The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge cluster randomized controlled recruitment trial

Background Conduct, anxiety and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. Methods We will conduct a two-arm individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated impact. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention), or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported impact of mental health difficulties, perceived stress, mental wellbeing and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added impact of a classroom-based sensitization intervention over school-level recruitment sensitization activities on the primary outcome of referral rate into the host trial (i.e. the proportion of adolescents referred as a function of the total sampling frame in each condition of the embedded recruitment trial). Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. Discussion Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems

Giving Voice to Working Mothers: A Consumer Informed Study to Program Design for Working Mothers

Working parents experience considerable stress as they strive to cope with competing demands from work and family. However, workforce participation has shown to safeguard their personal wellbeing. It is therefore important that parents are adequately supported though appropriate and acceptable interventions in order to help them achieve quality of life, without needing to sacrifice one life domain for the other. This study adopted a consumer-focused perspective to program design to identify the relative fit between parental needs an existing workplace intervention. Focus groups were conducted with fifteen working mothers aged 30-44 years (M = 38.67). A thematic analysis revealed eight themes: (a) the impact of guilt, (b) crossover effects of work on family, (c) the availability of support, (d) being a quality parent, (e) getting the balance right, (f) impact on couple relationship, (g) having a career counts, and; (h) the need for low intensity programs. The extracted themes provided a good fit with existing workplace interventions that address stress and parenting. However, the results also indicated that working mothers need further assistance with strategies to manage guilt and the need to build on career strengths. Working parents also indicated a desire for briefer interventions. The implications for program design, including possible modifications, to current workplace interventions are discussed

Using father preference data to increase father engagement in evidence-based parenting programs

Survey (n = 161) and focus group (n = 15) methods were used to collect data from a community sample of New Zealand fathers about their knowledge and experience with parenting programs, and their preferences for program content, features, and delivery methods. The prevalence of perceived child behavioral and emotional difficulties, parenting risk and protective factors, fathers' parenting confidence, and the family and personal correlates of father preferences were also examined. Survey results showed that fathers' knowledge and experience of available parenting programs was low. The topics rated most highly by fathers to include in a program were building a positive parent-child relationship, increasing children's confidence and social skills, and the importance of fathers to children's development. Fathers' most preferred program delivery methods were father only group programs, individually-tailored programs, and a range of low intensity options, including seminar, television series, and web-based. Program features most likely to influence father attendance were demonstrated program effectiveness, location of sessions, practitioner training, and that content addressed personally relevant issues. Fathers' level of education, stress and depression, and perceptions of child behaviour difficulty were linked to program content and delivery preferences. New insights were gained from focus group participants about messages to include in program advertisements and program content to emphasise in order to engage fathers. Findings highlight a variety of program and delivery options that could be offered to meet a range of father parenting support needs, including concerns about coping with specific child behaviours and emotions, and managing personal and parenting stress