What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies

Suicide among transport industry workers: A systematic review and meta-analysis

OBJECTIVES

Working in high-stress and male-dominated occupations is associated with an elevated risk of suicide. The current study sought to conduct the first systematic literature review and meta-analysis aimed at determining suicide risk across the diverse, high pressure and male-dominated transport industry (commercial aviation, merchant seafaring, transit/driving) as compared to the general/employed population.

METHODS

Searches of PubMed/Medline, Scopus and PsycINFO databases were conducted without date restriction until March 2021. Studies were included if they were written in English, were peer reviewed, and presented primary observational research data. Studies referring exclusively to suicidal ideation, suicide attempts, self-harm, and/or accidents were excluded.

RESULTS

Following deletion of duplicates and non-English titles, a total of 4201 titles/abstracts were screened and 92 full-texts were read against inclusion/exclusion criteria. The final included sample consisted of 23 articles (16 used for meta-analysis). Results from the meta-analysis indicated that transport workers had a significantly elevated risk for suicide as compared to the general/employed population. Results were consistent across sensitivity analyses, and there was some variation across subgroup analyses.

CONCLUSIONS

Overall, we found transport workers had a significantly higher risk for suicide than the general/employed population, and this appeared to be driven by the association for those working in merchant seafaring/maritime occupations. The findings are discussed in relation to an identified need for the development, implementation, and evaluation of tailored workplace suicide prevention strategies for transport industry workers.

Facilitators and barriers of mental health help-seeking behaviours among adolescents in Oman: a cross-sectional study

OBJECTIVES

This study aimed to explore and identify facilitators and barriers to help-seeking behaviours among adolescents in Oman, by exploring the relationship between knowledge, attitude, and behaviour towards mental health help-seeking.

METHODS

A cross-sectional descriptive study was used and 424 adolescents were recruited to participate in the study. Participants were asked to complete five self-reported questionnaires, including two open-ended questions about the main motivations and barriers to seeking professional help for mental problems.

RESULTS

It was found that those with positive help-seeking attitudes towards mental health were more knowledgeable about mental health, had more positive attitudes towards mental illness, and had higher intention to help seeking. On the contrary, those with higher help-seeker stereotypes had more negative attitudes towards mental illness. Having an adequate support system, being positive and knowledgeable about mental illness, and the reputation of mental health are the main factors facilitating seeking professional help. However, fear, lack of family support, and the time-consuming procedures were the main barriers emerging from the open-ended questions.

CONCLUSIONS

This study contributes by identifying facilitating factors as well as barriers in an Arabic context (Oman) to fill the exiting knowledge gap; both need to be considered when planning interventions targeting the younger individuals in this society.

From parenting skills to adolescent treatment needs: Questions elicited by parents of adolescents discharged from residential treatment

Background

Despite the utility of parent involvement in continuing care following adolescent residential treatment, parent engagement in traditional office-based treatment is low. In our prior work, we found that parents who had access to a continuing care forum directed questions to a clinical expert and to other parents around five topics: parenting skills; parent support; managing the post-discharge transition; adolescent substance use; family functioning. The current qualitative study elicited questions from parents without access to a continuing care support forum to explore overlapping and new themes.

Methods

This study was embedded within the pilot trial of a technology-assisted intervention for parents of adolescents in residential treatment for substance use. Thirty-one parents randomized to residential treatment as usual were asked two prompts at follow-up assessments: what questions they would like to ask a clinical expert and what questions they would like to ask other parents of adolescents discharged from residential care. Thematic analysis identified major themes and subthemes.

Results

Twenty-nine parents generated 208 questions. Analyses revealed three themes identified in prior work: parenting skills; parent support; adolescent substance use. Three new themes emerged: adolescent mental health; treatment needs; socialization.

Conclusions

The current study identified several distinct needs among parents who did not receive access to a continuing care support forum. Needs identified in this study can inform resources to support parents of adolescents during the post-discharge period. Parents may benefit from convenient access to an experienced clinician for advice on skills and adolescent symptoms, paired with access to parental peer support.

Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i): protocol for a cluster randomised controlled trial to compare screening, feedback and intervention for child anxiety problems to usual school practice

Background

Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and procedures for administering screening questionnaires, sharing screening outcomes with families, and offering and delivering a brief parent-led online intervention (OSI: Online Support and Intervention for child anxiety) through schools. This trial aims to evaluate clinical and health economic outcomes for (1) children (aged 8–9) who screen positive for anxiety problems at baseline (target population) and (2) the wider population of all children in participating classes (total population) in schools randomly allocated to receive identification-to-intervention procedures and usual school practice (‘screening and intervention’), compared to assessment and usual school practice only (‘usual school practice’). 

Methods

The trial design is a parallel-group, superiority cluster randomised controlled trial, with schools (clusters) randomised to ‘screening and intervention’ or ‘usual school practice’ arms in a 1:1 ratio stratified according to the level of deprivation within the school. We will recruit schools and participants in two phases (a pilot phase (Phase 1) and Phase 2), with progression criteria assessed prior to progressing to Phase 2. In total, the trial will recruit 80 primary/junior schools in England, and 398 children (199 per arm) who screen positive for anxiety problems at baseline (target population). In schools allocated to ‘screening and intervention’: (1) parents/carers will complete a brief parent-report child anxiety screening questionnaire (at baseline) and receive feedback on their child’s screening outcomes (after randomisation), (2) classes will receive a lesson on managing fears and worries and staff will be provided with information about the intervention and (3) parents/carers of children who screen positive for anxiety problems (target population) will be offered OSI. OSI will also be available for any other parents/carers of children in participating classes (total population) who request it. We will collect child-, parent- and teacher-report measures for the target population and total population at baseline (before randomisation), 4 months, 12 months and 24 months post-randomisation. The primary outcome will be the proportion of children who screen positive for anxiety problems at baseline (target population) who screen negative for anxiety problems 12 months post-randomisation.

Discussion

This trial will establish if systematic screening for child anxiety problems, sharing screening outcomes with families and delivering a brief parent-led online intervention through schools is effective and cost-effective.

Trial registration

ISRCTN registry ISRCTN76119074. Prospectively registered on 4.1.2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06773-0.

Factors Related to Perceived Stigma in Parents of Children and Adolescents in Outpatient Mental Healthcare

Little is known about factors contributing to perceived stigma in parents of children and adolescents with behavioral and emotional problems in outpatient mental healthcare. We aimed to identify the most relevant factors related to perceived parental stigma using least absolute shrinkage and selection operator (LASSO) regression including a broad range of factors across six domains: (1) child characteristics, (2) characteristics of the primary parent, (3) parenting and family characteristics, (4) treatment-related characteristics, (5) sociodemographic characteristics, and (6) social-environmental characteristics. We adapted the Parents' Perceived Stigma of Service Seeking scale to measure perceived public stigma and affiliate stigma in 312 parents (87.8% mothers) during the first treatment year after referral to an outpatient child and adolescent clinic. We found that the six domains, including 45 individual factors, explained 34.0% of perceived public stigma and 19.7% of affiliate stigma. Child and social-environmental characteristics (social relations) explained the most deviance in public stigma, followed by parental factors. The strongest factors were more severe problems of the child (especially callous-unemotional traits and internalizing problems), mental healthcare use of the parent, and lower perceived parenting competence. The only relevant factor for affiliate stigma was lower perceived parenting competence. Our study points to the multifactorial nature of perceived stigma and supports that parents' perceived public stigma is susceptible to social influences, while affiliate stigma relates to parents' self-evaluation. Increasing parents' perceived parenting competence may help mitigate perceived stigma. Future studies should explore how stigma relates to treatment outcomes.

Benchmarking Trauma in Child Welfare: A Brief Report

Trauma exposure is common; however, considerably higher rates are reported in some vulnerable groups including adults and children involved in child welfare systems. In this context, early screening and service linkage may ameliorate its negative impact on the physical and mental well-being of adults and children alike. Using data from two Ohio-based child welfare interventions targeting co-occurring maltreatment and substance use (Ohio START¹ and EPIC2), the purpose of this brief report was to first describe the rate of trauma exposure among participating adults (Adverse Childhood Experiences or ACEs, N = 402), children 0-5 years (CTAC, N = 271) and youth 6-18 years (CTAC, N = 177), and second to benchmark observed rates against reported rates in other child welfare or similar populations across the United States. Results show that adults were exposed to 4.2 ACEs on average, a 24% increase over previous child welfare estimates. While mean CTAC scores were not significantly different among young children ages 0-5, older children reported on average 5.6 exposures which is 27% higher than previously reported estimates. Our findings highlight the difference in risk profiles between families involved child welfare due primarily to substance misuse and those without substance misuse concerns, or where substance misuse was not the primary cause of entry. We discuss implications for service provision and time-sensitive child welfare requirements.

Implicit attitudes toward psychotherapy and explicit barriers to accessing psychotherapy in youths and parent–youth dyads

Background

Few studies have investigated implicit and explicit attitudes toward psychotherapy in youths (Study 1), although information about attitudes would improve interventions that aim to decrease barriers to accessing psychotherapy including parents (Study 2), who facilitate the help-seeking process of youths.

Method

The Study 1 sample comprised 96 youths (14–21 years) and the Study 2 sample 38 parent–youth dyads. Differences in implicit attitudes regarding psychotherapy and a medical treatment were measured with the Implicit Association Test, and psychotherapy knowledge and self-reported barriers to psychotherapy were assessed with questionnaires. The actor-partner interdependence model was used to test the dyadic effects of implicit attitudes on explicit attitudes in parents and youths.

Results

We did not find evidence for an implicit bias toward psychotherapy compared to a medical treatment, neither in youths, nor in parents. Self-reported barriers were a predictor for lower help-seeking intentions. Deficits in psychotherapy knowledge were more relevant in younger participants. Having a prior or current experience with psychotherapy and having a friend or family member with a prior or current experience with psychotherapy were predictors for better psychotherapy knowledge, but was not for lower barriers to accessing psychotherapy. Partner effects (degree to which the individual’s implicit attitudes are associated with explicit attitudes of the other dyad’s member) were not found.

Conclusion

Specific deficits in psychotherapy knowledge should be addressed in interventions to lower barriers accessing psychotherapy. Parents should be included in interventions as a valuable resource to support youths in seeking psychotherapy for mental disorders.

Effect of Reading Activities on Children's Mental Health under the Environment of Artificial Intelligence and Deep Learning

The illustrations in picture books are lovely and emotional; pictures and text work together to express a theme and weave into one another to create a seamless and comprehensive visual image in picture books. Reading helps children improve for life and is an unending source of wealth in one's life. Picture book reading has a positive effect on children's psychological well-being since it allows them to develop different intelligences and their spiritual worlds in addition to reading stories and learning facts. This thesis investigates, against the backdrop of artificial intelligence (AI) and deep learning, the impact of reading activities on children's psychological health. Deep learning and AI are the tools used where students can engage in a more in-depth conversation with the article and comprehend the author's mindset and background after completing the basic reading. This can help students' analytical, thinking, writing, and other application skills, as well as give them the opportunity to learn from and build upon their first reading accumulation. Research has shown that this method produces impressive results, and it is suited for widespread use because its reasonable strength has improved by 17.24% when compared to the conventional method.

GPs’ and practice nurses’ views on their management of paediatric anxiety problems: an interview study

Background

Anxiety problems are common in both children and adolescents, and many affected children do not receive appropriate treatment. Understaffing of mental healthcare services and long waiting lists form major barriers. In the Netherlands, practice nurses have been introduced into general practice to support general practitioners (GPs) in the management of psychosocial problems. In this study we investigated the views of GPs and practice nurses on their management of paediatric anxiety problems.

Methods

We performed an exploratory study using semi-structured interviews with 13 GPs and 13 practice nurses in the greater Rotterdam area in 2021. Interviews were transcribed and coded into topics, which were categorized per research question.

Results

In their management of paediatric anxiety problems, both GPs and practice nurses try to explore the case and the needs of affected children and their parents. GPs rarely follow up affected children themselves. They often refer the child, preferably to their practice nurse. Practice nurses regularly initiate follow-up consultations with affected children themselves. Practice nurses reported using a variety of therapeutic techniques, including elements of cognitive behavioural therapy. In more severe cases, practice nurses refer the child to external mental healthcare services. GPs reported being satisfied with their collaboration with practice nurses. Both GPs and practice nurses experience significant barriers in the management of paediatric anxiety problems. Most importantly, long waiting lists for external mental health care were reported to be a major difficulty. Improving cooperation with external mental healthcare providers was reported to be an important facilitator.

Conclusions

In their management of paediatric anxiety problems, GPs and practice nurses experience major challenges in the cooperation with external mental healthcare providers and in the long waiting lists for these services. GPs and practice nurses believe that thanks to their shared approach more children with anxiety problems can remain treated in general practice. Future research is needed to evaluate the treatment outcomes of the shared efforts of GPs and practice nurses in their management of paediatric anxiety problems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01802-y.

Associations between child mental health, carer worry and help-seeking

Carers may not always express child mental health concerns to health professionals. Therefore, identifying factors delaying help-seeking is important. The aim of this study was to examine the relationship between carer affect and help-seeking. In a secondary analysis of data collected from school-aged children (N = 1,857, mean age = 9.85 years, 51% female), we used logistic regression to examine the associations between carer worry, help-seeking and child mental health. Regarding worry, higher levels of emotional problems (OR = 1.42, 95% CI = 1.33-1.52), conduct problems (OR = 1.24, 95% CI = 1.12, 1.36), peer problems (OR = 1.17, 95% CI = 1.05-1.27) or functional impairment (OR = 1.37, 95% CI = 1.2-.56) were associated with higher levels of carer worry. Regarding help-seeking, higher levels of functional impairment were associated with higher levels of help-seeking (OR = 1.51, 95% CI = 1.09-2.11). After controlling for mental health problems, carers who reported being worried about their child's mental health were less likely than other carers to seek help (OR = 0.13, 95% CI = 0.05-0.35). Knowledge of these factors may inform early interventions. Alongside implications for future research and practice, limitations of the study are discussed.

Barriers for recruitment to treatment of youths with co-occurring substance use disorders and depression

BACKGROUND AND OBJECTIVES

Recruitment challenges for treatment trials of adolescents with substance use disorder (SUD) and co-occurring depression (COD) have not been reported. The objective is to examine whether recruitment and engagement during the pretreatment assessment phase differ between adolescents in a SUD-COD versus SUD-only treatment study.

METHODS

A similar recruitment approach compared five-stage progressions in the pretreatment phase between a SUD-only (n = 252) and SUD-COD (n = 212) study. We examined the "gradient" of recruitment and retention along four stages after referral/inquiries; (a) screening for eligibility by phone, (b) meeting eligibility in an interview, (c) completion of baseline assessment, and (d) participation in the first psychotherapy session of each study.

RESULTS

Compared to SUD-only, the retention of adolescents with SUD-COD was significantly poorer from referral/inquiry to all subsequent stages. In particular, the odds ratio and 95% confidence interval from referral/inquiry to screening for eligibility by phone, meeting eligibility in an interview, completion of baseline assessment, and participation in the first psychotherapy session were all less than one. Male attrition rates were slightly higher than females but were not statistically significant.

DISCUSSION AND CONCLUSIONS

A high proportion of referred adolescents did not meet the study criteria. This indicates a need to examine (1) potential strategies for overcoming recruitment challenges in adolescents and their engagement in the pretreatment phase for studies of COD and (2) baseline variables for predictors and moderators for adequately powered studies.

SCIENTIFIC SIGNIFICANCE

This is the first study to assess recruitment challenges for adolescents with COD.

A Brief Cognitive Behavioural Intervention for Parents of Anxious Children: Feasibility and Acceptability Study

Background

Parent-only psychological interventions can be effective treatments for child anxiety. Involving parents in treatment may be beneficial for children, ensuring that interventions are delivered effectively in a supportive environment. Few studies have investigated the feasibility and acceptability of parent-only interventions for child anxiety.

Objective

In this study, we report on feasibility, acceptability and preliminary clinical outcomes of a brief cognitive behavioural group intervention for parents of children (4- to 10-years-olds) experiencing anxiety in the absence of a diagnosed anxiety disorder.

Method

Parent participants attended a three-session group intervention delivered online. We collected feasibility information (recruitment and retention rates); parents and children (when appropriate) completed acceptability and clinical outcome measures after each session. Participants were also interviewed about the acceptability of the intervention and study processes.

Results

Nineteen parents consented to take part (child mean age 6.47, SD 1.23). Participant retention rates (68.4%) and intervention satisfaction (total mean CSQ score 28.52) were high​. Calculated effect sizes were moderate to large for parent-rated outcomes, small for child self-reported anxiety, and small to moderate for parent confidence/efficacy. Thematic analysis of interview data identified benefits, such as connecting with parents and learning strategies, as well as challenges associated with the intervention.

Conclusions

Attendance appeared to be associated with positive changes for parents and children. Overall, participants found this to be an acceptable and useful intervention. These findings demonstrated the potential benefit of a brief intervention for parents of anxious children. A larger trial is required to further investigate these preliminary findings.

Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial

OBJECTIVE

Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial.

METHOD

A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied.

RESULTS

SC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower.

CONCLUSION

Stepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents.

CLINICAL TRIAL REGISTRATION INFORMATION

Stepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.

Can CBT-E be delivered in an online group format? A pilot study of the Body Image module in a child and adolescent eating disorder service

The increased prevalence of eating disorders during the COVID-19 pandemic has led to long waiting lists in child and adolescent services. A pilot study was conducted to evaluate the feasibility and acceptability of providing the Body Image module, from the enhanced cognitive behavioral therapy for eating disorders (CBT-E), in a virtual group setting. Primary outcomes were acceptance rates, completion rates, qualitative feedback and quantitative data from routine questionnaires. From 22 eligible referrals, 12 participants accepted and enrolled in therapy. Eight completed all six sessions. Qualitative feedback was positive, with both the content and group nature of the intervention being described as helpful. There was an reduction in scores in the Clinical Impairment Assessment and all subscales of the Eating Disorder Examination for Adolescents, suggesting this was a feasible method of providing psychological therapy within the service. A larger trial is recommended to robustly test the effectiveness of the intervention compared to one-to-one in-person CBT-E, and whether the full CBT-E protocol can be effectively delivered in the same format.

Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

OBJECTIVE

Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes.

METHODS

Ontario youth aged 14-29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared.

RESULTS

As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables.

CONCLUSIONS

IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.

Treatment Engagement Following a Positive Mental Health Screening Questionnaire

INTRODUCTION

Less than half of U.S. adolescents with major depressive disorder receive treatment. Despite the U.S. Preventive Services Task Force 2016 statement supporting primary care major depressive disorder screening, there is limited data examining whether positive screens prompt treatment engagement. This study evaluated treatment engagement following a positive Patient Health Questionnaire-Adolescent Version screen and assessed the impact of demographics, clinical variables, and provider recommendations on treatment engagement.

METHODS

This was a retrospective cohort study (analysis November 2021) of adolescents aged 11-18 years seen at a primary care clinic of an academic medical center from July 2017 to December 2018 and identified with a positive Patient Health Questionnaire-Adolescent Version (broadest definition score ≥10; ≥1 for Item 9 regarding suicidal thoughts; yes for unscored Items 1, 3, or 4; or very or extremely difficult for unscored Item 2). Positive screen by score ≥10 alone was also considered. The primary outcome was treatment engagement, defined as initiation of a psychotropic medication, or a behavioral health treatment session within 1 year of symptom identification.

RESULTS

Of the 1,315 eligible adolescents, 23.0% had a positive Patient Health Questionnaire-Adolescent Version (n=302) by the broadest criteria; 92/302 (30.5%) engaged in treatment. Patients whose providers recommended treatment had 7.32 times the odds (95% CI=3.76, 14.2, p<0.001) of treatment engagement. For those positive by Patient Health Questionnaire-Adolescent Version ≥10 (85/302, 28.1%), 37/85 (43.5%) engaged in treatment. The influence of provider recommendations was comparable (OR=6.96, 95% CI=3.56, 13.6, p<0.001).

CONCLUSIONS

Less than half of adolescents with a positive Patient Health Questionnaire-Adolescent Version at an academic primary care clinic engaged with treatment. Provider recommendation was an impactful intervention to improve mental healthcare treatment engagement.

What Works When Treating Children and Adolescents With Low Back Pain?

BACKGROUND

Low back pain is a common health condition for all ages. One quarter to a third of children report persistent pain, including low back pain.

CLINICAL QUESTION

The aim of this Clinical Commentary is to provide an overview of evidence-based treatment approaches for children and adolescents with low back pain.

KEY RESULTS

Physical, psychological, and pharmacological interventions are effective in reducing pain intensity and disability. Interdisciplinary and patient- and family-centered treatment approaches are the gold standard for persistent pain in children and adolescents. Communication between health professionals, children, and parents is a key part of a therapeutic alliance. The use of holistic and complementary therapies is not supported by compelling evidence.

CLINICAL APPLICATION

Physical interventions can be delivered alone or as a component of other interventions. The interventions are delivered over 8 to 12 weeks. Psychological therapies are mostly delivered as a component of a multidisciplinary treatment program: cognitive behavioral therapy is most often used, and interventions usually run from 4 to 10 weeks. Pharmacological interventions should be delivered in combination with physical and psychological interventions. Tailor family-centered interventions to personal aspects, such as age, gender, and family structure. When communicating with children and adolescents, use simple language that is clear and direct. Aim to support trust between health professionals and parents to facilitate family decision making. J Orthop Sports Phys Ther 2022;52(7):419-424. Epub: 18 May 2022. doi:10.2519/jospt.2022.10768.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

The prevalence and impact of adolescent hospitalization to adult psychiatric units

BACKGROUND

With increasing psychiatric hospitalizations among adolescents and constrained hospital resources, there are times when youth are hospitalized in adult inpatient psychiatry units. Evidence on the prevalence of this practice and associated impacts is lacking.

AIMS

We sought to explore the prevalence, determinants, and outcomes related to the hospitalization of adolescents aged 12-17 years on adult inpatient psychiatry units in Ontario.

METHODS

Using health administrative data, we constructed a cohort of adolescents with an inpatient psychiatric admission in Ontario (2007-2011). We classified adolescents as having an admission to an adult psychiatry unit or to other inpatient units. Multivariable regression models were used to estimate prevalence ratios (PR) for factors associated with adult admission, as well as risk ratios (RR) for the impact of adult admission on length of stay, discharge against medical advice, and 30-day readmission.

RESULTS

Over the study period, 22.6% of adolescents with a psychiatric hospitalization (n = 16 998) had an admission to an adult psychiatry unit. Older age (16 vs. 15 years: PR = 2.27, 95% CI = 2.07-2.48; 17 vs. 15 years: PR = 2.91, 95% CI = 2.66-3.18), rural residence (PR = 1.46, 95% CI = 1.38-1.55), psychotic (PR = 1.25, 95% CI = 1.15-1.36) or personality disorder (PR = 1.59, 95% CI = 1.41-1.80) diagnoses, and involuntary status (PR = 2.18, 95% CI = 2.05-2.31) were independently associated with adult admission. Adolescents admitted to adult units were more likely to be discharged against medical advice (RR = 1.77, 95% CI = 1.45-2.17).

CONCLUSIONS

Nearly one in four adolescent psychiatric admissions occurs on an adult psychiatric unit. These findings help to fill gaps in the prior literature, and highlight the need for further research to inform policy decisions and resource allocation for adolescent inpatient psychiatric care.

Providers as Stakeholders in Addressing Implementation Barriers to Youth Mental Healthcare

Research has shown that youth with mental health disorders often do not receive adequate care. School- and community-based mental health organizations are integral to implementing evidence-based mental healthcare to the vast majority of youth. It is therefore important to understand the perspectives of this stakeholder group, to determine how to improve access to high-quality care. A series of three focus groups with community mental health providers and three school counselors and social workers focus groups were conducted to get their perspective on existing barriers that prevent youth who need mental health services from being treated. A grounded theory inductive qualitative analysis revealed six major themes (Lack of Services, Lack of Knowledge, Stigma, Logistics, Poor Past Experiences with Mental Health, and Poor Coordination of Services). Each of these themes are discussed and implications are framed within the context of implementation science.

Parent and Adolescent Thoughts About Suicide Risk Screening in Pediatric Outpatient Settings

Suicide rates among adolescents in the United States continue to climb and many at-risk youths are undetected. Screening for suicidal thoughts has become the primary approach to identify those at risk, but no studies have assessed reactions to its deployment in pediatric outpatient settings. This mixed-method study assessed parents' and adolescents' thoughts about suicide risk screening in non-psychiatric, pediatric outpatient specialty settings.As part of a multi-site measurement validation study, adolescents (n = 269; ages 10-21) and parents (n = 246) at pediatric specialty clinics in the Midwest completed a survey regarding thoughts about suicide risk screening. Data were collected on tablet computers and transcribed verbatim. Three study team members independently coded transcripts of open-ended responses to identify major themes, and frequency data were analyzed using StataSE 15.1. Inter-rater agreement was substantial (Fleiss' Kappa ranged 75-86%).Parents (55% 41-50 years of age, 20% male, 80% White) and adolescents (Mean age = 14.3, 50% male, 77% White) agreed medical providers should screen adolescents for suicide risk (93% and 88%, respectively). Majority of parents indicated that the pediatric outpatient setting is appropriate for suicide risk screening. Major themes included the important role of providers in identifying at-risk youth, the potential for screening to prevent suicides, and concerns about iatrogenic risk and misdiagnosis.Most parents and adolescents support screening for suicide risk in pediatric outpatient settings. Nevertheless, some have concerns about the screening process and implications. As suicide risk screening becomes standard practice in adolescent care, it's critical to develop screening processes that maximize comfort and address concerns.

Adjustment Method of College Students' Mental Health Based on Data Analysis Under the Background of Positive Psychology

Colleges and universities are in an important position to train builders and successors of the socialist cause whilst promoting quality education. Mental health education is an important foundation and condition for comprehensively improving students' overall quality. This research explores adjustment methods for college students' mental health based on virtual reality under the background of positive psychology. It discusses the importance of system requirements analysis in the software development process, analyzes the system's functional requirements, safety requirements, and software and hardware requirements, and uses the Apriori algorithm to explore the influencing factors of college students' mental health. Based on the system engineering method and using the data mining clustering method undertake detailed analysis and research on the mental health of college students, it then designs an anomaly mining algorithm based on clustering to quickly find anomalous data health problems. The interface design of the system is concise and the operation is simple. Users can conveniently input, query, and count information according to the various controls on the interface, which fully embodies human-oriented characteristics. Exploration of the characteristics of students' frequent Internet access ensures the efficiency, accuracy, and comprehensiveness of the evaluation and consultation work, facilitating psychological counseling for teachers and students, and saving paper. By establishing a data mining model, mining the database, and learning about different student groups and their respective characteristics, we discuss our research on student psychology and summarize the mental health status and gender, adaptation and anxiety, introversion, emotionality, and calmness of college students. We also consider the relationship between sex, negative, and courage. Using positive psychology theory, we examine the positive experiences of students and interconnected qualities, to build a mental health practice system. In the experiment, the happiness index evaluation of the virtual reality treatment system group was significant, P = 0.002 < 0.05. Mental health education plays an important role in cultivating the healthy psychology of college students, developing their psychological potential, enhancing their adaptability, and improving their personality. This analysis based on actual data provides a reliable basis for psychological educators to improve the efficiency and effectiveness of school psychological counseling and to facilitate schools in establishing new methods of early prevention and intervention for psychological disorders, enabling institutions to create a healthy atmosphere for college students.

Barriers to Seeking Mental Help and Interventions to Remove Them in Medical School during the COVID-19 Pandemic: Perspectives of Students

Medical students are at increased risk for psychological morbidity but the majority of those with mental health problems do not seek professional care. We aimed to uncover the viewpoints of medical students regarding barriers and facilitators to using university mental health services and their attitudes and preferences towards online counselling. Four semi-structured focus groups were conducted (n = 26, mean age = 21.8, ±1.88, 73% males). After reaching data saturation, interviews were audio-recorded, transcribed and content-analysed by two independent coders. Intrapersonal barriers emerged to be perceived low risk, excessive self-reliance, lack of belief in the effectiveness of service, lack of openness. Interpersonal factors were the following: assumed long waiting list, insufficient provision of service information, fear of exposure, and not being familiar with the counsellor and the process. Extrapersonal barriers such as insurance problems, the number of available sessions, adverse sociocultural attitudes, fear of stigmatisation were identified. Students suggested that the university should provide psychoeducation and routine screening, apply social marketing and stigma reduction campaigns, improve information flow, and offer not only personal but also online video counselling to target removing these barriers. The results provide a reference for the redesign of mental health services to facilitate their access by students. Implications and limitations are discussed.

Digital Screening and Automated Resource Identification System to Address COVID-19-Related Behavioral Health Disparities: Feasibility Study

BACKGROUND

Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources.

OBJECTIVE

This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant's responses.

METHODS

Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant's responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided.

RESULTS

A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60).

CONCLUSIONS

This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use.

School-based screening for childhood anxiety problems and intervention delivery: a codesign approach

OBJECTIVES

A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems.

DESIGN

Codesign.

SETTING

UK primary schools.

PARTICIPANTS

Data were collected from year 4 children (aged 8-9 years), parents, school staff and mental health practitioners.

RESULTS

We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback.

CONCLUSIONS

We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.

Families post-release: Barriers and pathways to family therapy

Family therapy has helped repair relational ruptures and restore stability within families for decades. However, service can be inaccessible and underutilized among many minoritized and stigmatized groups, including families post-release. Harmful sociocultural and relational experiences pose considerable risks to families before, during, and after incarceration. While not exhaustive, this article highlights potential attitudinal, relational, and logistical obstacles to family therapy engendered by therapists, clients, or both. Feasible and accessible clinically oriented conceptual and practical pathways of support to combat such obstacles are outlined to help therapists attract and retain families post-release.

The factors and outcomes of stigma toward mental disorders among medical and nursing students: a cross-sectional study

BACKGROUND

Medical and nursing students' attitudes toward mental disorders have a large impact on their working intentions in mental health settings and patients' health outcomes. However, there are few studies about the stigma toward mental disorders among medical and nursing students in China.

METHODS

In this cross-sectional study, a total of 838 medical and nursing students completed questionnaires on their sociodemographic characteristics and familiarity with people diagnosed with mental disorders as well as the Community Attitudes toward Mental Illness Scale (CAMI). The stigma was compared between medical students and nursing students by ANOVA. A multiple logistic regression model was built to explore the relationships among sociodemographic characteristics, familiarity with mental disorders and stigma.

RESULTS

The total mean score of the CAMI was 137.61 (SD = 15.63). The score for authoritarianism (M = 33.33, SD = 3.62) was the lowest score of the four subscales. Medical students showed more positive attitudes toward mental disorders than nursing students. However, after controlling the co-variables, the difference disappeared. Stigma was significantly associated with students' education, area of residence, marital status, economic status, history of mental disorders and familiarity with mental disorders.

CONCLUSIONS

Medical and nursing students show a negative attitude toward mental illness to a certain degree, especially regarding the view that people with mental disorders are inferior. Higher education level, residence in urban areas, single marital status, better economic status, and better familiarity with mental disorders may be related to less stigma among medical and nursing students.

Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion

Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.

Health status, healthcare, and access in children with long-term medication use and difficulties with emotion, concentration, and behavior

PROBLEM

Children with chronic conditions often have difficulties with emotions, concentration, and behaviors (ECB) and are not recognized and treated adequately. In this paper, long-term medication use (LTM) was adopted as a proxy for chronic illness due to the lack of consistent and standardized diagnostic criteria for chronic illnesses in children.

METHODS

Children (8-12 years) were selected from the California Health Interview Survey (2017) based on: (1) households with children (<12 years), (2) parent/adult caregivers report about child's health indicating "yes" to, (3) "does your child require prescription medicine for a health condition that has lasted or is expected to last at least 12 months or more," and (4) "difficulties with ECB in past 6 months."

FINDINGS

A total of 1600 children were included by the CHIS data set, and children whose parental report had met the selection criteria were children with LTM (n = 144; 7.4 ± 2.9 years), ECB (n = 233; 8.16 ± 2.14), and both LTM + ECB (n = 62; 8.61 ± 1.81). Children with LTM+ ECB were Caucasian (56.4%), Hispanic (19.3%), and males (64.5%). Children with both LTM + ECB had two to three (33.87%) or at least four (53.2%) physician visits, and/or receiving special therapy (45.1%). Children with LTM had prescription delays (n = 144; 5.6%) and were not able to get medical care due to lack of insurance (n = 144; 6.9%). The majority of the children with LTM (54.2%) and LTM + ECB (43.5%) had parental employment-based insurance. More children that have both LTM and ECB (48.4%) than children with LTM, No ECB (32.9%) were on Medi-Cal/Medicaid.

CONCLUSION

Children with LTM need further evaluation for difficulties with ECB. Future studies are required to examine health status, healthcare use, and access for children with LTM and ECB.

Communicating about Mental Health with Youth and Their Families: A Scoping Review of Best Practices and Implications for Youth with Disabilities

Minimal attention has been placed on supporting the mental health needs of youth with disabilities. Due to a dearth of research on best practices in mental health communication with youth with disabilities, the aim of the scoping review was to identify existing peer-reviewed evidence regarding mental health communication for the general youth population in clinical settings. Three electronic databases were searched. Inclusion criteria were: 1) published in English between 2009 and 2019; 2) children and youth and/or their parents/caregivers; 3) addressed communication-based mental health practices; 4) based in pediatric health care settings. Seven articles were included. Promoting autonomy and engagement, building collaboration and trust, and supplementing conversations with alternative communication approaches were identified as important for having mental health conversations. While implications can be drawn, more work is needed for clinicians to have a rigorous evidence base to draw upon when having these conversations with youth with disabilities.

Online administration of a pilot mindfulness-based intervention for adolescents: Feasibility, treatment perception and satisfaction

Adolescents may be more vulnerable to COVID-19-related impacts and require long-term mental health care. Services that bolster emotion regulation, such as mindfulness-based interventions (MBIs) promote positive impacts on psychosocial outcomes and have high acceptability. No studies have assessed feasibility, treatment perceptions and satisfaction of online MBIs with adolescents. 56 moderate- and high-risk adolescent (m = 14.5 years, 66.1% female, 26.8% LatinX) participants tested the feasibility, treatment perceptions and satisfaction of an 8-session online MBI focused on observing non-judgmentally, attending to positivity, and self-soothing. The study achieved acceptable feasibility with high attendance (m = 5.75) and retention rates (87.5%). The moderate- vs. high-risk group reported significantly higher ratings of treatment perceptions (t = 2.03, p < .05, d = 0.60). Significant associations were found between increased pre-test depression and anxiety symptomology and reduced intervention utility (rs = -0.34 and -0.32, ps < .05). This study demonstrated feasibility, treatment perceptions and satisfaction of an online MBI for adolescents presenting with two risk levels. Higher-risk adolescents may need a higher-touch intervention than moderate-risk, who may be more likely to find online MBIs acceptable. The impact of adjunctive MBIs for adolescents on treatment attendance and mental health outcomes over longer periods is necessary to understand patterns in effective adolescent treatment options.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03025-x.

Psychogenic Nonepileptic Seizures in Children and Adolescents

Psychogenic nonepileptic seizures (PNES) are a common condition seen in children and adolescents. The diagnosis is clinical, based on a description of events, and can be supported using video electroencephalography recording. Children and adolescents with PNES often have comorbid psychiatric conditions and psychosocial stressors, although this is not a requisite for diagnosis. The pathophysiology is not fully understood but may be related to emotional processing and underlying aberrant functional connectivity. Communication of the diagnosis to patients and families in a compassionate way that leads to understanding is of paramount importance and the key first step to treatment. Psychotherapy that utilizes principles of cognitive behavioral therapy is the current standard for therapy. Symptoms can improve and many with PNES do experience remission of events with treatment, although not all. There is still much to be elucidated regarding underlying mechanisms and best treatments to help patients with this condition. In this article I review current knowledge about PNES in children and adolescents as well as share practical advice gleaned from clinical experience at Nationwide Children's Hospital's PNES Clinic.

Determining stakeholder priorities and core components for school-based identification of mental health difficulties: A Delphi study

Only approximately half of children and young people (CYP) with mental health difficulties access mental health services in England, with under-identification of need as a contributing factor. Schools may be an ideal setting for identifying mental health difficulties in CYP, but uncertainty remains about the processes by which these needs can best be identified and addressed. In this study, we conducted a two-round, three-panel Delphi study with parents, school staff, mental health practitioners, and researchers to inform the development of a program to identify mental health difficulties in primary schools. We aimed to assess and build consensus regarding (a) the aims of such a program, (b) identification model preferences, (c) key features of the identification model, and (d) key features of the implementation model. A total of 54 and 42 participants completed the Round 1 and 2 questionnaires, respectively. In general, responses indicated that all three panels supported the idea of school-based identification of mental health difficulties. Overall, 53 of a possible 99 items met the criteria for inclusion as program core components. Five main priorities emerged, including that (a) the program should identify children experiencing mental health difficulties across the continuum of severity, as well as children exposed to adversity, who are at greater risk of mental health difficulties; (b) the program should train staff and educate pupils about mental health in parallel; (c) parental consent should be obtained on an opt-out basis; (d) the program must include clear mechanisms for connecting identified pupils to care and support; and (e) to maximize implementation success, the program needs to lie within a school culture that values mental health and wellbeing. In highlighting these priorities, our study provides needed stakeholder consensus to guide further development and evaluation of mental health interventions within schools.

The gap between perceived mental health needs and actual service utilization in Australian adolescents

Despite being highly prevalent, adolescent mental health problems are undertreated. To better understand the mental health treatment gap, we assessed the prevalence and correlates of help-seeking, including perceived need for care and access to that care. Data were drawn from Young Minds Matter (YMM) survey-the second Australian child and adolescents survey of mental health and wellbeing. Parent-reported data and self-reported child data were combined into one dataset to analyse 2464 Australian adolescents aged 13-17 years. We employed bivariate and multivariate logistic regression models to assess the correlation between independent variables (professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both) and their distribution over outcome variables (perceived need and service use). Mental disorders include depression, anxiety, ADHD and conduct disorder. Our study revealed 15.0%, 4.6% and 7.7% had professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both, respectively. Overall, 47.4% and 27.5% of adolescents respectively perceived need for care and used services in the past-12-months. While among those only who perceived the need, only 53% of adolescents used any services. Professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both were associated with higher likelihood of perceived need and service use (p < 0.001 for all). However, adolescents who self-reported self-harm/suicidality only were not found to be significantly associated with service use among those who perceived the need for care. Adolescents who perceived the need for mental health care but did not seek care represent a treatment gap. Our results suggest the importance of reducing the wide treatment gap that exists between need and care.

Program evaluation of a pilot mobile developmental outreach clinic for autism spectrum disorder in Ontario

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing prevalence worldwide. Early identification of ASD through developmental screening is critical for early intervention and improved behavioural outcomes in children. However due to long wait times, delays in diagnosis continue to occur, particularly among minority populations who are faced with existing barriers in access to care. A novel Mobile Developmental Outreach Clinic (M-DOC) was implemented to deliver culturally sensitive screening and assessment practices to increase access to developmental health services, reduce wait times in diagnoses, and aid in equitable access to intervention programs among vulnerable populations in Ontario.

Methods

This study applied two evaluation frameworks (process and outcome evaluation) to determine whether the delivery model was implemented as intended, and if the program achieved its targeted goals. A mixed-methods design was undertaken to address the study objectives.

Results

Between September 2018–February 2020, M-DOC reached 227 families with developmental health concerns for their child, while successfully targeting the intended population and achieving its goals. The mean age of the child-in-need at intake was 31.6 months (SD 9.9), and 70% of the sample were male. The program’s success was attributed to the use of cultural liaisons to break cultural and linguistic barriers, the creation of multiple points of access into the diagnosis pathway, and delivery of educational workshops in local communities to raise awareness and knowledge of autism spectrum disorder.

Conclusions

The findings underscore the need for community-based intervention programs that focus on cultural barriers to accessing health services. The model of delivery of the M-DOC programs highlights the opportunity for other programs to adopt a similar mobile outreach clinic approach as a means to increase access to services, particularly in targeting hard-to-reach and vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07789-7.

Young help-seeker profiles in Israel: The case of the first Israeli headspace centre

AIM

To describe clinical and demographic characteristics of youths who seek help at the first Headspace centre in Israel and their families.

METHODS

A sample of 291 (65%) of the youths (12- to 25-year-olds) who applied to Headspace between March 2016 and June 2018 completed an assessment, including reasons for referral and clinical status; the Kessler Psychological Distress Scale, evaluating psychological distress; and the Strengths and Difficulties Questionnaire, measuring emotional and behavioural difficulties. Their families reported burden of care via the Burden Assessment Scale.

RESULTS

Of the sample, 75% were between the ages of 12 and 17 years (equal gender distribution); for 45%, Headspace was their first encounter with mental health services. Participants' most-reported referral source was school counsellors (27%), and presenting concern (51%) was emotional problems, mainly depression (18%) and anxiety (16%). Female and older participants had more emotional difficulties than did males and younger participants, respectively. Overall, most help-seekers expressed high distress levels upon entry, and their family's burden was associated with those levels.

CONCLUSIONS

This first study of the first Headspace centre in Israel sheds light on and broadens knowledge about young help-seekers of Headspace outside of Australia. It emphasizes the trend across all ages of help-seeking youths with high psychological-distress levels and the role of family and school staff in the help-seeking process. Establishing youth services that improve access and deliver early intervention to a widely underserved population at times of high distress can be a global trajectory.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions

The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.

Review: Cultural adaptations to psychosocial interventions for families with refugee/asylum-seeker status in the United Kingdom - a systematic review

BACKGROUND

Young people with refugee or asylum-seeker status (R/AS) often present with complex mental health needs, in the context of traumatic life experiences. Generic mental health services in the United Kingdom (UK) may be ill-equipped to manage the unique experiences of these young people. Culturally adapted interventions (CAI) could provide a culturally sensitive approach to mental health support for refugee children experiencing difficult symptoms. A systematic review was conducted to determine the different types of cultural adaptation in the included studies, and to determine the efficacy of CAIs in comparison to generic treatment.

METHODS

Systematic searches of eleven databases were completed in December 2020. Any psychosocial interventions conducted in the United Kingdom aimed at providing mental health support for refugee young people and families were included. This was to ensure the potential inclusion of all studies regardless of their adherence to the traditional framework of assessment and intervention in high-income countries, for example randomised control trials.

RESULTS

Eleven studies of varying methodology, participant group, intervention type and outcome measures were included in this review. Studies used a variety of cultural adaptations including surface-level and deep-level adaptations. Studies showed some support for the use of CAIs with young people with R/AS, with varying degrees of symptom reduction. It was not possible to compare the effectiveness of CAIs against 'treatment-as-usual', nor to determine the effectiveness of different CAI components.

CONCLUSIONS

Whilst there is evidence for the use of CAIs with R/AS young people, the heterogeneity between studies limits the generalisability of these results. The available research is not sufficient to provide conclusive evidence of the use of CAIs over 'treatment-as-usual'. Research and clinical implications are highlighted. Future research could examine the most effective components of CAIs and aim to increase the evidence base of interventions for young people and families with R/AS.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics

OBJECTIVES

New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein.

SETTING

Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics.

PARTICIPANTS

Data on 126 095 youth (0-18 years) were available for analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary, specialised and residential youth care use were the primary outcomes.

RESULTS

Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time.

CONCLUSION

Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa

Background

Living with or managing an adolescent suffering from depression predisposes the adolescent and parents to various experiences, considering the multifactorial nature of depression and associated symptoms.

Objective

This study explored and described the experiences of adolescents and their parents on the mental health management of depression in the North West province (NWP), South Africa.

Method

A qualitative, exploratory, descriptive, contextual research design was adopted. Data was collect from two mental health care institutions and two mental health care units attached to two general hospitals in the NWP, SA. Thirty-two participants (18 adolescents and 14 parents) were purposefully selected for the study. Data were collected through individual interviews and analysed using Tesch’s open-coding method to generate themes and categories which were presented with the concurrent support of participants direct quotations.

Results

The study revealed that the experiences of adolescents with depression and their parents taking care of them at homes include the following: emotional distress, poor coping mechanisms, financial burden, repeated suicidal attempts, negative attitudes from support systems and withdrawal behaviours. Appropriate therapeutic environments, ongoing monitoring by mental healthcare practitioners and adequate support systems were suggested by participants as management approaches that could enhance the recovery of adolescents from depression.

Conclusion

The findings revealed the devastating experiences of adolescents with depression and their parents taking care of them in their various homes which confirms the dire need for attention on the plights of these groups in order to facilitate adolescents’ recovery and strengthen the adolescents’ and parents’ coping mechanisms for a healthier family.

Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders

BACKGROUND

Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.

METHODS

The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.

DISCUSSION

The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.

TRIAL REGISTRATION

ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.

Mental healthcare for children with chronic conditions: a qualitative study

OBJECTIVE

To explore parent perspectives on accessing mental healthcare for children with a chronic physical health condition.

DESIGN

Qualitative research using semistructured interviews and Framework Analysis. Rankings were used to select attributes for a Discrete Choice Experiment (DCE).

SETTING

Four specialty outpatient clinics (diabetes, epilepsy, bronchiectasis unrelated to cystic fibrosis and epidermolysis bullosa) at an Australian tertiary paediatric hospital.

PARTICIPANTS

Eighteen parents of children with a chronical physical health condition.

RESULTS

Most parents identified the child's general practitioner and/or hospital team as an initial pathway to seek help if they were worried about their child's mental health. Parents see mental healthcare as part of care for the whole child and want the outpatient clinics to proactively discuss child and family mental health, as well as refer to appropriate services as needed. The hospital being a familiar, child-friendly environment was identified as a key reason the hospital might be a desired place to access mental healthcare, as previous research has found. Six attributes of mental health services were identified as important and will be included in an upcoming DCE: travel time, cost, wait time, available hours, knowledge of physical health condition, and recommendation.

CONCLUSIONS

This study highlights the opportunity presented in specialist outpatient clinics to address the often unmet mental healthcare needs of children with chronic physical health conditions. Parents identified practical ways for outpatient clinics to better facilitate access to mental healthcare. These will be further explored through a quantitative study of parent preferences.

An overview of and recommendations for more accessible digital mental health services

Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.

Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review

OBJECTIVE

Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children.

METHOD

This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD.

RESULTS

This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels.

CONCLUSION

Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.

Correlates of help-seeking by parents for the socioemotional development of their 3-year-old children: a longitudinal study

OBJECTIVES

Timely parental help-seeking regarding their child's socioemotional development is associated with a lower rate and lower severity of psychosocial problems in later life. This study aimed to examine the correlates of parental help-seeking for the socio-emotional development of 3-year-old children.

DESIGN

Retrospective cohort study.

SETTING

Community-based survey in Rotterdam.

PARTICIPANTS

Of 2305 parents and their 2-year-old children at baseline, 1507 who completed follow-up questionnaires were included in the analyses when children were 3 years old.

OUTCOME MEASURES

Parental help-seeking regarding their child's socioemotional development and types of formal and informal help sources (eg, general practitioner, internet) used in the past 12 months were measured. Hierarchical logistic regression models were applied to identify factors correlates of parental help-seeking among 13 predisposing, enabling and need factors according to Andersen's behavioural model.

RESULTS

In total, 22.6% of parents reported help-seeking in the past 12 months for socioemotional development of their 3-year-old child; 6.8% addressed formal help sources and 17.5% addressed informal help sources. General practitioner (2.7%) and family (12.5%) were the most frequently used formal and informal sources, respectively. In the full model, predisposing factors associated with higher odds of parental help-seeking were child's other western ethnic background (OR=1.66, 95% CI 1.02 to 2.68) and parental age ≤29 years old (OR=1.71, 95% CI 1.01 to 2.92). No associated factors were found among enabling factors. The need factors associated with higher odds of parental help-seeking were having previous help-seeking (OR=2.52, 95% CI 1.83 to 3.48) and discussing child's socioemotional development in the well-child visit (OR=2.47, 95% CI 1.73 to 3.53).

CONCLUSIONS

Predisposing and need factors were associated with parental help-seeking for socioemotional development of 3-year-old children. The findings can be used to further develop support for parents accessing adequate information, prevention and anticipatory care with regards to the child's socio-emotional development.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

BACKGROUND

Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown.

METHODS

The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income.

RESULTS

An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care.

CONCLUSIONS

The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.