Phase 1

A new RISE paper has been published in Family Process. The article entitled “Preventing child mental health problems in southeastern Europe: Feasibility study (phase 1 of MOST framework)” describes the main Pre-Post results of the Feasibility study (Phase 1). The accepted version of the published article is available here: https://zenodo.org/record/5499718#.YTsXRC0Rqu4.

Phase 2

Results from Phase 2 indicated that the most cost-effective version of PLH for Young Children was five sessions delivered with basic engagement boosters (e.g., providing transport and childcare to assist parents in reducing barriers for participation) and supervision on demand for program facilitators. Investment in reducing more barriers and increasing incentives did not turn out to be cost-effective in these LMICs.  This optimised version of the program is to be tested in the gold standard evaluation (a randomised controlled trial) in Phase 3 of the RISE project.

Phase 3

Because of restrictions on in-person meetings during the COVID-19 pandemic, the optimised program had to be delivered online (via Zoom, Teams and similar software) during Phase 3.  In this randomised controlled trial, the program was compared with one group-based lecture on child development.  Under these conditions, compared with the lecture, the program demonstrated small advantageous effects in key outcomes, including child mental health (oppositional defiant disorder and conduct disorder), when these were measured immediately after parents had received the program. At follow-up 12 months later, there was no difference in outcomes, except for parental stress, for parents who received the program and those who received the lecture. Parental stress was lower in the intervention group than in the lecture group at both the immediate and 12-month follow-up.  We designed the lecture to be useful for parents (without specifically addressing child mental health), but some parents reported disappointment at not being allocated to the PLH condition.

Final Conclusion

We recommend a stepped-care approach to making parenting and child development information widely available to everyone, so that all parents can receive some information, and others who report higher levels of child behavior problems and parenting challenges receive longer, more intensive programs. Mechanisms for effectively supporting parents with challenges over the longer term, and finding low-cost solutions for sustainability – especially when using online delivery formats instead of in-person delivery – need further evaluation.