Henna Hasson

Research idea and purposeIn Sweden, there is a lack of evidence-based methods to reduce and prevent young children´s emotional problems, such as worry and anxiety. In the project, researchers collaborate with clinics and parents to jointly adapt cognitive behavioral therapy to the online intervention Tiny Heroes. The aim of the project is to develop Tiny Heroes and to assess its preliminary effectiveness.Research questions: ·       What components and modes of delivery are perceived as helpful by clinicians and parents?·       What support or change in clinical routines are needed to implement Tiny Heroes within first-line mental healthcare?·       Is Tiny Heroes preliminary effective in reducing children’s anxiety problems compared to treatment as usual?The next step after the planning project will be to apply for funding to conduct a randomized controlled trial.Workplan, methods and project realisationInternationally, there are a number of treatments with parent-based cognitive behavioral therapy, which have shown good effects for children with anxiety problems. Based on these, Tiny Heroes will be co-developed and fitted into first-line mental healthcare for young children, to the so-called MALINA clinics within Region Stockholm.In the project, a structured scientific method will be used to adapt parent-based cognitive behavioral therapy to MALINA – the clinics for first-line mental healthcare for young children 0-5 years in Region Stockholm. After this development phase, Tiny Heroes will be preliminary evaluated in a pilot study. Societal relevance and utilisationAnxiety problems have increased among children and young people in recent years in Sweden. Parent-based cognitive behavioral therapy is recommended to help young children with anxiety problems and to prevent future difficulties, but access to cognitive behavioral therapy is very limited for young children and their parents. One way to increase access to cognitive behavioral therapy is to deliver it via the internet. It enables the intervention to be scaled up, and parents can participate without taking time off from work. Other advantages are that internet interventions can be easily translated into different languages and that fidelity of the intervention is ensured (patients get the exact intervention that has been evaluated).

Research problem and specific questions: This program sheds light on the implementation challenges involved in changing health determinants to achieve improvements in public health. The aim of the program is to explore implementation challenges related to decision-making and practical implementation of structural interventions as well as preventive programs and their implication for health equity. The program combines expertise in public health and implementation science with the goal of identifying ways to close the gaps in health among societal groups. Data and method: The program builds on complexity theory to reflect that implementation of public health initiative involves multiple, often interdependent, stakeholders, decisions and activities. The program has three phases. The first is an exploratory qualitative phase including interviews with local politicians and administrators (in municipalities and regions) to understand how they make decisions about public health, including how the needs of different societal groups and conflicting societal goals are prioritized. The second phase involves several naturalistic experiments of local implementation and de-implementation cases investigating barriers and facilitators to these processes, strategies to overcome barriers, management of fidelity and adaptations and implementation outcomes. This entails a participatory approach in which the local actors implement initiatives and participate in collecting data. Analysis includes qualitative and quantitative cross-case comparisons. In the third phase, implementation capacity-building interventions aimed at decision-makers and implementers of public health initiatives are designed and evaluated. Relevance and utilisation: Although Sweden has one of the most developed welfare systems and ambitious public health policy goals, health inequalities are growing and systematic inequalities in health remain in almost all health outcomes and determinants. Implementation of structural interventions and preventive programs are needed, yet implementation research shows that these too often fail to reach, retain and deliver value to those most in need. If implementation between groups diverge, implementation of public health initiatives may increase rather than decrease health inequalities. This program addresses this contradiction by developing new knowledge on how public health initiatives can be implemented for disadvantaged populations. Plan for program realisation: This multidisciplinary program takes a participatory approach involving three research environments at two universities. A total of 63% of the costs cover salaries for the 12 participating junior and senior researchers. Operating costs (15%) include reference group reimbursement, communication activities and data collection.