Global child and adolescent mental health perspectives: bringing change locally, while thinking globally.

Child and adolescent mental health (CAMH) are a global priority. Different countries across the globe face unique challenges in CAMH services that are specific to them. However, there are multiple issues that are also similar across countries. These issues have been presented in this commentary from the lens of early career CAMH professionals who are alumni of the Donald J Cohen Fellowship program of the IACAPAP. We also present recommendations that can be implemented locally, namely, how promoting mental health and development of children and adolescents can result in better awareness and interventions, the need to improve quality of care and access to care, use of technology to advance research and practices in CAMH, and how investing in research can secure and support CAMH professionals and benefit children and adolescents across the globe. As we continue to navigate significant uncertainty due to dynamic circumstances globally, bolstering collaborations by "bringing change locally, while thinking globally" are invaluable to advancing global CAMH research, clinical service provision, and advancement of the field.

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities.

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Latinx Mental Health Scholars' Experiences with Cultural Adaptation and Implementation of Systemic Family Interventions.

An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families.

Un número cada vez mayor de intervenciones adaptadas culturalmente a nivel familiar abordan las desigualdades en la salud mental con poblaciones marginadas en los Estados Unidos. Sin embargo, con estos avances han surgido muchos obstáculos, como las dificultades con el grado de integración cultural, la participación y la sostenibilidad. Realizamos veinte entrevistas fenomenológicas selectas con investigadores de la salud mental dedicados a la investigación familiar en materia de prevención e intervenciones con varias comunidades latinas dentro y fuera de los Estados Unidos. Estos investigadores comentaron sus experiencias de superación de los obstáculos en su investigación. Utilizamos el análisis temático para decodificar y analizar las respuestas de los participantes; nuestros resultados respaldan la falta de datos en publicaciones previas y destacan las posibles vías para superar los obstáculos en la investigación sobre la adaptación cultural. Los temas incluyeron la nacesidad de: (a) una mejor comprensión del enlace entre la cultura y el contexto; (b) enfoques centrados en la comunidad para abordar las dificultades de implementación; y (c) cambios estructurales dentro de los niveles institucionales, gubernamentales y políticos. Debatimos las implicancias para los investigadores y los profesionales que trabajan con familias latinas.

Self-Regulation in Low- and Middle-Income Countries: Challenges and Future Directions.

Self-regulation is developed early in life through family and parenting interactions. There has been considerable debate on how to best conceptualize and enhance self-regulation. Many consider self-regulation as the socio-emotional competencies required for healthy and productive living, including the flexibility to regulate emotions, control anger, maintain calm under pressure, and respond adaptively to a variety of situations. Its enhancement is the focus of many child and family interventions. An important limitation of the self-regulation field is that most empirical and conceptual research comes from high-income countries (HICs). Less is known about the manifestation, measurement and role of self-regulation in many collectivistic, rural, or less-developed contexts such as low- and middle-income countries (LMICs). This position paper aims to present an initial review of the existing literature on self-regulation in LMICs, with a focus on parenting, and to describe challenges in terms of measurement and implementation of self-regulation components into existing interventions for parents, children and adolescents in these settings. We conclude by establishing steps or recommendations for conducting basic research to understand how self-regulation expresses itself in vulnerable and low-resource settings and for incorporating components of self-regulation into services in LMICs.

Parenting Programs for Underserved Populations in Low- and Middle-Income Countries: Issues of Scientific Integrity and Social Justice.

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the US and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the U.S., Latin America, Africa and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities.

Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL): Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 ("Familias Fuertes") in Panama.

BACKGROUND: Interpersonal violence can significantly reduce adolescents' opportunities for becoming happy and healthy adults. Central America is the most violent region in the world and it is estimated that adolescents are involved in 82% of all homicides in this region. Family skills training programmes have been designed to prevent interpersonal violence in adolescents. Several studies in high-income countries suggest they are effective. However, there are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). The aim of this study is to test the effectiveness of the Strengthening Families Programme 10-14 (SFP 10-14 or "Familias Fuertes") in Panama, a LMIC in Central America. An embedded process evaluation will examine the extent to which the intervention is delivered as intended, variation across trial sites, influences on implementation and intervention-context interactions. Cost-effectiveness will also be assessed. METHODS: This is a cluster randomised controlled trial. The 28 townships with the highest homicide rates in Panama will be randomly allocated to implementation of SFP 10-14 alongside services-as-usual or to services-as-usual only. Approximately 30 families will be recruited in each township, a total sample of 840 families. Families will be assessed at baseline, approximately eight weeks after baseline (i.e. post intervention), six months and 12 months after. The primary outcome measure will be the parent reported externalising subscale of the Child Behaviour Checklist at T3 (i.e., which is approximately 12 months after baseline). For the process evaluation, recruitment, attendance, fidelity and receipt will be measured. Qualitative interviews with facilitators, trainers, parents and adolescents will explore barriers/facilitators to implementation and intervention receipt. For the cost-effectiveness analysis, service use information will be gathered from parents and adolescents with a three-month recall period. Costs and consequences associated with implementation of the intervention will be identified. DISCUSSION: This trial will be the first to evaluate SFP 10-14 in a LMIC. Results have the potential to guide public policies for the prevention of interpersonal violence in Central America and beyond. TRIAL REGISTRATION: ISRCTN Registry, 14023111 . Registered on 13 July 2017.

Different Strokes for Different Folks? Contrasting Approaches to Cultural Adaptation of Parenting Interventions.

Relevant achievements have been accomplished in prevention science with regard to disseminating efficacious parenting interventions among underserved populations. However, widespread disparities in availability of parenting services continue to negatively impact diverse populations in high-income countries (e.g., the USA) and low- and middle-income countries. As a result, a scholarly debate on cultural adaptation has evolved over the years. Specifically, some scholars have argued that in diverse cultural contexts, existing evidence-based parenting interventions should be delivered with strict fidelity to ensure effectiveness. Others have emphasized the need for cultural adaptations of interventions when disseminated among diverse populations. In this paper, we propose that discussions on cultural adaptation should be conceptualized as a "both-and," rather than an "either-or" process. To justify this stance, we describe three distinct parenting intervention projects to illustrate how cultural adaptation and efficacy of evidence-based interventions can be achieved using contrasting approaches and frameworks, depending on cultural preferences and available resources of local contexts. Further, we suggest the need to develop guidelines for consistent reporting of cultural adaptation procedures as a critical component of future investigations. This discussion is relevant for the broader public health field and prevention science.

Preventing interpersonal violence in Panama: is a parenting intervention developed in Australia culturally appropriate?

OBJECTIVES: To explore cultural appropriateness of a transported parenting intervention in Panama. METHODS: Panamanian parents (n = 25) were interviewed after participation in an Australian parenting intervention. A thematic analysis was conducted to interpret qualitative data. RESULTS: Three themes emerged; cultural context, appropriateness of the intervention, and development of support networks. In terms of cultural context, parents described economic difficulties, living in a dangerous world, struggling to balance parenting and work, and using aggressive communication patterns. In terms of appropriateness of the intervention, they rated materials as appropriate, although suggested modifications to its delivery by including children and teachers in the training. Finally, parents commented that the intervention prompted the development of social networks within their communities. CONCLUSIONS: Overall, parents considered a transported parenting intervention as appropriate to their local needs. This study might be useful to local governments and international funders in charge of deciding whether transporting parenting interventions North to South as a strategy for violence prevention would be respectful of local needs. Our findings cannot be generalized beyond Panama, but the methodology can be replicated to answer this question in other settings.

Distress in significant others of patients with chronic fatigue syndrome: A systematic review of the literature.

PURPOSE: The objective of this study was to systematically review existing empirical research assessing levels and correlates of distress in significant others of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). METHODS: Systematic searches in CINAHL, Web of Science and PsycINFO were conducted in August 2014. The search was repeated in January 2015 to check for newly published articles. Studies published in English with quantitative, qualitative, or mixed designs exploring distress, poor subjective health, poor mental health, reduced quality of life and well-being, and symptoms of depression and anxiety in significant others (>18 years) of children and adults with CFS/ME were included. Quality appraisal of included studies was carried out. Quantitative and qualitative studies were summarized separately. RESULTS: Six articles met eligibility criteria. Two quantitative studies with significant others of adult patients, and one quantitative and two mixed-methods studies with significant others of child patients showed moderate to high levels of distress. One qualitative study (adult patients) found minimal evidence of distress and that acceptance of CFS/ME was related to better adjustment. In the quantitative and mixed-methods studies, significant others who attributed some level of responsibility for symptoms to the patient, or who were female, or whose partners had poorer mental health, had higher levels of distress. CONCLUSIONS: The small number of studies to date, the contrary evidence from a qualitative study, and the limited data available on levels of distress in significant others of patients with CFS/ME mean that our conclusion that distress levels are elevated is provisional. We recommend that future qualitative studies focus on this particular topic. Further longitudinal studies exploring correlates of distress within the context of a predictive theoretical model would be helpful. Statement of contribution What is already known on this subject? Chronic fatigue syndrome (CFS/ME) entails considerable economic, social, and personal costs. Uncertainties exist around diagnosis and management. This may lead to particular difficulties for significant others trying to support patients. What does this study add? Few studies have examined distress and its correlates in significant others of people with CFS/ME. Significant others report elevated levels of distress on quantitative measures.

Exploration of Mechanisms behind Changes after Participation in a Parenting Intervention: A Qualitative Study in a Low-Resource Setting.

Parenting interventions are effective for preventing psychological difficulties in children. However, their active ingredients have not been comprehensively explored. How do they work? What are the mechanisms operating behind changes? In 2012, a randomized controlled trial of a parenting intervention was conducted in low-resource communities of Panama. Effects on child behavioral difficulties, parental stress, and parenting practices were large in the short and long term. This was an ideal opportunity to explore potential mechanisms operating behind effects found in this low-resource setting. Twenty-five parents were interviewed. Data were analyzed through an inductive semantic thematic analysis. Three themes emerged from the data: (a) psychological mechanisms behind changes, (b) behavioral changes in parent, and (c) changes in the children. Parents described that the intervention triggered changes in emotion regulation, self-efficacy, and problem solving. Parents also reported behavioral changes such as praising their children more often, who in turn seemed more responsible and better at following instructions. The study offers participant-driven insight into potential pathways of change after participation in this parenting intervention, pathways that are often overlooked in quantitative studies. Future studies should further explore these pathways, through mediator and moderator analyses, and determine how much is shared across interventions and across different cultural settings.

[CHILD'S LIFESTYLE BEHAVIOURS RELATING TO WEIGHT AND MATERNAL SELF-EFFICACY IN MANAGING THEM]. / CONDUCTAS DEL ESTILO DE VIDA DEL HIJO RELACIONADAS CON EL PESO Y AUTOEFICACIA MATERNA PARA MANEJARLAS.

INTRODUCTION: parenting represents challenges. Mothers of overweight (OW) - obesity (OB) children face their children's lifestyle behaviors related to body weight. OBJECTIVES: 1) To assess the reliability of The Lifestyle Behaviour Checklist (LBC) in Spanish, 2) To evaluate the children's lifestyle behaviour that represent for the mother a problem for managing (PB) and self-efficacy (SE) to manage them in mothers of children with and without OW-OB and 3) To verify the differences between groups. METHODS: participated 367 dyads (mother / child). Mothers answered the LBC with two scales, problems behaviour scale (PBS) and self-efficacy to managing them scale (SMS). The dyads' weight and size were measured. Cronbach's alpha coefficient, descriptive statistics and ANOVA were calculated. RESULTS: Cronbach's alpha for PBS was 0.86 and 0.96 for SMS. Watches too much television was the greatest problem in managing for mothers of children with and without OW-OB (F = .232, p = .630). The mothers of children with OW-OB had lower self-efficacy compared to mothers of children without OW-OB (F = 14,155, p = .001). The mothers of children with OW-OB perceived more PB (Mean = 55.40) and less SE compared to mothers of children without OW-OB (F = 15.45, p.

Introducción: la crianza de los hijos representa retos. Las madres de hijos con sobrepeso (SP) - obesidad (OB) enfrentan conductas del estilo de vida del hijo (CEVH) relacionadas con el peso corporal. Objetivos: 1) Evaluar la confiabilidad de la escala Lista de Verificación de CEVH (LVC) en Español. 2) Evaluar las CEVH que representan un problema para su manejo (PC) y la autoeficacia (AE) para manejarlos, en madres de hijos con y sin SP-OB y 3) Verificar diferencias entre los grupos. Métodos: participaron 367 diadas (madre/hijo). Las madres contestaron la Escala LVC con dos escalas: escala problemas de conductua (EPC) y escala autoeficacia para manejarlos (EAE). Se midió peso y talla a las diadas. Se obtuvó coeficiente alpha de Cronbach, estadísticas descriptivas y se aplicó ANOVA. Resultados: el alpha de Cronbach para la EPC fue 0,86 y para la EAE 0,96. Ver mucha televisión fue el mayor PC que las madres de hijos con y sin SP-OB tienen que manejar (F = ,232, p = ,630). Las madres de hijos con SP-OB tuvieron menor AE respecto a las madres de hijos sin SP-OB (F = 14,155, p = ,001). Las madres de hijos con SP-OB percibieron más PC (media = 55,40) y tuvieron menor AE respecto a las madres de hijos sin SP-OB (F = 15,45, p < ,001). Conclusiones: la Escala LVC en Español mostró una consistencia interna aceptable. Las madres de hijos con SP-OB percibieron más PC y tuvieron menor AE. Se recomienda implementar programas para fortalecer la AE materna.

Conductas del estilo de vida del hijo relacionadas con el peso y autoeficacia materna para manejarlas / Child’s lifestyle behaviours relating to weight and maternal self-efficacy in managing them

Introducción: la crianza de los hijos representa retos. Las madres de hijos con sobrepeso (SP) - obesidad (OB) enfrentan conductas del estilo de vida del hijo (CEVH) relacionadas con el peso corporal. Objetivos: 1) Evaluar la confiabilidad de la escala Lista de Verificación de CEVH (LVC) en Español. 2) Evaluar las CEVH que representan un problema para su manejo (PC) y la autoeficacia (AE) para manejarlos, en madres de hijos con y sin SP-OB y 3) Verificar diferencias entre los grupos. Métodos: participaron 367 diadas (madre/hijo). Las madres contestaron la Escala LVC con dos escalas: escala problemas de conductua (EPC) y escala autoeficacia para manejarlos (EAE). Se midió peso y talla a las diadas. Se obtuvó coeficiente alpha de Cronbach, estadísticas descriptivas y se aplicó ANOVA. Resultados: el alpha de Cronbach para la EPC fue 0,86 y para la EAE 0,96. Ver mucha televisión fue el mayor PC que las madres de hijos con y sin SP-OB tienen que manejar (F = ,232, p = ,630). Las madres de hijos con SP-OB tuvieron menor AE respecto a las madres de hijos sin SP-OB (F = 14,155, p = ,001). Las madres de hijos con SP-OB percibieron más PC (media = 55,40) y tuvieron menor AE respecto a las madres de hijos sin SP-OB (F = 15,45, p < ,001). Conclusiones: la Escala LVC en Español mostró una consistencia interna aceptable. Las madres de hijos con SP-OB percibieron más PC y tuvieron menor AE. Se recomienda implementar programas para fortalecer la AE materna (AU)

Introduction: parenting represents challenges. Mothers of overweight (OW) - obesity (OB) children face their children’s lifestyle behaviors related to body weight. Objectives: 1) To assess the reliability of The Lifestyle Behaviour Checklist (LBC) in Spanish, 2) To evaluate the children´s lifestyle behaviour that represent for the mother a problem for managing (PB) and self-efficacy (SE) to manage them in mothers of children with and without OW-OB and 3) To verify the differences between groups. Methods: participated 367 dyads (mother / child). Mothers answered the LBC with two scales, problems behaviour scale (PBS) and self-efficacy to managing them scale (SMS). The dyads’ weight and size were measured. Cronbach’s alpha coefficient, descriptive statistics and ANOVA were calculated. Results: Cronbach’s alpha for PBS was 0.86 and 0.96 for SMS. Watches too much television was the greatest problem in managing for mothers of children with and without OW-OB (F = .232, p = .630). The mothers of children with OW-OB had lower self-efficacy compared to mothers of children without OW-OB (F = 14,155, p = .001). The mothers of children with OW-OB perceived more PB (Mean = 55.40) and less SE compared to mothers of children without OW-OB (F = 15.45, p (AU)

A pilot randomized controlled trial of a brief parenting intervention in low-resource settings in Panama.

The aim of this study was to determine whether an intervention from the Triple P Positive Parenting Program system was effective in reducing parental reports of child behavioral difficulties in urban low-income settings in Panama City. A pilot parallel-group randomized controlled trial was carried out. A total of 108 parents of children 3 to 12 years old with some level of parent-rated behavioral difficulties were randomly assigned to a discussion group on "dealing with disobedience" or to a no intervention control. Blinded assessments were carried out prior to the intervention, 2 weeks, 3 months, and 6 months later. Results indicated that parental reports of child behavioral difficulties changed over time and decreased more steeply in the intervention than in the control group. The effects of the intervention on parental reports of behavioral difficulties were moderate at post-intervention and 3-month follow-up, and large at 6-month follow-up. Parents who participated in the discussion group reported fewer behavioral difficulties in their children after the intervention than those in the control condition. They also reported reduced parental stress and less use of dysfunctional parenting practices. There is a limited amount of evidence on the efficacy of parenting interventions in low-resource settings. This pilot trial was carried out using a small convenience sample living in low-income urban communities in Panama City, and therefore, the findings are of reduced generalizability to other settings. However, the methodology employed in this trial represents an example for future work in other low-resource settings.

Measuring parenting practices and family functioning with brief and simple instruments: validation of the Spanish version of the PAFAS.

A set of instruments with different response formats is usually used to assess parenting practices in clinical settings and in research studies. These complex protocols can be problematic for parents with low-literacy levels. The Parenting and Family Adjustment Scales (PAFAS) is a brief, easy to read instrument that has been developed to address these concerns. The English version of this instrument suggested that it has good internal consistency (range from .70 to .96), as well as satisfactory construct and predictive validity. The aim of the present study was to explore the validity and reliability of the Spanish version of the PAFAS. A sample of 174 Spanish-speaking parents (85% mothers; M = 37 years old; SD = 9.1) from Panama in Central America completed the instrument alongside the Parenting Scale and the Depression Anxiety Stress Scale (DASS-21). Psychometric evaluations revealed that the measure had satisfactory construct and concurrent validity as well as good internal consistency (values >.60 for all subscales) and test-retest reliability (ICC >.60 for all subscales). The PAFAS shows promise as a brief outcome measure to assess parenting practices and family functioning with Spanish-speaking parents. Potential uses of the measure and implications for further validation with diverse samples are discussed.

An exploration of parents' perceptions and beliefs about changes following participation in a family skill training program: a qualitative study in a developing country.

Family skill training programs have been recognized as effective strategies for preventing substance use. However, they have been evaluated mainly in high-income countries. Families in developing countries also face difficulties; therefore, it is important to explore the fit of existing programs in this context. The present study explores parents' perceptions and beliefs about changes following participation in the Strengthening Families Program 10-14, which was implemented in Panama by the United Nations Office on Drugs and Crime. Thirty parents who had taken part in the program between 2010 and 2011 were interviewed. Thematic analysis was conducted taking a participant-driven inductive stand. An exploration of parents' narratives suggested that, after the program, they observed changes in themselves as parents, in their children, in the interaction between the two of them, and in their functioning as a couple. Perceived changes centered on communication, limits, obedience, relationship roles, emotional regulation, and social development. For example, parents reported being able to control their emotions in a healthier manner, reducing the use of shouting and setting limits in a more effective way. All these factors have been recognized in previous research as strategies for preventing substance use. It is important to assess participants' perceptions of programs brought from elsewhere before dissemination efforts can take place. Parents interviewed for this study appeared to hold positive views about this program. This methodology is discussed as a means of evaluating evidence-based interventions in different cultural settings.

A review of parenting programs in developing countries: opportunities and challenges for preventing emotional and behavioral difficulties in children.

Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited. International organizations such as the World Health Organization have called for the implementation of programs to prevent behavioral difficulties through the development of stable relationships between children and their parents. The aim of the present paper was to review the literature on parenting programs in developing countries in order to identify challenges, opportunities and directions for further research. First, reports of international organizations were reviewed in order to gain a preliminary overview of the field. In a second stage, a non-systematic review was carried out. Databases were searched in order to identify empirical evaluations of parenting programs in low-income countries. Finally, a systematic review was carried out to specifically identify evaluations of programs targeting emotional or behavioral outcomes. Only one study had a strong methodology among those designed to prevent emotional and behavioral outcomes. Opportunities for further program development and research are identified.