Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-015985 on 13 July 2017. Downloaded from Let’s Talk about Children Evaluation (LTCE) study in northern Finland: a multiple group ecological study of children’s health promotion activities with a municipal and time-trend design Veikko Kujala,1,2,3 Jaana Jokinen,1,4 Hanna Ebeling,2,5 Anneli Pohjola4 To cite: Kujala V, Jokinen J, ABSTRACT Strengths and limitations of this study Ebeling H, et al. Let’s Talk Introduction Making change towards child and family- about Children Evaluation (LTCE) based and coordinated services is critical to improve study in northern Finland: a ► The Let’s Talk about Children Evaluation study’s quality, outcomes and value. The Let’s Talk about Children multiple group ecological study protocol is suitable when intervention is of children’s health promotion (LTC) approach, which consists of brief psychoeducational implemented annually in real-life municipalities. By activities with a municipal and discussions with parents of kindergarten-aged and school- creating a regional database for the Let’s Talk about time-trend design. BMJ Open aged children, has been launched as a municipality- Children (LTC) results, we can sample over 100 000 2017;7:e015985. doi:10.1136/ specific programme in the Council of Oulu Region. The aim children and youths. The merit of such large-scale bmjopen-2017-015985 of this paper is to present a protocol of an ecological study evaluations is high. evaluating the group-specific effects of an intervention ► Prepublication history for ► The LTC approach seeks to better link community this paper is available online. about LTC activities in a geographically defined population. services provided to families and to assist families To view these files please visit The programme is designed to promote children’s in accessing the support they need. socioemotional well-being. the journal online (http:// dx. doi. ► Adequately measuring individual-level LTC org/ 10. 1136/ bmjopen- 2017- Methods and analysis A quasi-experimental ecological intervention results is difficult, because the 015985). study protocol is implemented to evaluate whether framework of strengths and vulnerabilities applies systematic LTC practices improve children’s well-being. to both the capacity of individuals and their social Received 23 January 2017 http://bmjopen.bmj.com/ A multi-informant setting covers 30 municipalities in and physical ecologies. Revised 5 June 2017 northern Finland and involves all the municipal teachers, Accepted 7 June 2017 social and healthcare workers. In each municipality, a Local Management Team is responsible for implementing the LTC programme and collecting the annual data of LTC Opportunities exist, however, to improve discussions and network meetings. The outcome data mental capital through interventions: we are retrieved from child welfare statistics and hospital can try to build the cognitive and emotional registers. The population data, child welfare statistics and resources that influence how an individual is referrals to hospitals was retrieved at baseline (2014), and will be retrieved annually. Furthermore, the annual data of able to experience a high quality of life. Some on September 30, 2021 by guest. Protected copyright. LTC discussions and network meetings will be collected of problems nevertheless extend beyond the 1Primary Health Care Unit, Oulu the years 2015–2018. individual to family members and communi- University Hospital, Oulu, Finland Ethics and dissemination The study design has been ties. Thus, system-wide changes and a settings 2 1 2 Center for Life Course approved by the management of the Oulu University approach are needed. The emergence of Epidemiology and Systems Hospital in accordance with the guidelines given by The such an approach has been attributed to the Medicine, University of Oulu, Regional Ethics Committee of the Northern Ostrobothnia Oulu, Finland Ottawa Charters (WHO, 1986) statement Hospital District in Oulu, Finland. All data are treated and 3Transforming Occupational which claims that health is created and lived Health Services, Finnish Institute implemented according to national data security laws. by people within the settings of their everyday of Occupational Health, Oulu, Study findings will be disseminated to provincial and life. More research into system interventions municipal partners, collaborative community groups and Finland is needed to produce an evidence base to 4Faculty of Social Sciences, the research and development community. The Let’s Talk transform child and family services. University of Lapland, about Children Evaluation study databases will guide Rovaniemi, Finland future regional development action and policies. Many evidence-based interventions fail to 5Department of Child Psychiatry, take an ecological perspective for achieving a Oulu University Hospital, Oulu, population-level impact. Children’s problems Finland INTRODUCTION may develop because of problems within their Correspondence to Children’s mental health problems disrupt families or communities, and may include Dr Veikko Kujala; veikko. kujala@ healthy development and are among the parental mental health problems, food and ttl. fi leading causes of child and youth disability.1 housing insecurity or exposure to dangerous Kujala V, et al. BMJ Open 2017;7:e015985. doi:10.1136/bmjopen-2017-015985 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-015985 on 13 July 2017. Downloaded from neighbourhoods or challenging schools.3 Intervention all public child and family services in 30 municipalities may be more effective when directed at the underlying in the Council of Oulu Region to promote the socio- issues and designed to fit the work flow and staffing of emotional well-being of children. The intervention will local child and family services.3 Integration efforts in identify children’s needs and provide them with support Finland involve work with school-based and public health in a broad spectrum of arenas in which it may be effective. services. Health promotion activities are delivered in the The intervention is expected to produce positive aspects context of co-occurring service conditions, and with a of child development and is impacted through changes focus on both individual and family strengths and vulner- to the children’s nearest social and physical ecologies. abilities. We intend to assess the associations between change in A strategic approach to health promotion consists of annual coverage of LTC actions and change in different both managerial and operational actions. This enables outcome measures among different age groups residing strong systems in local child and family services and in both urban and rural municipalities. The intervention universal delivery. Service systems are currently often is expected to improve children’s well-being after each expensive in terms of duplication, inefficiency and high municipality implements the LTC activities in all child procurement costs.4 The challenges to developing child and family services. We also anticipated changes in inci- and family services include the fragmentation of services, dents of emergency placement or taking a child into care, inter-sector borders, different work cultures and data and in incidents of new referrals to child or adolescent transmission difficulties. Furthermore, families have a psychiatric units. wide diversity of needs and varying degrees of access to assistance and advice.5 METHODS AND ANALYSIS In planning the present development programme, we Design used the following framework to conceptualise the inte- The present study is an ongoing quasi-experimental gration of child and family services. Activity integration ecological study, which is conducted in a naturalistic involves the joint provision of intervention by different setting of public child and family services in the Council sectors of services and joint training sessions for profes- of Oulu Region, Finland. The study focuses on the popu- sionals. At the regional level, policy integration includes lation under the age of 18. We assess the ecological the development of a harmonised incentive structure for association between the average LTC intervention activity operationalising actions, and the formation of a new part- and the aggregated measurement of the rate of adverse nership for municipal-based delivery of child and family incidents among multiple groups of children. The data services. Furthermore, capacity building strengthens the sources used involve observations of multiple groups evaluation of health promotion activities among munic- based on place and time (figure 1). The evaluation ipal child and family services. http://bmjopen.bmj.com/ consists of data collection at five time points (baseline The present development programme in the Council and four other time points). of Oulu Region is based on elements of brief psycho- The rollout of intervention across municipalities is educational discussions with parents (Let’s Talk about assigned without using randomisation. In each inter- Children, LTC).5 LTC was developed for the Effective vention area, the selection and timing is based on the Family Programme, which provided methods for health and social services to support families and children of mentally ill parents. LTC has earlier been tested in mental health clinics to fit the real-life settings of multi- on September 30, 2021 by guest. Protected copyright. professional child and family services.5–7 While the LTC development