Promoting mental health in young children – a sustainable dialogue based approach in kindergartens (PRO-DIALOG)

Around 7% of Norwegian 4-year-olds have such severe mental difficulties that they qualify for a diagnosis, but it often takes a long time from the difficulties arise, until they are discovered and the children get the right help. The authorities have therefore laid down clear guidelines so that those who work with children must know what to look for and how to proceed in order for the children to get the help they need. In Norway, over 95% of children attend kindergarten where the teachers get to know the children well over time and have appraisals with the parents 1-2 times a year. The kindergarten should therefore be an ideal arena for early detection. However, no adapted method has been available for the practice and terminology in kindergartens. We have therefore developed the method Dialogue-based early detection (DBED) in close collaboration with educators and parents in 8 different kindergartens. The method involves using the appraisal more systematically by having both parents and kindergarten teachers complete a questionnaire in advance about possible concerns they have had for the child's development and well-being in recent months. In the conversation, they can then explore and try to agree on the understanding of the child and whether there is a need for further assessment or other measures. Feedback during early testing indicates that the method works well and is perceived as a useful tool. In order to obtain documented knowledge about how DBED works, we have developed the research project PRO-DIALOG. We wish to gain knowledge about (1) how DBED functions as a screening instrument, (2) how user-friendly it is, (3) how it affects the timing of interventions, and (4) how it affects the development of the mental health of the children over time. 12 kindergartens have been selected at random to implement the method, while 11 will act as controls. Parents of around 300 children who have three years left in kindergarten will be asked to participate.

There is an unambiguous call for early interventions at the municipal level for children at risk of developing mental health problems. However, there is a surprisingly absence of socially valid methods for detecting children in need of early support. The aim of the project is to establish the properties of such a novel method; Dialogue Based Early Detection (DBED). We will study its properties as a mental health screener, how well it is adapted in an ordinary kindergarten context, and whether it affects activation of interventions for mental health concerns and children’s future mental health. The novel aspect of DBED is the systematic assessment of the child’s development and well-being by the kindergarten teacher and his/her parents, and the subsequent dialogue that aims to explore and converge their understanding of the child and conclude whether there is a need for further assessment or supportive actions. Parents of approximately 300 children in 23 different kindergartens aged 2-3 years will be invited to participate for the three last years before school start and follow-up the next two years. The kindergartens will be randomized to an implementation group or a control group. Parents’ socio-demographic characteristics and data from parent-teacher meetings, initiated interventions, user satisfaction, parental stress, and child mental health will be collected biannually, as well as tape recordings from interviews about user experiences of parents and teachers. The most critical challenges of the project will be participation rate of the invited parents in addition to attrition due to the time pressures in a busy workday in the kindergartens, and willingness of the control parents to complete the repeated questionnaires. Appropriate measures are made to take those risks into account.