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This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N 1= 112, N 2 = 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Motheŕs own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence. [ABSTRACT FROM AUTHOR]

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Background: Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children's future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs.Methods/design: A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group.Discussion: This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme.Trial Registration: ClinicalTrials.gov ., Registration number: NCT04721730 ( https://clinicaltrials.gov/ct2/show/NCT04721730 ). Registered 13.01.2021. [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]

Background: Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool., Methods: As part of the RISE project (prevention of child mental health problems in South-eastern Europe-adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted., Results: The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost-benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes., Conclusion: The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others-with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies., Trial Registration: ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730 . Registered on 13 January 2021., (© 2024. The Author(s).)

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.)