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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 2–9 in North Macedonia, the Republic of Moldova and Romania in 2018. Parents completed assessments pre‐ and post‐program. Results demonstrated positive pre–post 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. [ABSTRACT FROM AUTHOR]

Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs). Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries. This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages 2–9 years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families, 108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components. This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021. Trial registration: NCT03865485 registered in ClinicalTrials.gov on March 5, 2019. [ABSTRACT FROM AUTHOR]

Introduction: Families 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 Analysis: This 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, χ 2 tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied., Ethics and Dissemination: The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study., Trial Registration Number: NCT03552250., Competing Interests: Competing interests: AB, XF, HMF, EJ, GL, MR, and MEW have nothing to disclose. IF reports personal fees from Hamburg University, and other institutions offering education for psychotherapy in Germany outside the submitted work; IF is a certified trainer of the Triple P program. FG is a co-developer of PLH for Young Children, which is licensed under a Creative Commons 4.0 Non-commercial No Derivatives license, and one of the co-founders of the Parenting for Lifelong Health initiative. FG has participated (and is participating) in a number of research studies involving the program, as an investigator, and the University of Oxford receives research funding for these. LML reports personal fees from Clowns Without Borders South Africa, grants from University of Oxford, and other from Parenting for Lifelong Health, outside the submitted work; NH reports grants and non-financial support from Technische Universität Braunschweig, during the conduct of the study; personal fees from other academic institutions offering continued education for psychotherapy education in Germany, outside the submitted work; and NH serves as an international advisory board member for the Triple P program. JH is a co-developer of PLH for Young Children, which is licensed under a Creative Commons 4.0 Non-commercial No Derivatives license, and one of the co-founders of the Parenting for Lifelong Health initiative. She is the director of the Children’s Early Intervention Trust, a non-profit institution responsible for the dissemination of the program in Europe. She receives occasional fees for providing training and supervision to facilitators and coaches. JH has participated (and is participating) in a number of research studies involving the program, as an investigator, and Bangor University receives research funding for these. JH contributed to the initial trial in South Africa, the trial in the Philippines and led the evaluation of the program in a pre-post trial in Montenegro. CLW reports grants from World Childhood Foundation, and grants from UBS Optimus Foundation via the Philippine Ambulatory Pediatric Association, outside the submitted work; CLW is a co-developer of PLH for Young Children, which is licensed under a Creative Commons 4.0 Non-commercial No Derivatives license, and one of the co-founders of the Parenting for Lifelong Health initiative. CLW has participated (and is participating) in a number of research studies involving the program, as an investigator, and the University of Cape Town receives research funding for these. She receives no direct personal income from this work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)