Effectiveness of Emotion Focused Skills Training (EFST)

To establish and measure change in childrens symptoms and diagnosis of mental distress, our main outcome measure will be the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (Kiddie-SADS-PL), DSM-IV version (Kaufman, 1997). the Kiddie-sads will be completed at randomization and then repeated after 3 months to investigate the presence of diagnosis. A diagnosis will be rated as present or not present, with the threshold for presence being defined as a score of at least 3 within each diagnosis.

To measure change in childrens symptoms of mental distress, the Strength and Difficulties Questionnaire, SDQ (Goodman et al., 2000) will be used. The child will be filling it out him/herself electronically (from 11 yeas of age), as well as the parents and teacher. The SDQ consists of 25 items describing positive and negative attributes of children and adolescents that can be allocated to 5 subscales. Each item has to be scored on a 3-point scale with 0 = 'not true', 1 = 'somewhat true', and 2 = 'certainly true'. A total difficulties score will also be calculated(range 0-40).Lower scores indicates better outcome.

To measure change in self-perceived quality of life, the Health-Related Quality of Life KINDL-R is used (Bullinger et al., 2008). KINDL-R will be filled out by parent and child.The KINDL-R questionnaire comprises 24 items to which the respondents are asked to respond on a 5-point Likert scale (never, seldom, sometimes, often, all the time). The resulting subscales are physical well-being, emotional well-being, self-esteem, family, friends, and everyday functioning (school or nursery school/kindergarten). The subscales of these six dimensions can be combined to produce a total score. Sum scale scores will be calculated by summing up the answer scores (1-5) of each scale. All scales will be transformed so that values range from 0 to 100, with higher values representing better quality of life.

To measure Changes in parents emotional style the Emotion-Related Parenting Styles, ERPS (Paterson et al., 2012) will be used. ERPS is self-report measure for parents. ERPS consists of 20 items. Each item has to be scored on a 5-point scale fram "always false" to "always true". Scores on the items draws four subscales: Emotion Coaching parenting style (EC), Parental Rejection of negative emotion (PR), Parental acceptance of negative emotion (PA), Feeling of uncertainty /ineffectiveness in emotion socialization (UI). Higher scores indicates a better outcome on sbscales: EC and PA. Lower scores indicates better outcome on subscales PR and UI.

To measure Changes in parents emotion regulation the Difficulties in Emotion Regulation Scale, short-form, DERS-18 (Victor, S. E., & Klonsky, E. D. (2016) will be used. DERS is self-report measure for parents.The DERS-18 is comprised of three items per subscale, for six subscales (Awareness, Clarity, Goals, Impulse, Nonacceptance and Strategies), a total of 18 items. These include three reverse- coded items, all on the Awareness subscale. A total score can also be calculated. Lower scores indicates better outcome.

To measure mental health, and change in mental health in parents, the Hopkins Symptom Checklist-10 (HSCL-10) will be used. HSCL-10 is a self report form filled out by parents. It contains 10 items on a 4 point scale from 0=" Not at all" to 4="Very much". Higher scores indicates higher level of distress.HSCL-10 is a short form of the HSCL 25. A comparison study by Strand et al. showed that the shorter version of SCL performed almost as well as the full version. (Strand et al. 2003)

To measure parents relationship with child, and changes in relationship with the child, "the relationship with child RWC" (Pinsof, 2017) will be used. RWC is a self report filled out by parents. It contains 6 items on a 5 point scale from "never" to "all the time". Higher scores indicates a better perceived relationship with the child.