Periodic Reporting for period 2 - DIGIPARENT (DIGIPARENT - Implementation, personalization and genetics of digitally assisted parent training intervention to improve child mental health services.)
Reporting period: 2023-05-01 to 2024-10-31
Childhood disruptive behavior problems pose huge challenge to societies given the high lifetime burden and costs associated. Mounting evidence shows that parent training is the most effective psychosocial treatment for these problems. However, most parents in need of such training do not receive it. DIGIPARENT shift the research focus from specialized care face-to-face parent training to study digitally assisted parent training interventions when implemented in primary health. The proposal is divided into four Work Packages (WP):
- WP1 is the first population-based study about the long-term outcomes and modifiers of digitally assisted parent training. It addresses what works and how it works in real-world practice.
- WP2 will yield novel knowledge on the genetic and epigenetic variants associated with childhood disruptive behavior and the epigenetic response to childhood psychosocial interventions.
- WP 3 shifts the research focus from a
manualized one-size-fits-all parent training intervention approaches to one that is personalized for families by artificial intelligence and machine learning algorithms.
- WP 4 adopts a novel approach by comparing community level, well-being indicators when different combinations of digital and face-to-face parent training strategies are implemented in “real world”.
DIGIPARENT combines an evidence-based approach to child mental health with the latest technology and offers the potential for scientific breakthroughs, including the use of artificial technology to produce digital content tailored to the needs of individual families. Detection of genetic factors related to treatment response and possible epigenetic outcomes of treatments opens avenues for new scientific questions on how treatments can affect human biology. DIGIPARENT responds to the urgent need to study digital and remote interventions as child mental health services struggle with the considerable increase in demand for services due to the COVID-19 pandemic.
- WP1 is the first population-based study about the long-term outcomes and modifiers of digitally assisted parent training. It addresses what works and how it works in real-world practice.
- WP2 will yield novel knowledge on the genetic and epigenetic variants associated with childhood disruptive behavior and the epigenetic response to childhood psychosocial interventions.
- WP 3 shifts the research focus from a
manualized one-size-fits-all parent training intervention approaches to one that is personalized for families by artificial intelligence and machine learning algorithms.
- WP 4 adopts a novel approach by comparing community level, well-being indicators when different combinations of digital and face-to-face parent training strategies are implemented in “real world”.
DIGIPARENT combines an evidence-based approach to child mental health with the latest technology and offers the potential for scientific breakthroughs, including the use of artificial technology to produce digital content tailored to the needs of individual families. Detection of genetic factors related to treatment response and possible epigenetic outcomes of treatments opens avenues for new scientific questions on how treatments can affect human biology. DIGIPARENT responds to the urgent need to study digital and remote interventions as child mental health services struggle with the considerable increase in demand for services due to the COVID-19 pandemic.
DIGIPARENT builds on the Strongest Families intervention, a digitally assisted parent training intervention with phone coaching that was developed to increase parents’ skills and reduce children’s disruptive behavior. So far over 105 000 families have been screened and over 5000 families have participated in the Strongest Families -intervention project. The DIGIPARENT project is divided into four Work Packages (WP): WP1 Long-term effectiveness and modifiers, WP2 Genetics and epigenetics, WP 3 Personalizing the intervention and WP 4 Community-level implementation.
In WP1 we have contacted guardians who have been in another, previous study and have given their consent to be contacted for further studies. The guardians have been asked to fill in a survey once more and to give consent on analysis of register data concerning them and their child. We are using previously collected data and combining it to the registries with an opt-out option for the study participants. We are following closely the instructions of the Findata and Office of the data protection ombudsman and they are currently processing material to be sent to all parents who filled in the screening questionnaire and did not refuse to be contacted by the research team. The material includes information on the register linkage and detailed information on the possibility to opt out of the study at any time. We have reported the 6-month results on the effectiveness of digital parent intervention using a population-based sample and are finalizing a manuscript of it and its 24-month follow-up. We have finalized and submitted a report on the results of a 24-month follow-up of the SFSW conducted within a clinical setting during the COVID-lockdown. We have also applied Psychological Network analysis to assess the multi-directional, dynamic relations between digital interventions, families, and child outcomes in the RCT data including almost 500 families and 4 measurements points (baseline before starting the intervention, 6 months, 12 and 24 months after starting the intervention). We recruited a researcher for the network analysis in Spring 2024.
Another part of the WP1 involves assessing the Strongest Families Smart Website (SFSW) from the user perspective. The research team developed a research plan and a semi-structured interview form for user interviews, focusing on experiences of SFSW with a focus on access, relevance, user-friendliness and quality. The research plan has received approval from the ethical reviews board. Two experienced staff members have been assigned to conduct the interviews, which will start in the Fall of 2024.
In WP2 the Development of WP2 digital platform started at the end of 2021 and screening and recruiting participants has started at the beginning of 2023. The number of families who filled the screening questionnaire was 16089. Of them 2328 fulfilled the screening criteria and agreed to participate in the study. Altogether 47% of the participants have given permission for genetic and epigenetic assessments, and 52% for the register study. In WP2 control group, 93% of the families who filled the screening questionnaire agreed to participate in the study, 89% participants have given permission for genetic and epigenetic assessments, and 85% for the register study. The collection of biological data (buccal epithelial samples) started in December 2022 and is still going on. The samples are collected from children based on their parents' consent. The children are four years old.
In WP3 we are working with a private company to build a chatbot with which a parent can interact to seek advice when participating in a digital parent training program. We are also working to build a personalized universal parenting intervention platform. Currently the platform development has finished for the non-personalized universal parenting intervention (1.0) and over 1000 parents have registered to it. For the personalized universal parenting intervention (2.0) platform development is currently under internal testing. Currently the artificial intelligence component for the Chatbot is under development. The back-end and front-end of the AI component are completed and are currently under training. The analytics for the AI are also currently still under construction. Focus group interviews (FGI) for AI personalization have been finalized.
In WP4, we have initiated the preparation for the study that will assess the implementation of the DIGIPARENT program in the community. The research team has developed a research plan for the WP4 implementation study based on the RE-AIM theoretical framework. Specific research questions were developed according to each of the RE-AIM framework’s themes (Reach, Effectiveness, Adoption, Implementation, Maintenance) and according to different levels of respondents (i.e. decision-makers and draft makers). The aim is to assess comprehensively the decision-making process within the healthcare system about mental health and psychosocial interventions. The data collection for the WP4 is planned to start in the Fall of 2024. We are also finalizing 2 articles based on time trends studies to allow us to identify trends in the main outcomes of interest.
In WP1 we have contacted guardians who have been in another, previous study and have given their consent to be contacted for further studies. The guardians have been asked to fill in a survey once more and to give consent on analysis of register data concerning them and their child. We are using previously collected data and combining it to the registries with an opt-out option for the study participants. We are following closely the instructions of the Findata and Office of the data protection ombudsman and they are currently processing material to be sent to all parents who filled in the screening questionnaire and did not refuse to be contacted by the research team. The material includes information on the register linkage and detailed information on the possibility to opt out of the study at any time. We have reported the 6-month results on the effectiveness of digital parent intervention using a population-based sample and are finalizing a manuscript of it and its 24-month follow-up. We have finalized and submitted a report on the results of a 24-month follow-up of the SFSW conducted within a clinical setting during the COVID-lockdown. We have also applied Psychological Network analysis to assess the multi-directional, dynamic relations between digital interventions, families, and child outcomes in the RCT data including almost 500 families and 4 measurements points (baseline before starting the intervention, 6 months, 12 and 24 months after starting the intervention). We recruited a researcher for the network analysis in Spring 2024.
Another part of the WP1 involves assessing the Strongest Families Smart Website (SFSW) from the user perspective. The research team developed a research plan and a semi-structured interview form for user interviews, focusing on experiences of SFSW with a focus on access, relevance, user-friendliness and quality. The research plan has received approval from the ethical reviews board. Two experienced staff members have been assigned to conduct the interviews, which will start in the Fall of 2024.
In WP2 the Development of WP2 digital platform started at the end of 2021 and screening and recruiting participants has started at the beginning of 2023. The number of families who filled the screening questionnaire was 16089. Of them 2328 fulfilled the screening criteria and agreed to participate in the study. Altogether 47% of the participants have given permission for genetic and epigenetic assessments, and 52% for the register study. In WP2 control group, 93% of the families who filled the screening questionnaire agreed to participate in the study, 89% participants have given permission for genetic and epigenetic assessments, and 85% for the register study. The collection of biological data (buccal epithelial samples) started in December 2022 and is still going on. The samples are collected from children based on their parents' consent. The children are four years old.
In WP3 we are working with a private company to build a chatbot with which a parent can interact to seek advice when participating in a digital parent training program. We are also working to build a personalized universal parenting intervention platform. Currently the platform development has finished for the non-personalized universal parenting intervention (1.0) and over 1000 parents have registered to it. For the personalized universal parenting intervention (2.0) platform development is currently under internal testing. Currently the artificial intelligence component for the Chatbot is under development. The back-end and front-end of the AI component are completed and are currently under training. The analytics for the AI are also currently still under construction. Focus group interviews (FGI) for AI personalization have been finalized.
In WP4, we have initiated the preparation for the study that will assess the implementation of the DIGIPARENT program in the community. The research team has developed a research plan for the WP4 implementation study based on the RE-AIM theoretical framework. Specific research questions were developed according to each of the RE-AIM framework’s themes (Reach, Effectiveness, Adoption, Implementation, Maintenance) and according to different levels of respondents (i.e. decision-makers and draft makers). The aim is to assess comprehensively the decision-making process within the healthcare system about mental health and psychosocial interventions. The data collection for the WP4 is planned to start in the Fall of 2024. We are also finalizing 2 articles based on time trends studies to allow us to identify trends in the main outcomes of interest.
The early results from our implementation studies indicate that the SFSW intervention can be successfully implemented in a real-world context. The effective mechanisms and quality of the intervention are maintained through a centralized intervention provision and supervision, while still reaching the users in their every-day context. Internationally, only a fraction of developed psychosocial and psychological interventions reach the implementation phase and even fewer undergo implementation studies. Our population-level research on SFSW is globally unique.