RISE: Prevention of Child Mental Health Problems in Southeastern Europe Adapt, Optimise, Test, and Extend Parenting for Lifelong Health for Young Children GACD Meeting 2018

Objectives of RISE Adapt, optimize, and test Parenting for Lifelong Health for Young Children (PLH) in Romania, FYR Macedonia, and the Republic of Moldova Determine the economic impacts of the PLH program and the costs of future dissemination and scale up Evaluate key barriers and facilitators at that impact prevention of child behavioural disorders Identify and address socioeconomic and contextual factors of relevance Develop strategies with local stakeholders to embed PLH into practice and policy and to sustain the intervention Countries selected because of High rates of poverty, and increasing rates of inequality, Relatively high exposure to mental health risk factors, and Need for evidence-based parenting interventions that can be implemented at scale. The aim of the RISE project is to implement cost-effective parenting interventions for the prevention of child mental health problems in LMICs in Eastern Europe. Adapt and implement PLH in three LMICs: Romania, Macedonia, and Moldova Develop a text-based adjunct program to increase outreach in underserved areas and among families with cultural, economic, or structural barriers to care. Optimize the PLH program within the three countries by determining which components are efficacious and cost-effective. Test the optimized PLH programs in three RCTS in the countries. Determine the economic impacts of the PLH program and the potential costs of future dissemination and scaling up. Systematically evaluate key barriers and facilitators at the local, national and international levels that impact prevention of child behavioral disorders. Identify and address socioeconomic and contextual factors of relevance to each targeted region and community. Develop strategies to embed PLH into practice and policy and to sustain the intervention after the end of the project by including local authorities, policy makers, and other stakeholders such as community groups and caregivers in the intervention from each country.

Parenting for Lifelong Health Aim to demonstrate rigorous evidence of effectiveness in reducing the risk of child maltreatment and improving child mental health PLH aims to be affordable and scalable in low resource contexts PLH Program materials are open source and freely available http://www.who.int/violence_injury_prevention/violence/child/plh/en/

PLH Children: Core components parent groups [15 parents + 2 facilitators] 12 sessions [1 session/week or every 2 weeks] pre-program home visit to set parent goals home visits, phone calls &SMS to support practice emphasis on collaborative discussion & problem solving modeling of positive behaviors (e.g. accept, praise) practicing skills in the parent group and at home See Lachman et al., 2016; Lachman, Cluver, Ward, Hutchings, Mlotshwa, Wessels, & Gardner, 2017

Study Design: Multiphase Optimization Strategy framework (MOST) Adaption and feasibility pilot of the intervention Interviews with officials, experts, and practitioners per country Focus group meetings and interviews with parents Pilot study (N = 40 families per country, pre and post assessment) Phase 2 Optimization phase uses a factorial design to determine the most cost-effective intervention components N = 720 families; n= 240 per country site Assessments: pre, post and 6 months after the pre-assessment Phase 3 RCT of the optimized intervention Control condition (one lecture on parenting) Assessments: pre, post and 12 months after the pre-assessment Outcomes: e.g., child and parental mental health, maltreatment, parenting behavior, implementation outcomes (such as reach)

First Year of RISE Phase 1 COMPLETED Ethical approvals Adaption and implementation of the intervention Interviews with officials, experts, and practitioners per country Focus group meetings and interviews with parents Pilot feasibility study (N = 40 families per country, pre and post assessment)

Milestones accomplished / Challenges PLH Program 2-9 adapted and publically available: Facilitator manuals and parent handbook for Romania, Moldova, and FYR Macedonia http://www.rise-plh.eu Phase 1 “Preparation and Adaptation” completed and reports submitted Study protocol on data management and Phase 1 submitted Challenges related to recruitment of parents identified and adjustments for Phase 2 planned

Engagement with policy makers / program implementers 3 stakeholder meetings took place In FYR Macedonia: 52 representatives from 16 organizations In Moldova: 34 representatives from 22 organizations In Romania: 26 representatives from 13 organizations Three expert working groups conducted 23 program implementers trained 5 day training took place in each country Post-implementation focus groups were conducted in all three countries with facilitators

Current Status of RISE Planning for Optimization (Phase 2) Study protocol under preparation Ethics amendment in preparation Training and recruitment starting in 2019

Principal Investigators of RISE Prof. Dr. Adriana Baban (UBB, Romania) Prof. Dr. Marija Raleva (IA, Macedonia) Dr. Galina Lesco (HYA, Republic of Moldova) Dr. Jamie Lachman (OXFORD, UK) Prof. Dr. Judy Hutchings (UWE, UK) Prof. Dr. Nina Heinrichs (Coordinator) Technical University of Braunschweig (TUBS), Germany Prof. Dr. Heather Foran Alpen-Adria-University Klagenfurt (UNI-KLU), Austria Dr. Jamie Lachman & Prof. Dr. Frances Gardner (PI) University of Oxford (OXFORD),UK Prof. Dr. Xiangming Fang Georgia State University (GSU), USA Prof. Dr. Adriana Baban Babes Boylai University, Cluj-Napoca (UBB) , Romania Prof. Dr. Marija Raleva Institute for Marriage, Family and Systemic Practice – ALTERNATIVA (IA), fYR Macedonia Dr. Galina Lesco (PI) Health for Youth Association (HYA) , Republic of Moldova   Prof. Dr. Nina Heinrichs (TUBS, Germany) Prof. Dr. Frances Gardner (OXFORD, UK) Prof. Dr. Heather Foran (UNI-KLU, Austria) Prof. Dr. Catherine Ward (UCT, South Africa) Prof. Dr. Xiangming Fang (GSU, USA) Thanks for your attention!