1. 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

2. 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.

3. 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

4. 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

5. 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)

6. 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)

7. Milestones accomplished / Challenges
PLH Program 2-9 adapted and publically available:
Facilitator manuals and parent handbook for Romania, Moldova, and FYR Macedonia
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

8. 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

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

10. 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!