Periodic Reporting for period 2 - FLOURISH (FAMILY-FOCUSED ADOLESCENT & LIFELONG HEALTH PROMOTION)
Berichtszeitraum: 2024-07-01 bis 2025-12-31
Adolescence is a critical period for mental health due to significant physical, emotional, and social changes. Approximately half of all mental health problems first appear during this age. In Eastern Europe, adolescents face heightened risks to their mental well-being from violence, poverty, inequality, and other adverse experiences. These challenges have been further intensified by the coronavirus pandemic and the ongoing conflict in Ukraine.
Evidence-based parenting programs that focus on caregiver-child/adolescent relationships and effective parenting practices are widely recommended to support adolescent mental health and well-being by addressing individual and family risk factors. Additionally, WHO guidelines recommend interventions aimed at enhancing interpersonal and emotion regulation skills among adolescents. Parenting for Lifelong Health (PLH; https://www.who.int/teams/social-determinants-of-health/parenting-for-lifelong-health(öffnet in neuem Fenster)) is a program developed by researchers, the WHO, and UNICEF to promote adolescent mental health, enhance caregiver-child/adolescent relationships, and prevent violence against children in low- and middle-income countries. Despite its potential, research on affordable and scalable evidence-based approaches for supporting adolescent mental health remains limited.
The FLOURISH project aims to adapt, optimize, and evaluate the PLH for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics for adolescents aged 10–14 and their caregivers in North Macedonia and the Republic of Moldova. Drawing on stakeholder co-production and intervention process evaluation, FLOURISH will evaluate the cost-effectiveness of intervention components and test the final intervention package in a randomized trial. This approach aims to promote the adoption and expansion of open-source, evidence-based family interventions for adolescents in low-resource settings, ultimately reducing risks for future non-communicable diseases.
FLOURISH will utilize the Multiphase Optimization Strategy (MOST) framework, progressing through three interconnected phases:
• Phase 1 - Preparation: Adapting and pilot testing the program package. https://clinicaltrials.gov/study/NCT05930535(öffnet in neuem Fenster)
• Phase 2 - Optimization: Optimizing the adapted program and determining the most cost-effective package using a factorial trial. https://clinicaltrials.gov/study/NCT06562244(öffnet in neuem Fenster)
• Phase 3 - Evaluation: Evaluating the optimized program package through a randomized trial. https://clinicaltrials.gov/study/NCT07240571(öffnet in neuem Fenster)
Evidence-based parenting programs that focus on caregiver-child/adolescent relationships and effective parenting practices are widely recommended to support adolescent mental health and well-being by addressing individual and family risk factors. Additionally, WHO guidelines recommend interventions aimed at enhancing interpersonal and emotion regulation skills among adolescents. Parenting for Lifelong Health (PLH; https://www.who.int/teams/social-determinants-of-health/parenting-for-lifelong-health(öffnet in neuem Fenster)) is a program developed by researchers, the WHO, and UNICEF to promote adolescent mental health, enhance caregiver-child/adolescent relationships, and prevent violence against children in low- and middle-income countries. Despite its potential, research on affordable and scalable evidence-based approaches for supporting adolescent mental health remains limited.
The FLOURISH project aims to adapt, optimize, and evaluate the PLH for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics for adolescents aged 10–14 and their caregivers in North Macedonia and the Republic of Moldova. Drawing on stakeholder co-production and intervention process evaluation, FLOURISH will evaluate the cost-effectiveness of intervention components and test the final intervention package in a randomized trial. This approach aims to promote the adoption and expansion of open-source, evidence-based family interventions for adolescents in low-resource settings, ultimately reducing risks for future non-communicable diseases.
FLOURISH will utilize the Multiphase Optimization Strategy (MOST) framework, progressing through three interconnected phases:
• Phase 1 - Preparation: Adapting and pilot testing the program package. https://clinicaltrials.gov/study/NCT05930535(öffnet in neuem Fenster)
• Phase 2 - Optimization: Optimizing the adapted program and determining the most cost-effective package using a factorial trial. https://clinicaltrials.gov/study/NCT06562244(öffnet in neuem Fenster)
• Phase 3 - Evaluation: Evaluating the optimized program package through a randomized trial. https://clinicaltrials.gov/study/NCT07240571(öffnet in neuem Fenster)
In Phase 1, the PLH for Parents and Teens program and the Helping Adolescents Thrive (HAT) Comics were adapted to local contexts and languages through feedback from advisory focus groups, expert interviews, and input from program developers as well as clinical experts in the consortium. Various other materials essential for Phase 1 were prepared and translated, including ethical forms, informed consents, assessments, focus group/interview guides, and recruitment materials. The adapted program was pilot tested among 64 adolescents aged 10-14 years and their caregivers in North Macedonia and Moldova. Based on findings from Phase 1, adjustments were made to the intervention content, the three intervention components (buddy, mental health, and incentives) and the assessment measures for Phase 2.
Phase 2 implemented the optimized intervention through a multi-country randomized factorial trial with an embedded process evaluation, assessing implementation, effectiveness, and cost among over 650 families. Primary outcomes included adolescent internalizing problems, social support, family functioning, and program attendance, while secondary outcomes examined broader adolescent and caregiver mental health, as well as implementation and cost indicators. Post-program focus groups and data analyses informed key adaptations to the intervention content, informed consent forms, and assessment tools. The FLOURISH Meetings in June & September 2025 supported planning for Phase 3.
Phase 3 (ongoing): Phase 3 aims to test the overall effectiveness, cost-effectiveness and scalability of the intervention program with a randomized trial. Enrolment started at the end of October.
Phase 2 implemented the optimized intervention through a multi-country randomized factorial trial with an embedded process evaluation, assessing implementation, effectiveness, and cost among over 650 families. Primary outcomes included adolescent internalizing problems, social support, family functioning, and program attendance, while secondary outcomes examined broader adolescent and caregiver mental health, as well as implementation and cost indicators. Post-program focus groups and data analyses informed key adaptations to the intervention content, informed consent forms, and assessment tools. The FLOURISH Meetings in June & September 2025 supported planning for Phase 3.
Phase 3 (ongoing): Phase 3 aims to test the overall effectiveness, cost-effectiveness and scalability of the intervention program with a randomized trial. Enrolment started at the end of October.
Initial study results are in the process of preparation for publications and will be available at a later stage in this project.
The adapted intervention manual has been made available on the project website (https://www.flourish-study.org/(öffnet in neuem Fenster)) serving as a valuable resource for implementing organizations across Europe and worldwide. We have prepared study tools, such as interview guides, that are available for free use by other researchers and implementers.
The adapted intervention manual has been made available on the project website (https://www.flourish-study.org/(öffnet in neuem Fenster)) serving as a valuable resource for implementing organizations across Europe and worldwide. We have prepared study tools, such as interview guides, that are available for free use by other researchers and implementers.