Jukka Mäkelä, MD, Child Psychiatrist Senior expert, unit for Children, Adolescents and Families

1. Supporting parenting programs in FinlandParenting for non-violent childhoods, Tallinn 17.-18.5.2018 Jukka Mäkelä, MD, Child Psychiatrist Senior expert, unit for Children, Adolescents and Families The National Institute for Health and Welfare (THL) Helsinki, Finland

2. What is the role and expected efforts of the government • The Lape Program : National Reform Program for Child, Adolescent and Family Services 2016-2018 • supporting parenting as an overarching principle • integrative work in all services and surroundings • The National Action Plan for Safety Promotion among Children and Youth 2018−2025. National Institute for Health and Welfare • for the first time, disciplinary violence is taken seriously on a national plan; as a corollary to suicides and accidents • previously a ministerial program: Do Not Hit the Child 2013-2015 • A parliamentary debate propagating the formation of a National Child Strategy • to implement the CRC at a national, regional and municipal level

3. What are the basic requirements of a child rights-based approach to parenting • CRC § 19: • all appropriate measures to …protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation • social programmes to provide necessary support for the child and for those who have the care of the child, • as well as for other forms of prevention and for identification, reporting, referral, investigation, treatment and follow-up • The Act on Child Custody and Right of Access (1983) • The purpose of child custody is to ensure the welfare and balanced development of a child in accordance with the child's individual needs and wishes • A child must not be subdued, corporally punished or treated offensively in any other way. • A child must be brought up with understanding, security and affection

4. Basic elements of evaluations that are child centred – based on children’s rights • CA: the Common Approach • formerly the Common approach to assessment, referral and support (CAARS) • an evidence informed way of making assessments using the language understood by children and parents themselves • and done with the children and parents themselves, to be taken over into every new setting and service • not particular to any one profession • not deficit-based nor from an expert mind-set • empowering, consistent, positive • collaborative • process for pilot-training in Finland • multi-disciplinary research built in • using games to help children describe their strengths and liabilities

5. Common Approach Australia

6. How to determine which positive parenting programme is the most appropriate for country and context • We do not often have relevant research • mainly done in Anglo-American cultures • mainly with clearly defined populations • generalizability is far from certain – and not just because of implementation • Be brave and honest in what really works. • Behavioral Insights and Parenting Lab, University of Chicago (Mayer, Kalil et al 2018) • Parents need less “education” and more support to go through behavioural bottlenecks • Use local research with relevant contexts • acceptability, sustainability, relevance • relevant client populations: using universally accepted services to recognize the needs of families • universal and targeted approaches as needed • Voimaperheet (Strongest Families) in Finland with RCT and implementation research on conduct problems – most relevant for corporal punishment • RCT going on on anxiety disorders (Sourander et al 2016) • Create a national advisory board with on-going assessment and supervision • Kasvuntuki in Finland

7. Kasvun tuki (Support of growth)– a program led bythe FinnishParliament • A web-based knowledge portal www.kasvuntuki.fi • inspired by: Nordens Barn – tidigainsatserförfamiljer • financed by the Independence anniversary foundation for children • focuses on disseminating evidence-based knowledge of psychosocial preventive interventions for families and children • describes the interventions in a standardized format and includes an evaluation assessing the quality of research evidence, level of effect and level of practical usefulness for every intervention. • The evaluations are drafted by a scientific editor and approved by the scientific committee, which comprises of top-level scientists from relevant fields (medicine, psychology, social sciences) • Targets primarily decision-makers in the social and health services, but aims to benefit researchers, developers, practitioners and parents as well

8. Achievements and challenges in the parenting programmes that you are in contact with • Strongest families • acceptability: very low attrition • using internet and phone coaching • generalizability: effect (at least) as good when transferred from research settings to real life • connection with universal practices • gives back-bone to universal practice detection of abusive parenting • difficult to ask and see if there is nothing one can really offer • major ethical question of screening • Incredible years • use with very troubled families • Lets talk about children • when parents have major stressors, they are more likely to be violent (Solantaus et al 2010) • Mentalization-based parental groups • ICDP

9. Achievements and challenges in the parenting programmes that you are in contact with • How to access all the families in need and to offer the support they can benefit from • dialogical service culture: “Taking up your worries” • Luoluottamusta–suojelelasta: “Create trust, protect a child” • net-based training for all professionals • How to address violence • a Finnish special question: history carries weight • Luotsi: “Pilot”-training for multiprofessional support in listening to children and taking action • How to create true, culturally relevant material • minority cultures always a question

10. Articles • Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Hinkka-Yli-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year Old Children. A Randomized Clinical Trial. JAMA Psychiatry 2016; 73(4):378-87. • Mayer, S. E., Kalil, A., Oreopoulos, P., & Gallegos, S. (2018). Using BehavioralInsights to IncreaseParentalEngagement: The Parents and ChildrenTogether Intervention. Journal of Human Resources, 0617-8835R. • Solantaus, Tytti, et al. "Preventiveinterventions in families with parental depression: children’spsychosocialsymptoms and prosocial behaviour." Europeanchild & adolescent psychiatry19.12 (2010): 883-892.

11. Thankyou - and congratulations to Estonia 100 !