Principal Investigators (in alphabetical order)
Prof. Dr. Nevena Calovska, Association of Systemic Therapists Education Center
Dr. Rhiannon Evans, Cardiff University
Prof. Dr. Heather Foran, University of Klagenfurt
Prof. Dr. Nina Heinrichs, University of Bielefeld
Dr. Galina Lesco, Health for Youth Association
Prof. Dr. Graham Moore, Cardiff University
Prof. Dr. Marija Raleva, ALTERNATIVA
Prof. Dr. Judit Simon, Medical University of Vienna
Dr. Yulia Shenderovich, Cardiff University
Prof. Dr. Bojan Shimbov, University Jaume I Castellon
Co Investigators (in alphabetical order)
Prof. Maite Alguacil, University Jaume I Castellon
Viorel Babii, Health for Youth Association
Dr. Slavica Gajdadzis-Knezhevikj, ALTERNATIVA
Janina Müller, University of Klagenfurt
Bethan Pell, Cardiff University
Dr. Antonio Piolanti, University of Klagenfurt
Franziska Waller, University of Klagenfurt
Dennis Wienand, Medical University of Vienna
Young people in Eastern Europe face multiple risks to their mental health and wellbeing, for many reasons, including poverty, inequality, and other adverse experiences, now exacerbated by the ongoing conflict in Ukraine. Family plays a critical role as a potential buffer for these risks. However, research on evidence-informed approaches to supporting adolescent mental health that are affordable and scalable in LMICs is still limited.
Mental health is more than the absence of mental health problems. Early adolescence is a key period for health because it is a time of vast physical, emotional, and social changes and a distinct phase of brain development. Early adolescence is also the age when about half of mental health problems emerge. Parenting approaches that offer warmth and autonomy have been associated with healthy behaviours in children and adolescents, such as longer and higher quality sleep, healthier nutritional and dietary behaviours, and physical activity, as well as with better mental health, such as lower anxiety and depression symptoms. Parental monitoring and communication about risk behaviours, such as substance use, has been linked to lower rates of risk behaviours among adolescents.
The intervention package will build on the open-access programme Parenting for Lifelong Health for Parents and Teens. This family program will be combined in a service package with other components to strengthen adolescent skills for wellbeing, such as problem-solving.
Parenting for Lifelong Health is a suite of group-based socio-behavioural interventions at the individual and family level. PLH is based on evidence regarding the components associated with positive outcomes in parenting practices, adolescent-caregiver communication, and other outcomes among families. PLH was developed with a focus on feasibility of implementation, in collaboration between researchers, World Health Organization and UNICEF, to meet the need of child and adolescent health promotion and prevention of violence against children in LMICs. The programmes are designed to be delivered by staff without specific professional background, and programme manuals are freely available under Creative Commons licensing.
FLOURISH’s aim is to optimize and evaluate the effectiveness, cost-effectiveness, and implementation at scale of Parenting for Lifelong Health for Teens. The main project objectives are:
Adapt the Parenting for Lifelong Health for Parents and Teens programme and implement it within sustainable delivery systems in Moldova and North Macedonia
Optimise the intervention package to identify the most cost-effective and scalable components;
Evaluate the implementation and outcomes of the adapted and optimised programme;
Develop a communication strategy and assess the dissemination and impact of the communication activities for families, implementers, and policy stakeholders
FLOURISH will include four interconnected studies to address the objectives of the project.
Phase 1 will focus on programme adaptation to a new context, piloting of the adapted programme, and exploring the selection of conditions for the factorial trial (Phase 2). We will explore the cultural changes that the programme may need, while maintaining integrity to the theory of change. In adapting the intervention, we will be guided by making it as scalable as possible within the delivery systems in North Macedonia and Moldova. We will form four advisory groups: (1) advisory groups with adolescents, (2) parents, (3) implementers, (4) other professional experts. Each of these groups will meet for a consultation to identify programme adaptations and provide feedback. Based on the consultations in each country, the programme adaptations will be identified and implemented.
Second, the adapted intervention will be piloted with families with young adolescents aged 10-14. The pilot Phase will involve pre-and post-programme quantitative and qualitative data collection with adolescents, parents, and facilitators. It will (1) test the feasibility of the revised programme, (2) produce updated intervention materials and theory of change, and (3) explore and prepare the elements to be tested in Phase 2.
In Phase 2, an 8-condition factorial trial will be used to select the most effective and cost-effective treatment package in the factorial experiment phase of the Phase. The recruitment strategy, inclusion and exclusion criteria, and measures tested in Phase 1 will be adapted based on the results related to design feasibility and measurement psychometrics and will be used in Phase 2 and 3. The Phase will include a pre- and post-programme measures of the primary and secondary outcomes.
Research questions for the factorial phase:
o How do participant engagement and family outcomes vary with and without a mental health component?
o How do participant engagement and family outcomes vary when delivering the programme with the adolescent peer support element (on/off)?
o Does the additional of an adolescent participation booster result in higher rates of participant engagement and improvements in outcomes, compared to the conditions without a booster?
In Phase 3, a hybrid implementation effectiveness RCT will be used to test the intervention package selected in Phase 2. The pause between the intervention group delivery and the waitlist group delivery will be used to make any final iterations to the programme package, if needed. The implementation and outcome measures will be consistent with Phase 1. In addition, in Phase 3 we will add a survey for caregivers on use of health and social services for themselves and their adolescents, to compare the intervention and waitlist group service use. Many programmes tend to focus on one outcome – but parenting programmes can impact multiple outcomes and be a vector of adolescent and caregiver outcomes. FLOURISH will look at cost-effectiveness for a specific outcome, but also outline all the additional benefits.
FLOURISH work packages (WP) will work across all four studies and service specific focal areas. More info on these can be found on the FLOURISH website: https://www.flourish-study.org/work-packages.html.
WP1: Development and co-production: adapting the intervention to optimize acceptability, scalability, and effectiveness on youth mental health
WP2: Programme implementation: delivery of the programme package in Moldova and North Macedonia
WP3: Data management, outcome assessment and data analyses: quantitative outcomes reported by families and staff
WP4: Implementation assessment and data analysis: quantitative programme implementation indicators and qualitative data
WP5: Health economic analyses: cost and cost-effectiveness of the programme package
WP6: Communication and impact: communication to public, practitioners, policymakers, researchers
WP7: Coordination and management: integration of activities and findings
Further information and publications
Horizon Europe and UKRI