Response

The State Chancellery of the Republic of Latvia [email protected] Your ref. 21.03.2025 / Our ref. 04.04.2025 No 1.4-2/808-2 Response Dear Ms Kruska Thank you for reaching out and for your interest in Estonia’s experience with evidence-based parenting programs. We are glad to hear about Latvia’s initiative to explore programs supporting children’s behavioral and emotional development. It's a pleasure to share our experience with The Incredible Years and Triple P programs, as your goals closely align with ongoing efforts in Estonia. The Incredible Years 1. Effectiveness and impact of the program 2. Challenges of program implementation in Estonia 3. Lessons learned, successes, best practices in implementing the program in Estonia 1. In order to assess the impact of The Incredible Years program, information has been collected from parents before and after the training. The main assessment tool used was the Eyberg Child Behavior Inventory, which is widely used in other countries implementing parenting programs. Over the years, the program results have shown that parents’ skills in managing their child’s behavioral difficulties and problem-solving have improved. Parents have also reported a decrease in children’s behavioral problems, hyperactivity, and emotional difficulties, as well as an increase in prosocial behavior by the end of the training. 2. The program is widely known in Estonia among parents, social sector professionals, and policymakers. The parenting program is offered with financial support from the state, meaning that program implementation is co-funded by the government. The program budget also includes support for the network of group leaders through training, supervision, and certification, as well as learning materials for both group leaders and participants. A key challenge is that the state-funded groups do not fully meet the needs of the entire target group – not all parents who would like or need to participate in a parenting program have the opportunity to do so. Although the government does not restrict the implementation of parenting groups without state funding, such practice has so far been rare. Another challenge is participant dropout, although according to the program developer, the rate in Estonia is low. On average, three participants drop out of a group over a four-month period. In the early years of implementation, the main challenges included developing a funding Suur-Ameerika 1 / 10122 Tallinn / ESTONIA / +372 626 9301 / [email protected] / www.sm.ee / Reg. no 70001952 model, transitioning to the state budget, and explaining the program’s benefits to policymakers. Parents have also provided feedback that the Incredible Years parent training videos are too U.S.-centric in terms of language and culture, making it hard for Estonian parents to relate to them. Furthermore, the videos have not been updated by the program developers and are no longer modern; their technical format (DVD) does not match today’s IT capabilities and requires group leaders to use DVD players. Although parental satisfaction with the Incredible Years program is high and dropout rates are low, the state is considering offering an alternative program alongside it. One current option under consideration is Invest in Play, which has emerged from the Incredible Years user network. The key advantage of Invest in Play is its cultural sensitivity – countries implementing it create training videos using their own people and in their own national language. Additionally, Invest in Play offers an ADHD module – there is a need in Estonia to provide an intervention program specifically for parents of children with ADHD. 3. As of 2024, the Incredible Years basic program has been implemented in Estonia for ten years. Nearly 800 groups have been conducted, with approximately 8,500 parents participating. Since 2018, the program has been funded from the state budget. It is implemented in cooperation with local governments (90% of which have participated) and child mental health centers. Local governments and mental health centers identify families in their region who are interested in the program and organize the parenting group trainings. The program has also been implemented in the substitute care sector, though the direct impacts in that area are not yet known. In Estonia, 127 group leaders have completed basic training, of whom 22 have also completed training for the follow-up program. Since 2022, Estonia also has a trained mentor for the program. Starting in 2025, the program will be coordinated by the Social Insurance Board and implemented through public procurement. Triple P Baby and Triple P Baby Online 1. Effectiveness and impact of the program 2. Challenges of program implementation in Estonia 3. Lessons learned, successes, best practices in implementing the program in Estonia 1. Triple P has been proven effective in various target groups. More specifically, Triple P for Baby has shown positive outcomes in reducing symptoms of maternal depression and stress. Preventive efforts have also contributed to increased parental satisfaction and efficacy, with studies also noting a decrease in coercive parenting. Studies have observed a reduction in the frequency of conflicts in couple relationships. Long- term impact evaluations show that Triple P has also helped reduce child maltreatment. Parents report high satisfaction with the Triple P for Baby program. The program helps parents prepare for and adapt to life with a newborn or infant. 2. This is a new program for Estonia and has not yet been implemented, though preparations are underway. An Estonian-language glossary and list of terms have been developed. Materials are currently being translated, and preparations are ongoing for specialist training. The start of the pilot implementation is planned for 2026 (both in-person and online formats). The pilot phase will include an implementation partner and a feasibility study partner. The biggest challenge so far has been bureaucratic procedures and work organization related to public sector external funding, which have slowed down the development process. 2 (3) 3. The Triple P program was selected for Estonia through a two-phase process: 1. A comparative analysis of evidence-based parenting programs was commissioned for the specific target group. 2. A sectoral working group was formed to choose from the suitable programs identified in the analysis. The working group included representatives from the following organizations: Ministry of Social Affairs, National Institute for Health Development, Social Insurance Board, Health Insurance Fund, Estonian Midwives Association, Estonian Family Doctors Association, Estonian Nurses Association, and the Center for Child Well-being and Development. One of the most important lessons in the current phase is that involving stakeholders in the decision-making process is both essential and valuable. In addition to the above, other evidence-based prevention programs are used in Estonia, focusing on children’s social-emotional skills. These programs are managed by both public and non-profit sector organizations:  VEPA Methodology (PAX Good Behavior Game): Aimed at developing self- regulation skills among primary school students in the school setting, implemented by teachers. Parental involvement is minimal, although some elements of the methodology could be applied at home. In use in Estonia for 10 years. The impact has also been measured locally. Program managed by: National Institute for Health Development.  Gordon’s Parent Effectiveness Training (PET): Focused on social skills and family relationships. Target group: parents. Program managed by: NGO Perekeskus Sina ja Mina.  KiVa Antibullying Program: Used in schools and implemented by teachers. Parents are involved via information sharing and updates on specific incidents. Program managed by: SA Kiusamisvaba Kool.  Let’s Talk About Children: A structured yet flexible format for conversations between a specialist and a family. Target group: parents whose child needs additional attention and support, and around whom a systematic, needs-based collaboration with specialists is to be developed. Program managed by: NGO Peaasi. Yours sincerely, Gerli Lehe Head of family policy [email protected] 3 (3)