Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children

Jo Magne Ingul; Kristin Martinsen; Frode Adolfsen; Anne Mari Sund; Kristin Ytreland; Elisabeth Valmyr Bania; Carina Lisøy; Lene-Mari Potulski Rasmussen; Ida Mari Haug; Joshua Patras; Linda M Collins; Philip C Kendall; Simon Peter Neumer

doi:10.3389/fpsyg.2021.703224

Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children

Front Psychol. 2021 Jun 21:12:703224. doi: 10.3389/fpsyg.2021.703224. eCollection 2021.

Authors

Jo Magne Ingul¹, Kristin Martinsen^{2

3}, Frode Adolfsen⁴, Anne Mari Sund^{1

5}, Kristin Ytreland¹, Elisabeth Valmyr Bania¹, Carina Lisøy^{2

3}, Lene-Mari Potulski Rasmussen⁴, Ida Mari Haug⁴, Joshua Patras⁴, Linda M Collins⁶, Philip C Kendall⁷, Simon Peter Neumer^{3

4}

Affiliations

¹ Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
² Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
³ Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
⁴ Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway.
⁵ St Olav's University Hospital, Trondheim, Norway.
⁶ Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States.
⁷ Department of Psychology, Temple University, Philadelphia, PA, United States.

Abstract

Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.

Keywords: child emotional problems; cognitive behavior therapy; emotion; evidence-based interventions; factorial design; mediators; optimization; prevention.