attended at least one session, an overall enrolment rate of 79% (North Macedonia: 86%; Republic of Moldova: 83.7%; Romania: 70.2%).…”

“…Informed consent was obtained from 100% of the 162 parents of whom 140 (86%) reported elevated levels of child behavior problems and were enrolled in the study. All 140 parents were allocated to one of four groups based on where they lived within each country, however 21 (15%) dropped out before allocation (for detailed participant flow see Jansen et al, 2021). Demographics are displayed in Table 1.…”

“…The institutions included: a family psychotherapy institute that conducts research and education in systemic practice and family psychotherapy (North Macedonia), a nongovernmental organisation that promotes access to services for adolescents and young people related to their general, mental, and sexual reproductive health (Republic of Moldova), and academics at a University (Romania). Jansen et al (2021) report positive pre-post changes for various child behavior and parenting practice outcomes, as well as positive associations between post-intervention outcomes and program participation from the same trial.…”

“…These implementation factors along with others will be addressed during the next phase of the study which examines differential effects of implementation components in a factorial experiment (Lachman et al, 2019). In addition to the promising prepost effects of the intervention (see Jansen et al, 2021), addressing these implementation factors enhances the probability that the optimised parenting intervention will be implemented successfully, at large scale, and sustainable in the three countries. Future implementation and research would benefit from exploring the role of additional engagement boosters (e.g., regular calls or text messages) as well as peer-support (e.g., facilitators could suggest parents to exchange phone numbers or emphasise that informal meetings of participants have been helpful for other groups).…”

“…Scores for internalizing behavior (1.5-5 years α = 0.79, 6-18 years α = 0.78) and aggression (1.5-5 years α = 0.86, 6-18 years α = 0.87) were used in this study. We used the aggression subscale although not pre-specified in the study protocol (Frantz et al, 2019) because of the low internal consistency of the externalizing subscale (for details see also Jansen et al, 2021).…”