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McQuillin SD, Hagler MA, Werntz A, Rhodes JE. Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:201-220. [PMID: 34318526 DOI: 10.1002/ajcp.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Matthew A Hagler
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alexandra Werntz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jean E Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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152
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Taylor A, Radford G, Calia C. Review: Cultural adaptations to psychosocial interventions for families with refugee/asylum-seeker status in the United Kingdom - a systematic review. Child Adolesc Ment Health 2022; 28:241-257. [PMID: 35195944 DOI: 10.1111/camh.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Alice Taylor
- NHS Lothian, Edinburgh, UK.,School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Clara Calia
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
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153
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Mieloo CL, van der Ende J, van Zijl AL, Schuring M, Steijn B, Jansen W. Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics. BMJ Open 2022; 12:e048933. [PMID: 35172992 PMCID: PMC8852673 DOI: 10.1136/bmjopen-2021-048933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Cathelijne L Mieloo
- Governance of Urban Transitions - Research Group Transforming Youth Care, Haagsche Hogeschool, Den Haag, Zuid-Holland, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Alissa Lysanne van Zijl
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Bram Steijn
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
- Department of Social Development, Gemeente Rotterdam, Rotterdam, The Netherlands
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154
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Reardon T, Dodd H, Hill C, Jasper B, Lawrence PJ, Morgan F, Rapee RM, Ukoumunne OC, Violato M, Davey E, Halliday G, Jones B, Martineau L, McCall A, Niekamp N, Placzek A, Potts R, Weisser T, Creswell C. 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. Trials 2022; 23:149. [PMID: 35168635 PMCID: PMC8848959 DOI: 10.1186/s13063-022-06010-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Tessa Reardon
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Helen Dodd
- College of Medicine and Health, University of Exeter, Exeter, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, England
| | | | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emily Davey
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Benjamin Jones
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Lindsey Martineau
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Amy McCall
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Natascha Niekamp
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Anna Placzek
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Potts
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Tamatha Weisser
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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155
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Chukwuere PC, Sehularo LA, Manyedi ME. Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa. Curationis 2022; 45:e1-e9. [PMID: 35261252 PMCID: PMC8905408 DOI: 10.4102/curationis.v45i1.2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/29/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Precious C Chukwuere
- Department of Nursing Science, Faculty of Health Science, North-West University, Mahikeng.
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156
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Jones R, Hiscock H, Wurzel D, Kao KT, Freeman JL, Ride J. Mental healthcare for children with chronic conditions: a qualitative study. Arch Dis Child 2022; 107:134-140. [PMID: 35058237 DOI: 10.1136/archdischild-2021-321795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Renee Jones
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Danielle Wurzel
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Health, Allergy and Lung Health Unit, The University of Melbourne School of Population and Global Health, Parkville, Victoria, Australia
| | - Kung-Ting Kao
- Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Diabetes Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeremy L Freeman
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurosciences Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jemimah Ride
- Health Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Economics Unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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157
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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158
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Kappi A, Martel M. Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review. J Atten Disord 2022; 26:408-425. [PMID: 33472504 DOI: 10.1177/1087054720986909] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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159
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Luo J, Raat H, Franse CB, Bannink R, Bai G, van Grieken A. Correlates of help-seeking by parents for the socioemotional development of their 3-year-old children: a longitudinal study. BMJ Open 2022; 12:e052595. [PMID: 35017243 PMCID: PMC8753387 DOI: 10.1136/bmjopen-2021-052595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Jie Luo
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Guannan Bai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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160
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 2022; 22:14. [PMID: 34986806 PMCID: PMC8728977 DOI: 10.1186/s12888-021-03654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland. .,International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland
| | - Mikko Aaltonen
- grid.7737.40000 0004 0410 2071Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland ,grid.9668.10000 0001 0726 2490Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland ,grid.419511.90000 0001 2033 8007Max Planck Institute for Demographic Research, Rostock, Germany ,grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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161
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Kusaka S, Yamaguchi S, Foo JC, Togo F, Sasaki T. Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review. Front Psychiatry 2022; 13:816508. [PMID: 35586407 PMCID: PMC9108239 DOI: 10.3389/fpsyt.2022.816508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents. METHODS PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies. RESULTS Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others. CONCLUSIONS A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.
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Affiliation(s)
- Sakurako Kusaka
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Satoshi Yamaguchi
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Jerome Clifford Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fumiharu Togo
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
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162
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Duarte CS, Lovero KL, Sourander A, Ribeiro WS, Bordin IAS. The Child Mental Health Treatment Gap in an Urban Low-Income Setting: Multisectoral Service Use and Correlates. Psychiatr Serv 2022; 73:32-38. [PMID: 34106744 DOI: 10.1176/appi.ps.202000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To efficiently target capacity-building efforts for child mental health services in low- and middle-income countries (LMICs), it is critical to define how care is structured across sectors and individual-level factors. METHODS In a community-based sample of 1,408 children and adolescents (ages 6-15 years) from Itaboraí, Brazil, the authors assessed need and service use across four care systems (mental health specialty, health, welfare, and informal). Individual-level factors included child gender and age, maternal perception of child mental health need, paternal absence, maternal education, and maternal anxiety and depression. RESULTS The mental health treatment gap was 88%, with only 12% of children with psychiatric problems using mental health services. Children with mental health problems were more likely than those without these problems to use health and other sectors of care and to use services in more than one sector of care. Overall, 46% of the children with any clinical mental health problems and 31% of those with only internalizing problems were identified by their mothers as having a mental health need. Among those with clinical mental health problems, factors associated with mental health service use were being a boy and paternal absence but not mental health problem type or maternal awareness. CONCLUSIONS Closing the child mental health treatment gap in urban settings in LMICs where resources are scarce will likely require system-level changes, such as engagement of diverse service sectors of care. Interventions need to target increased maternal awareness about mental health problems and encourage provision of mental health services to girls.
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Affiliation(s)
- Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Kathryn L Lovero
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Andre Sourander
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Wagner S Ribeiro
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Isabel A S Bordin
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
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163
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Frank HE, Milgram L, Freeman JB, Benito KG. Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework. FRONTIERS IN HEALTH SERVICES 2022; 2:892294. [PMID: 36925863 PMCID: PMC10012822 DOI: 10.3389/frhs.2022.892294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Methods Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Results Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Conclusions Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.
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Affiliation(s)
- Hannah E Frank
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Lauren Milgram
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Jennifer B Freeman
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
| | - Kristen G Benito
- Warren Alpert Medical School of Brown University, Providence, RI, United States.,Bradley Hospital, East Providence, RI, United States
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164
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Lawrence PJ, Harvey K, Williams C, Creswell C. Barriers and facilitators to targeted anxiety prevention programmes in families at risk: a qualitative interview study. Eur Child Adolesc Psychiatry 2022; 31:565-575. [PMID: 33346882 PMCID: PMC9034995 DOI: 10.1007/s00787-020-01703-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022]
Abstract
Anxiety disorders are the most common psychiatric disorder in children and young people. They can be prevented in those at risk, but families do not always take up opportunities to participate in prevention programmes. This qualitative study aimed to understand what families with children who were at prospective risk of anxiety disorders perceived to be the barriers to access to targeted anxiety prevention programmes, and to explore what would help facilitate access. We used Information Power to determine our sample size, and individually interviewed seven young people (14-17 years) who had anxiety disorders and their mothers, each of whom had pre-natal anxiety disorders. We transcribed all interviews and thematically analyzed them to identify perceived barriers and facilitators to targeted anxiety prevention programmes. Perceived potential barriers to access included possible negative consequences of anxiety prevention, difficulties in identifying anxiety as a problem and concerns about how professions would respond to raising concerns about anxiety. Possible facilitators included promoting awareness of anxiety prevention programmes and involvement of schools in promotion and delivery of prevention. Our findings illustrate that implementation of targeted anxiety prevention could be improved through (i) the provision of tools for parents to recognize anxiety in their children as a problem, (ii) promotion of awareness, as well as delivery, of anxiety prevention via schools and (iii) the involvement of parents and possibly adolescents in the intervention programme, but not younger children.
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Affiliation(s)
- P J Lawrence
- School of Psychology, University of Southampton, Southampton, UK.
| | - K Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - C Williams
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Creswell
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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165
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Radez J, Reardon T, Creswell C, Orchard F, Waite P. Adolescents' perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. Eur Child Adolesc Psychiatry 2022; 31:891-907. [PMID: 33502596 PMCID: PMC9209355 DOI: 10.1007/s00787-020-01707-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/16/2020] [Indexed: 10/29/2022]
Abstract
Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11-17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents' parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents' dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.
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Affiliation(s)
- Jerica Radez
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL UK ,grid.4991.50000 0004 1936 8948The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, OX3 7JX UK
| | - Tessa Reardon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK. .,Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG, UK.
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG UK
| | - Faith Orchard
- grid.12082.390000 0004 1936 7590School of Psychology, University of Sussex, Brighton, BN1 9RH UK
| | - Polly Waite
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL UK ,grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, OX2 6GG UK
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166
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Bordin IA, Handegård BH, Paula CS. Professional and informal help-seeking among low-income adolescents exposed to violence in the community and at school. CHILD ABUSE & NEGLECT 2022; 123:105382. [PMID: 34763186 DOI: 10.1016/j.chiabu.2021.105382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/20/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adolescents may seek help for many reasons beyond health needs, such as personal stress due to violence exposure. OBJECTIVE To investigate factors associated with receiving professional assistance and informal help due to violence exposure in the community and at school. PARTICIPANTS AND SETTING This study was conducted in Itaboraí, a low-income medium-size city in the State of Rio de Janeiro, Southeast Brazil, characterized by poverty, inequality and violence. It analyses data reported by 669 in-school adolescents (11-15-years, 51.7% girls). METHODS This is a cross-sectional study nested in a longitudinal study (Itaboraí Youth Study). The Itaboraí Youth Study involved a probabilistic community-based sample of 1409 6-to-15-year-olds based on a 3-stage probabilistic sampling plan that included a random selection of census units, eligible households and the target child. RESULTS Professional assistance was mainly received from psychologists (the Brazilian population has free access to health services). Family members were the main source of informal help. Correlates of professional assistance were having clinical emotional problems and not counting on an adult (if needing help) for community violence victims, and absent father for community and school violence victims. Correlates of informal help were female sex, maternal anxiety/depression and absent father for community violence victims, and younger age and higher maternal education for school violence victims. CONCLUSIONS The mental health needs of violence victims, and maternal difficulties to deal with the adolescent distress resulting from violence exposure (maternal increased burden due to father absence and/or having anxiety/depression) are important influences on the help-seeking process.
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Affiliation(s)
- I A Bordin
- Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, SP, Brazil.
| | - B H Handegård
- University of Tromsø, Faculty of Health Sciences, Tromsø, Troms, Norway
| | - C S Paula
- Universidade Presbiteriana Mackenzie, Programa de Pós-Graduação em Distúrbios do Desenvolvimento, São Paulo, SP, Brazil
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167
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Murphy D, Heary C, Hennessy M, O'Reilly MD, Hennessy E. A Systematic Review of Help-Seeking Interventions for Parents of Adolescents. J Adolesc Health 2022; 70:16-27. [PMID: 34462191 DOI: 10.1016/j.jadohealth.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE Parents do not always seek timely help for adolescents when the need arises. Although interventions to increase parental help-seeking have been evaluated and published, no systematic review of these interventions has been conducted. The aim of this systematic review is to collate, synthesise, and evaluate research on help-seeking interventions for parents of adolescents. METHODS Six electronic databases were searched from inception to May 2020 using terms related to the concepts of "parent" and "help-seeking" and focusing on parents of adolescents (aged 10-19 years). Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies; the Behavioural Change Taxonomy was used to code behavioral change techniques, and "promising interventions" were identified using pre-established criteria. RESULTS Eighteen studies met inclusion criteria, with six rated strong for design and methodology. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as "promising" because of strong methodology, significant positive outcomes, and strong evidence-base. CONCLUSIONS More high-quality, theory-driven parental help-seeking interventions using common outcome measures are needed to advance the literature in this area. Future research should replicate the promising interventions identified to develop best practice guidelines.
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Affiliation(s)
- Daráine Murphy
- School of Psychology, University College Dublin, Dublin, Ireland.
| | - Caroline Heary
- School of Psychology, National University of Galway, Galway, Ireland
| | - Marita Hennessy
- College of Medicine and Health, University College Cork, Ireland
| | | | - Eilis Hennessy
- School of Psychology, University College Dublin, Dublin, Ireland
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168
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Bøe T, Hysing M, Askeland KG, Skogen JC, Heradstveit O. Do Parental Education-Related Inequality Matter in Child and Adolescent Utilization of Mental Health Services: Results From a Norwegian Register Linkage Study. Health Serv Insights 2021; 14:11786329211055302. [PMID: 34916801 PMCID: PMC8669118 DOI: 10.1177/11786329211055302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
Equitable access to health care point to equal access to care for those with equal needs, but pro-rich and pro-educated inequities have been documented in specialized mental health care utilization. This study aimed to investigate equity in Norwegian adolescents’ use of child and adolescent mental health services (CAMHS) with regards to parental education levels, using a survey of 10 257 Norwegian 16- to 19-year-olds subsequently linked to CAMHS data from the Norwegian Patient Registry (n = 970 had been in contact with CAMHS). Analyses using concentration indices (C) suggested adolescents with parents with lower education levels had more mental health problems (ie, larger need; C = −0.032, P < .001) and were more in contact with CAMHS (C = −0.025, P < .001). Regression analysis suggested that CAMHS contact, and number of unique admissions was largely distributed according to need, but participants whose parents had basic education levels were in contact with CAMHS for slightly longer than predicted from their self-reported mental health problems, age, and sex. Results from this study suggested that contact with CAMHS was largely equitable and mostly influenced by need. There was little evidence of parental education-related inequity in access to, and use of, specialized mental health services.
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Affiliation(s)
- Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Kristin G Askeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Ove Heradstveit
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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169
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MacNeill LA, Allen NB, Poleon RB, Vargas T, Osborne KJ, Damme KSF, Barch DM, Krogh-Jespersen S, Nielsen AN, Norton ES, Smyser CD, Rogers CE, Luby JL, Mittal VA, Wakschlag LS. Translating RDoC to Real-World Impact in Developmental Psychopathology: A Neurodevelopmental Framework for Application of Mental Health Risk Calculators. Dev Psychopathol 2021; 33:1665-1684. [PMID: 35095215 PMCID: PMC8794223 DOI: 10.1017/s0954579421000651] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The National Institute of Mental Health Research Domain Criteria's (RDoC) has prompted a paradigm shift from categorical psychiatric disorders to considering multiple levels of vulnerability for probabilistic risk of disorder. However, the lack of neurodevelopmentally-based tools for clinical decision-making has limited RDoC's real-world impact. Integration with developmental psychopathology principles and statistical methods actualize the clinical implementation of RDoC to inform neurodevelopmental risk. In this conceptual paper, we introduce the probabilistic mental health risk calculator as an innovation for such translation and lay out a research agenda for generating an RDoC- and developmentally-informed paradigm that could be applied to predict a range of developmental psychopathologies from early childhood to young adulthood. We discuss methods that weigh the incremental utility for prediction based on intensity and burden of assessment, the addition of developmental change patterns, considerations for assessing outcomes, and integrative data approaches. Throughout, we illustrate the risk calculator approach with different neurodevelopmental pathways and phenotypes. Finally, we discuss real-world implementation of these methods for improving early identification and prevention of developmental psychopathology. We propose that mental health risk calculators can build a needed bridge between RDoC's multiple units of analysis and developmental science.
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Affiliation(s)
- Leigha A MacNeill
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Norrina B Allen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roshaye B Poleon
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL
| | | | | | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Ashley N Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Elizabeth S Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Christopher D Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Vijay A Mittal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Psychology, Northwestern University, Evanston, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Institute for Policy Research, Northwestern University, Evanston, IL
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
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170
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Wasson Simpson KS, Gallagher A, Ronis ST, Miller DAA, Tilleczek KC. Youths' Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:476-489. [PMID: 34812964 DOI: 10.1007/s10488-021-01177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
Youths' experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths' interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n = 20 girls, n = 11 boys; 12 to 21 years old [M = 16.97, SD = 2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n = 26), anxiety (n = 22), eating disorders (n = 9), autism spectrum disorder (n = 2), or conduct disorder or oppositional defiant disorder (n = 2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., "Could you describe what was happening in your life when you first felt you would need support for your mental health?"). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.
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Affiliation(s)
- Kendra S Wasson Simpson
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.,Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Anna Gallagher
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.,Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Scott T Ronis
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.
| | - David A A Miller
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada
| | - Kate C Tilleczek
- Faculty of Education, 218, Winters College, Keele Campus, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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171
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Kaushik A, Papachristou E, Telesia L, Dima D, Fewings S, Kostaki E, Gaete J, Ploubidis GB, Kyriakopoulos M. Experience of stigmatization in children receiving inpatient and outpatient mental health treatment: a longitudinal study. Eur Child Adolesc Psychiatry 2021; 32:675-683. [PMID: 34751811 PMCID: PMC10115721 DOI: 10.1007/s00787-021-01904-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children's perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8-12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.
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Affiliation(s)
- Anya Kaushik
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Efstathios Papachristou
- Department of Psychology and Human Development, UCL Institute of Education, University College London, London, UK
| | - Laurence Telesia
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (PO66), King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra Fewings
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Evgenia Kostaki
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Learning Disability Specialist Health Services, Hertfordshire Partnership University NHS Foundation Trust, Braintree, Essex, UK
| | - Jorge Gaete
- Faculty of Education, Universidad de los Andes, Santiago, Chile.,Millennium Nucleus To Improve the Mental Health of Adolescents and Youths, Santiago, Chile
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK. .,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (PO66), King's College London, De Crespigny Park, London, SE5 8AF, UK. .,First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.
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172
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Vázquez AL, Culianos D, Flores CMN, Alvarez MDLC, Barrett TS, Domenech Rodríguez MM. Psychometric Evaluation of a Barriers to Mental Health Treatment Questionnaire for Latina/o/x Caregivers of Children and Adolescents. CHILD & YOUTH CARE FORUM 2021; 51:847-864. [PMID: 34642563 PMCID: PMC8494628 DOI: 10.1007/s10566-021-09656-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Background Knowledge regarding barriers faced by Latina/o/x caregivers in accessing youth mental health services (MHS) have largely depended on resource intensive interview-based assessments. Objective We evaluated a questionnaire for Latina/o/x caregivers of youths that presents a briefer and more feasible alternative. Method We conducted a psychometric evaluation of the Barriers to Treatment Questionnaire - Latina/o/x Caregivers (BTQ-LC) with a sample of 598 Latina/o/x caregivers from across the United States. Descriptive statistics and confirmatory factor analyses were used to identify common barriers to services, confirm the factor structure of the scale, and establish construct validity. Results Descriptive statistics suggest that not knowing where and how to access services, and normalization of youth psychopathology were the most frequently reported barriers among caregivers of youth with clinically elevated problems on the CBCL. Confirmatory factor analysis suggests that the BTQ-LC was best represented by a three-factor structure: (1) structural, (2) perceptions regarding mental health problems, and (3) services. Our finding suggest that the BTQ-LC could also be used as a single factor as fit indices ranged from acceptable to poor. BTQ-LC scales were all negatively correlated with the utilization of common youth MHS (i.e., psychological counseling, medical doctors, school professionals). Conclusions The BTQ-LC represents an important step towards improving our understanding and assessment of barriers to services contributing to mental health disparities among Latina/o/x youths.
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Affiliation(s)
- Alejandro L. Vázquez
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | - Demi Culianos
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | | | | | - Tyson S. Barrett
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
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173
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Deng Z, Xing J, Katz I, Li B. Children's Behavioral Agency within Families in the Context of Migration: A Systematic Review. ADOLESCENT RESEARCH REVIEW 2021; 7:1-61. [PMID: 34632045 PMCID: PMC8493537 DOI: 10.1007/s40894-021-00175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Migration may lead to changing power dynamics between parents and children in families. Children may change their behavior in order to exercise agency to respond to migration of family members or themselves. This systematic review seeks to understand how children exercise agency within families in the context of migration. The authors searched ten databases to collect English-written articles published in academic journals in or after 2010. The studies were coded to generate a quality indicator. 65 Articles with moderate and strong quality were included in this review, including 41 qualitative studies, 16 quantitative studies, and 8 mixed-methods studies. Children and adolescents with demographically and culturally diverse backgrounds were analyzed in these studies. The systematic review shows that children have different levels of behavioral agency in the migration decision-making process; they also exercise agency in different aspects of family life. For example, left-behind children exercise agency in care provision and information nondisclosure, and migrant children in media and language brokering. Children's behavioral agency is place-specific. Adults working with children need to pay more attention to children's behavioral agency in order to support children's healthy development and facilitate their adaptation in the context of migration. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40894-021-00175-0.
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Affiliation(s)
- Zihong Deng
- Social Policy Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Jianli Xing
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Ilan Katz
- Social Policy Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
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174
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Otto C, Reiss F, Voss C, Wüstner A, Meyrose AK, Hölling H, Ravens-Sieberer U. Mental health and well-being from childhood to adulthood: design, methods and results of the 11-year follow-up of the BELLA study. Eur Child Adolesc Psychiatry 2021; 30:1559-1577. [PMID: 32918625 PMCID: PMC8505294 DOI: 10.1007/s00787-020-01630-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
Mental health and well-being are of great interest in health policy and research. Longitudinal surveys are needed to provide solid population-based data. We describe the design and methods of an 11-year follow-up of the German BELLA study in children, adolescents and young adults, and we report on age- and gender-specific courses of general health and well-being, long-term health-related outcomes of mental health problems, and mental health care use. The BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Standardised measures were used at each of the five measurement points of the BELLA study. In the 11-year follow-up, young people aged 7-31 years participated (n = 3492). Individual growth modelling, linear regression and descriptive analyses were conducted. Self-reported general health and well-being were both better in younger (vs. older) and in male (vs. female) participants according to the data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) predicted impaired health outcomes at 6-year and 11-year follow-ups. Approximately one out of four children with a diagnosed mental disorder was not undergoing mental health treatment. With its 11-year follow-up, the prospective longitudinal BELLA study provides new and solid data on mental health and well-being from childhood to adulthood in Germany, and these data are important for health promotion and prevention practices. These results are consistent with previous findings. Promising future analyses are planned.
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Affiliation(s)
- Christiane Otto
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Franziska Reiss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Catharina Voss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Wüstner
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ann-Katrin Meyrose
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Clinical Psychology, Helmut-Schmidt-University, Holstenhofweg 85, 22043 Hamburg, Germany
| | - Heike Hölling
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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175
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Lawrence PJ, Parkinson M, Jasper B, Creswell C, Halligan SL. Supporting the parents of children and young people with anxiety and depressive disorders is an opportunity not to be missed: a scoping review. Lancet Psychiatry 2021; 8:909-918. [PMID: 34537101 DOI: 10.1016/s2215-0366(20)30315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 10/20/2022]
Abstract
Guidance is scarce on whether and how to involve parents in treatment for anxiety and depressive disorders in children and young people. We did a scoping review of randomised controlled trials of psychological interventions for anxiety and depressive disorders in children and young people, in which parents were involved in treatment, to identify how parents and carers have been involved in such treatments, how this relates to both child and broader outcomes, and where research should focus. We identified 73 trials: 62 focused on anxiety and 11 on depressive disorders. How parents were involved in treatments varied greatly, with at least 13 different combinations of ways of involving parents in the anxiety trials and seven different combinations in the depression trials. Including parents in treatment did not impair children's and young people's outcomes, but the wide variability in how they were involved prevents clarity about why some trials favoured parent involvement and others did not. Studies must consider the long-term and wider benefits beyond children's and young people's mental health, such as enhanced engagement, family wellbeing, and economic gains.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Monika Parkinson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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176
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Hawke LD, Thabane L, Iyer SN, Jaouich A, Reaume-Zimmer P, Henderson J. Service providers endorse integrated services model for youth with mental health and substance use challenges: findings from a discrete choice experiment. BMC Health Serv Res 2021; 21:1035. [PMID: 34598693 PMCID: PMC8487137 DOI: 10.1186/s12913-021-07038-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Given high rates of mental health and substance challenges among youth and substantial system access barriers, system innovation is required. Integrated youth services (IYS) models aim to transform youth mental health and substance use services by creating integrative, collaborative models of care in youth-friendly settings. This study examines service provider perspectives on the key service components to include in IYS models. METHOD A discrete choice experiment modeled service provider preferences for the service components of IYSs. The sample includes 388 service provider/agency leader participants (age 18+) from youth-serving organizations in Ontario. Importance scores and utility values were calculated for 12 attributes represented by four levels each. Latent class analysis identified subgroups of participants with different preferences. RESULTS The majority of participants were direct service providers working in larger organizations in the mental health and/or substance use sectors in large urban centers. Participants strongly endorsed service models that provide rapid access to the widest variety of culturally sensitive service options, with supplementary e-health services, in youth-focused community settings with evening and weekend hours. They prefer caregiver involvement in youth services and treatment decisions and support youth and family engagement. Latent class analyses reveal three segments of service providers: a Youth-Focused Service Accessibility segment representing 62.1% (241/388) of participants, a Service Options segment representing 27.6% (107/388) of participants, and a Caregiver Integration segment representing 10.3% (40/388) of participants. Within these segments, the degree of prioritization of the various service components differ; however, the overall endorsement of the service components remains largely consistent across classes for most attributes. The segments did not differ based on demographic or agency characteristics. CONCLUSIONS The core characteristics of IYS settings for youth with mental health and substance use challenges, i.e., rapid access to a wide range of youth-oriented services, are strong priorities of service providers and youth-serving agency leaders. These findings confirm that youth-oriented service providers endorse the importance and relevance of IYS models as a whole; strong service provider buy-in to the model is expected to facilitate development, implementation and scaling of IYS models. Hearing stakeholder perspectives, including those of service providers, youth, and caregivers, is essential to developing, effectively implementing, and scaling effective youth services.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada.
- University of Toronto Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada.
| | - Lehana Thabane
- McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Srividya N Iyer
- McGill University, 845 Sherbrooke St W, Montreal, Quebec, Canada
- Douglas Hospital Research Centre, 6875 Boulevard LaSalle, Montréal, Quebec, Canada
| | - Alexia Jaouich
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada
| | - Paula Reaume-Zimmer
- Bluewater Health, 89 Norman St, Sarnia, Ontario, Canada
- Canadian Mental Health Association Lambton Kent, 240 Grand Ave. West, Chatham, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada.
- University of Toronto Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada.
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177
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Tsamadou E, Voultsos P, Emmanouilidis A, Ampatzoglou G. Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece. BMC Psychiatry 2021; 21:461. [PMID: 34548063 PMCID: PMC8456699 DOI: 10.1186/s12888-021-03471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A subset of adolescents with mental disorders are likely to have decision-making capacity that facilitates their therapy engagement. However, there are high rates of drop-out in mental health settings. AIM This study aims to identify perceived barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece. METHODS A qualitative study was conducted using semi-structured interviews of adolescents with a wide range of mental health problems. In addition, two psychometric assessment measures were used to define who to include or exclude from the study sample. RESULTS Positive attitudes and experiences with therapy were reported as strong ("major") facilitators of therapy engagement for adolescents with mental disorders, whereas negative experiences with therapy were reported as strong barriers to it. Furthermore, and most importantly, a "good" adolescent-therapist relationship was reported as a strong facilitator, whereas negative experiences of participants with their therapist were reported as strong barriers. Moreover, goals such as getting rid of symptoms, improving personal well-being, and improving social skills and relationships (especially with peers) emerged as strong facilitators of therapy engagement. Importantly, the early remission of symptoms emerged from the study as a strong barrier to therapy engagement for participants. Among the weaker ("minor") perceived facilitators were goals such as confessing to a trustworthy person, becoming able to achieve personal expectations and life goals, enhancing independence and self-esteem, and developing a positive self-image. The (active or supportive) role of family emerged as a facilitator. The stigma related to mental health emerged as both a ("minor") facilitator of and barrier to therapy engagement for participants. Friends were reported as having a role ranging from neutral to mildly supportive. CONCLUSION A number of more or less strong barriers and facilitators were identified that, for the most part, were consistent with prior literature. However, the authors identified some nuances that are of clinical importance. For instance, adolescents are most likely to terminate the treatment prematurely if they experience early symptom remission. Highlighting the role of therapy in achieving their goals or improving their families' well-being might be used by therapists to reduce the attrition rate.
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Affiliation(s)
- E Tsamadou
- Department of Child & Adolescent Psychiatry, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos 49, Postal Code 546 42, Thessaloniki, Greece
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Postal Code 541 24, Thessaloniki, Greece
| | - P Voultsos
- Laboratory of Forensic Medicine & Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, Postal Code 541 24, Thessaloniki, Greece.
| | - A Emmanouilidis
- Department of Child & Adolescent Psychiatry, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos 49, Postal Code 546 42, Thessaloniki, Greece
| | - G Ampatzoglou
- Department of Child & Adolescent Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University, Campus, Postal Code 541 24, Thessaloniki, Greece
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178
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Boussat ML, Fourcade L, Mourouvaye M, Grandclerc S, Moro MR, Lachal J. [Qualitative study of parents' experience after their teen's suicide attempt]. Encephale 2021; 48:390-396. [PMID: 34538622 DOI: 10.1016/j.encep.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Suicidal attempts are frequent during adolescence and concern the whole family, particularly parents whose role is crucial in provision of therapeutic support. Yet very few studies have been performed bearing on their lived experience. In this study, we will analyze the experience of parents after the suicidal attempt of their adolescent. PARTICIPANTS & METHODS Qualitative study based on semi-structured interviews of 13 parents of teenagers followed in child and adolescent psychiatry for suicidal behavior. Interview included 5 to 6 open and conversational questions. We analyzed interviews, after transcription, using the Interpretative Phenomenological Analysis approach. RESULTS The parents' wellness and behavior are directly affected by their child's mental status. When they are informed of the suicidal attempt, they feel very deep sadness, in a form of initial distress which is part of the grieving process regarding their image of idealized parents. They feel anger against the teenager, their anger is also directed against family members and close friends as well as against caregivers. Given the uncertainty, they doubt their own educative and empathetic competences, and lack confidence in their capacity for providing help. They express their need for help and support with regard to understanding their child's suicidal attempt, with regard to the emotional turmoil they experience and in reinforcing their competencies as carers. CONCLUSION It appears that parents are extremely touched by their teenager suicidal attempt. They need a personal follow up, including familial medical care but also a personal space of support. Parents group, as well as psycho educative intervention, are also welcomed to give efficient method to lift their child.
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Affiliation(s)
- M L Boussat
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France
| | - L Fourcade
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, 75015 Paris, France
| | - M Mourouvaye
- APHP, Hôpital Necker, Department of Child and Adolescent Psychiatry, 75015 Paris, France
| | - S Grandclerc
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Établissement public de santé mentale ERASME, pôle de psychiatrie de l'enfant et de l'adolescent, 92160 Antony, France
| | - M-R Moro
- APHP, Hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - J Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, 63000 Clermont-Ferrand, France.
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179
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Linkenheil A, Honigfeld L, Pidano A. Family History of Mental Health Disorders and Parental Help-Seeking for Behavioral Health Concerns in Pediatric Primary Care Offices. J Pediatr Health Care 2021; 35:518-525. [PMID: 34092454 DOI: 10.1016/j.pedhc.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pediatric mental health needs are common in primary care, but many children never access treatment. With parents as a critical gatekeeper, it is important to identify barriers and facilitators to treatment access and explore the role of family history. METHOD Parents/caregivers (N = 1,763) with children aged 3-17 years were recruited in the original study and participated in a 71-item survey that addressed mental health-related communication. RESULTS An association was found between family history of mental health disorders and recognition of behavioral concerns, and between anxiety/depression disorders and sharing of concerns. In addition, parents with a family history were less likely to feel completely satisfied with time spent discussing mental health or with how the provider answered questions. DISCUSSION Although fear of stigma has been previously cited in the literature as a barrier to accessing treatment, findings suggest a family history of mental health disorders can facilitate parental help-seeking steps.
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180
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Fredwall M, Terry D, Enciso L, Burch MM, Trott K, Albert DVF. Outcomes of children and adolescents 1 year after being seen in a multidisciplinary psychogenic nonepileptic seizures clinic. Epilepsia 2021; 62:2528-2538. [PMID: 34339046 DOI: 10.1111/epi.17031] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNES) are paroxysmal events that may involve altered subjective experience and change in motor activity with a psychological cause. The aim of this work is to describe a population of pediatric patients with PNES and identify factors predictive of 12-month outcomes. METHODS We conducted a prospective observational study of children and adolescents referred to the multidisciplinary Nationwide Children's Hospital PNES clinic between November 2017 and July 2019. Information was collected from patients during clinic visits and semistructured follow-up phone calls. Descriptive statistics and Fisher exact test were used for analysis. RESULTS Of the 139 consecutive patients referred to the PNES clinic, 104 were seen in clinic and 63 answered 12-month follow-up calls. Patients with comorbid epilepsy had increased rates of participation at 12-month follow-up (p = .04). Complete remission was achieved by 32% (20/63) of patients at 12 months. Combined PNES remission and improvement was 89% (56/63) at 12 months. Patients and families who were linked with counseling at 1 month were more likely to achieve remission at 12 months (p = .005). Less than half (44%, 28/63) of patients reached at 12 months had their events documented on video-electroencephalogram (EEG) at diagnosis; however, those who did were not more likely to be accepting of the diagnosis at 12 months (p = 1.0), be linked with counseling at 12 months (p = .59), or be event-free at 12 months (p = .79). SIGNIFICANCE Remission occurred in one third of patients by 12 months; however, improvement in events was seen in 89%. Connection to counseling by 1 month was associated with increased remission rates at 12 months. Capturing events on video-EEG was not associated with increased acceptance or event freedom at 12 months. Diagnosis should be followed by strong encouragement to connect with counseling quickly to achieve a goal of increasing 12-month PNES remission rates.
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Affiliation(s)
- Megan Fredwall
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Debbie Terry
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Laurie Enciso
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Maggie Mary Burch
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Kristen Trott
- Department of Pediatrics, Division of Psychology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Dara V F Albert
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
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181
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Darling S, Dawson G, Quach J, Smith R, Perkins A, Connolly A, Smith A, Moore CL, Ride J, Oberklaid F. Mental health and wellbeing coordinators in primary schools to support student mental health: protocol for a quasi-experimental cluster study. BMC Public Health 2021; 21:1467. [PMID: 34320975 PMCID: PMC8316894 DOI: 10.1186/s12889-021-11467-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Half of mental health disorders begin before the age of 14, highlighting the importance of prevention and early-intervention in childhood. Schools have been identified globally by policymakers as a platform to support good child mental health; however, the majority of the research is focused on secondary schools, with primary schools receiving very little attention by comparison. The limited available evidence on mental health initiatives in primary schools is hindered by a lack of rigorous evaluation. This quasi-experimental cluster study aims to examine the implementation and effectiveness of a Mental Health and Wellbeing Co-ordinator role designed to build mental health capacity within primary schools. METHODS This is a primary (ages 5-12) school-based cluster quasi-experimental study in Victoria, Australia. Before baseline data collection, 16 schools selected by the state education department will be allocated to intervention, and another 16 matched schools will continue as 'Business as Usual'. In intervention schools, a mental health and well-being coordinator will be recruited and trained, and three additional school staff will also be selected to receive components of the mental health training. Surveys will be completed by consenting staff (at 2-, 5-, 10- and 17-months post allocation) and by consenting parents/carers (at 3-, 10- and 17-months post allocation) in both intervention and business as usual schools. The primary objective is to assess the change in teacher's confidence to support student mental health and wellbeing using the School Mental Health Self-Efficacy Teacher Survey. Secondary objectives are to assess the indirect impact on systemic factors (level of support, prioritisation of child mental health), parent and teachers' mental health literacy (stigma, knowledge), care access (school engagement with community-based services), and student mental health outcomes. Implementation outcomes (feasibility, acceptability, and fidelity) and costs will also be evaluated. DISCUSSION The current study will examine the implementation and effectiveness of having a trained Mental Health and Wellbeing Coordinator within primary schools. If the intervention increases teachers' confidence to support student mental health and wellbeing and builds the capacity of primary schools it will improve student mental health provision and inform large-scale mental health service reform. TRIAL REGISTRATION The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on July 6, 2021. The registration number is ACTRN12621000873820 .
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Affiliation(s)
- S Darling
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA
| | - G Dawson
- Centre for Program Evaluation, Melbourne Graduate School of Education, University of Melbourne, Carlton, VIC, 3053, USA
| | - J Quach
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Centre for Program Evaluation, Melbourne Graduate School of Education, University of Melbourne, Carlton, VIC, 3053, USA
| | - R Smith
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA.
| | - A Perkins
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - A Connolly
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - A Smith
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - C L Moore
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - J Ride
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, 207 Bouverie St, Parkville, VIC, 3010, USA
| | - F Oberklaid
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA
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182
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Colleran A, O'Connor A, Hogan MJ, Harney OM, Durand H, Hanlon M. Who asked you? Young People and practitioners identify ways to facilitate access to mental health supports. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13328.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Despite representing the highest level of total population mental health burden, young people are the least likely to seek help from mental health services. It has been suggested that service design can influence the likelihood that young people will look for help, but little is known about how young people would like a service to be designed. This study addresses a gap in research regarding how mental health services can be designed to facilitate access for young people. Methods: A collective intelligence, scenario-based design methodology was used to facilitate stakeholders to identify and prioritise ways to improve youth mental health services. In total, 74 15–17-year-olds from three geographically diverse schools in Ireland worked to identify barriers to help-seeking and to generate and prioritise options in response to barriers. Nine practitioners with experience of working in youth mental health services rated all options in terms of both potential impact on help-seeking and feasibility for service implementation. Results: A total of 326 barriers across 15 themes were generated by youth stakeholders, along with 133 options in response to barriers. Through a process of voting, young people identified 30 options as the most impactful for improving access to mental health services. Of these options, 12 were also rated by practitioners as having both high potential impact and high feasibility. These 12 options focused on four areas: making services more familiar and welcoming; providing specialist mental health input in schools; improving parental understanding; and improving the visibility of appropriate supports. Conclusions: The results of the current study inform mental health service innovation and development, in particular, by highlighting potentially impactful and feasible ways to adapt existing mental health services to improve young people’s help-seeking behaviour.
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183
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Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health 2021; 26:1177-1188. [PMID: 34219346 DOI: 10.1111/tmi.13651] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. METHODS An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool. RESULTS Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs. CONCLUSIONS As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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184
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Batchelor S, Stoyanov S, Pirkis J, Kõlves K. Use of Kids Helpline by Children and Young People in Australia During the COVID-19 Pandemic. J Adolesc Health 2021; 68:1067-1074. [PMID: 33858763 DOI: 10.1016/j.jadohealth.2021.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The benefits of helplines are particularly valuable during a pandemic when face-to-face services and natural supports are difficult to access. Kids Helpline, Australia's national youth helpline, provides children and young people with free 24/7 information and counseling through telephone, WebChat, and e-mail. We aimed to examine the use of Kids Helpline during the COVID-19 pandemic. METHODS We analyzed monthly and weekly time trends of demand for and response by the Kids Helpline. The frequency of counseling contacts by common concern types, age, and gender were also examined. We used Joinpoint regression. RESULTS Analyses of weekly demand for Kids Helpline showed an increase when the pandemic was declared, followed by a gradual decline. A second rise from 12 July 2020 when parts of Australia experienced a second wave of infections, followed by another decline, occurred more recently. Increased demand was almost entirely in the WebChat modality. Most answered counseling contacts were from girls and those aged 13-18 years. The number of contacts about mental health, suicide/self-harm, and family relationships increased, with mental health contacts also increasing as a proportion of total contacts. COVID-19-related concerns were the most common reason for contact in April 2020. CONCLUSIONS In Australia, the COVID-19 pandemic saw a rapid increase in demand for Kids Helpline, mainly by WebChat, with the virus itself, mental health, suicide/self-harm, and relationships common reasons for contact. Responding to rapid changes in demand for particular modalities is challenging and understanding of the use and effectiveness of different modalities is needed.
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Affiliation(s)
| | - Stoyan Stoyanov
- Advocacy and Research Division, Yourtown, Brisbane, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kairi Kõlves
- Australian Institute For Suicide Research and Prevention, WHO Collaborating Centre For Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia.
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185
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Patel ZS, Casline E, Jensen-Doss A, Timpano KR. Parent Distress Intolerance, Repetitive Negative Thinking, and Mental Health Service Use. Child Psychiatry Hum Dev 2021; 52:365-375. [PMID: 32632828 DOI: 10.1007/s10578-020-01017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While extensive evidence links service use for mental health problems to demographic variables and positive attitudes, studies have not explored the role of transdiagnostic risk factors, like distress intolerance (DI) and repetitive negative thinking (RNT). This study examined the relationship between parental DI and RNT on mental health treatment seeking for parents themselves and their children. Results suggest higher DI and RNT predict service use among parents (p < 0.05) but were not significantly associated with help seeking for their children, indicating that factors more proximal to the child may have greater influence when parents make treatment decisions for their children. Results also indicte that DI moderates the relationship between parent psychopathology and parent service use, such that parent psychopathology is significantly associated with service use for those with lower DI, but not at moderate or high levels of DI. Implications for marketing mental health information to parents and engaging them in treatment are discussed.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Elizabeth Casline
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
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186
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Helseth SA, Scott K, Escobar KI, Jimenez F, Becker SJ. What parents of adolescents in residential substance use treatment want from continuing care: A content analysis of online forum posts. Subst Abus 2021; 42:1049-1058. [PMID: 33945453 DOI: 10.1080/08897077.2021.1915916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Parents of adolescents in residential substance use (SU) treatment face a myriad of barriers to continuing care services. Growing research suggests that mobile health (mHealth) technologies can overcome common barriers to continuing care services, yet no work has addressed parents' needs. To gain insight into parents' continuing care needs, we analyzed online forum posts made by parents who received a novel mHealth intervention. Methods: Thirty parents received access to an online networking forum where they could connect with our adolescent SU expert or the community of parents also navigating their adolescent's post-discharge transition. In real-time, participants could ask questions and share information, experiences, and emotional support. Results: Twenty-one parents (70%) posted at least once; 12 parents made 15 posts to our expert, while 18 parents made 50 posts to the parent community. Thematic analysis uncovered five major themes: parenting skills; parent support; managing the post-discharge transition; adolescent SU; and family functioning. Conclusions: Parents discussed a range of topics directly and indirectly related to their adolescent's treatment. Incorporating networking forums into mHealth continuing care interventions offers parents a secure space to ask questions, share concerns, and gather information needed to support their adolescent's transition home.
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Affiliation(s)
- Sarah A Helseth
- The Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kelli Scott
- The Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Frances Jimenez
- The Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sara J Becker
- The Brown University School of Public Health, Providence, Rhode Island, USA
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187
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Paton K, Gillam L, Warren H, Mulraney M, Coghill D, Efron D, Sawyer M, Hiscock H. Clinicians' perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions. Aust N Z J Psychiatry 2021; 55:494-505. [PMID: 33461341 DOI: 10.1177/0004867420984242] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child's mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system. METHODS A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims. FINDINGS Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services. CONCLUSION Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia's children's mental health.
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Affiliation(s)
- Kate Paton
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Hayley Warren
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Melissa Mulraney
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - David Coghill
- Mental Health, The Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Daryl Efron
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Sawyer
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
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188
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Hawke LD, Thabane L, Wilkins L, Mathias S, Iyer S, Henderson J. Don't Forget the Caregivers! A Discrete Choice Experiment Examining Caregiver Views of Integrated Youth Services. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:791-802. [PMID: 33855684 PMCID: PMC8046579 DOI: 10.1007/s40271-021-00510-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
Background The design and implementation of community-based integrated youth service hubs (IYSHs) is burgeoning around the world. This collaborative model of care aims to address barriers in youth service access by designing services that meet the needs of youth and caregivers. However, heterogeneity across models requires a better understanding of the preferences for key service characteristics. Method A discrete choice experiment was conducted among 274 caregivers of youth aged 14–29 years with mental health challenges. The experiment consisted of 12 attributes with four levels each, representing different service components; additional measures were collected, including demographics and burden assessments. Utility values were calculated, representing the degree of preference for a given level of an attribute. Latent class analysis was conducted to understand subgroups with different service preferences, identifying three latent classes with differing IYSH service preferences. Results The largest class (n = 173, 63.1%), entitled ‘Comprehensive, Integrative Service Access’, strongly valued practical aspects of service design, such as rapid access and support for a wide range of needs. The ‘Service Process Features’ class (n = 67, 24.5%) expressed a relative prioritization of process features of service access, while the smaller ‘Caregiver Involvement’ (n = 34, 12.4%) class most highly prioritized caregiver involvement in their youths’ services. Similar demographic characteristics and caregiver burden were found across classes, although participants in the Caregiver Involvement latent class were supporting younger youth. Discussion and Conclusions Caregivers have diverse youth service preferences and relative priorities that should be taken into account when designing services. System designers and service providers are encouraged to take caregivers’ preferences and priorities into account, alongside youth priorities, whether designing service delivery models or an individual service plan for a youth. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00510-6.
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Affiliation(s)
- Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health; University of Toronto, Toronto, ON, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leanne Wilkins
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Srividya Iyer
- McGill University; ACCESS Open Minds (Youth Mental Health Services Research Network), Montreal, QC, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health; University of Toronto, Toronto, ON, Canada.
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189
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Hawke LD, Sheikhan NY, MacCon K, Henderson J. Going virtual: youth attitudes toward and experiences of virtual mental health and substance use services during the COVID-19 pandemic. BMC Health Serv Res 2021; 21:340. [PMID: 33853602 PMCID: PMC8045568 DOI: 10.1186/s12913-021-06321-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background During the COVID-19 pandemic, youth mental health and substance use services rapidly moved to virtual modalities to meet social distancing requirements. It is important to understand youth attitudes toward and experience of virtual services. Objective This study examined the attitudes toward and experiences of virtual mental health and substance use services among youth drawn from clinical and non-clinical samples. Method Four hundred nine youth completed a survey including questions about their attitudes toward and experience of virtual services. The survey included quantitative and open-ended questions on virtual care, as well as a mental health and substance use screener. Results The majority of youth with mental health or substance use challenges would be willing to consider individual virtual services, but fewer would consider group virtual services. However, many have not received virtual services. Youth are interested in accessing a wide variety of virtual services and other supportive wellness services. Advantages and disadvantages of virtual services are discussed, including accessibility benefits and technological barriers. Discussion As youth mental health and substance use services have rapidly gone virtual during the COVID-19 pandemic, it is essential that we hear the perspectives of youth to promote service utilization among those in need. Diverse, accessible, technologically stable virtual services are required to meet the needs of different youth, possibly with in-person options for some youth. Future research, engaging youth in the research process, is needed to evaluate the efficacy of virtual services to plan for the sustainability of some virtual service gains beyond the pandemic period.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Y Sheikhan
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada
| | - Karen MacCon
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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190
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Mulraney M, Lee C, Freed G, Sawyer M, Coghill D, Sciberras E, Efron D, Hiscock H. How long and how much? Wait times and costs for initial private child mental health appointments. J Paediatr Child Health 2021; 57:526-532. [PMID: 33170548 DOI: 10.1111/jpc.15253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/28/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine: (i) wait times and out-of-pocket costs for children attending private specialists for initial mental health appointments; and (ii) whether these differed between specialists working in metropolitan versus rural areas and in low, medium and high socio-economic areas. METHODS Prospective secret shopper study whereby a researcher posed as a parent seeking an appointment for her child with anxiety or attention-deficit/hyperactivity disorder. We contacted 317 private paediatrician, psychiatrist and psychologist practices in Victoria and South Australia between 12 March and 5 May 2019. RESULTS One third (29.8%) of private practices were closed to new referrals. The average wait times for paediatricians, psychiatrists, and psychologists were 44, 41 and 34 days, respectively. Average out-of-pocket costs quoted were AU$120 for paediatricians, AU$176 for psychiatrists and AU$85 for psychologists. CONCLUSION Parents face extensive wait times and substantial out-of-pocket costs when seeking private mental health services for their child.
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Affiliation(s)
- Melissa Mulraney
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Cindy Lee
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Freed
- Department of Paediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Michael Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - David Coghill
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emma Sciberras
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daryl Efron
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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191
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Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai. Int J Ment Health Syst 2021; 15:29. [PMID: 33789685 PMCID: PMC8011192 DOI: 10.1186/s13033-021-00452-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai. Methods Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models. Results The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders. Conclusions The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.
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192
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Haugland BSM, Hysing M, Baste V, Wergeland GJ, Rapee RM, Hoffart A, Haaland ÅT, Bjaastad JF. Sleep Duration and Insomnia in Adolescents Seeking Treatment for Anxiety in Primary Health Care. Front Psychol 2021; 12:638879. [PMID: 33841272 PMCID: PMC8024547 DOI: 10.3389/fpsyg.2021.638879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
There is limited knowledge about sleep in adolescents with elevated levels of anxiety treated within primary health care settings, potentially resulting in sleep problems not being sufficiently addressed by primary health care workers. In the current study self-reported anxiety, insomnia, sleep onset latency, sleep duration, and depressive symptoms were assessed in 313 adolescents (12–16 years; mean age 14.0, SD = 0.84, 84.0% girls) referred to treatment for anxiety within primary health care. Results showed that 38.1% of the adolescents met criteria for insomnia, 34.8% reported short sleep duration (<7 h), and 83.1% reported long sleep onset latency (≥30 min). Total anxiety symptoms were related to all sleep variables after controlling for age and sex. Furthermore, all anxiety symptom sub-types were associated with insomnia and sleep onset latency, whereas most anxiety subtypes were associated with sleep duration. Adolescents’ depressive symptoms accounted for most of the anxiety-sleep associations, emphasizing the importance of depressive symptoms for sleep. However, anxiety was associated with insomnia and sleep onset latency also among youth with low levels of depressive symptoms. The findings suggests that primary health care workers should assess sleep duration, sleep onset latency, and insomnia in help-seeking adolescents with anxiety.
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Affiliation(s)
- Bente S M Haugland
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Valborg Baste
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Centre, Bergen, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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193
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Lu W, Todhunter-Reid A, Mitsdarffer ML, Muñoz-Laboy M, Yoon AS, Xu L. Barriers and Facilitators for Mental Health Service Use Among Racial/Ethnic Minority Adolescents: A Systematic Review of Literature. Front Public Health 2021; 9:641605. [PMID: 33763401 PMCID: PMC7982679 DOI: 10.3389/fpubh.2021.641605] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Mental disorders represent serious public health concerns in the U.S. Compared with Whites, racial/ethnic minority adolescents are more likely to be affected by mental disorders but less likely to use mental health services. This systematic review aimed to summarize factors related to mental health service use among minority adolescents in the U.S. as identified in previous research. Methodology: Following the PRISMA guideline, we systematically searched seven databases for peer reviewed articles related to barriers and facilitators of mental health service use among racial/ethnic minority adolescents. Results: Thirty-two quantitative studies met our inclusion criteria, among which 12 studies (37.5%) sampled mostly Blacks or African Americans, 6 studies (18.7%) focused primarily on Hispanics or Latin/a/x, including Mexican Americans and Puerto Ricans, and 4 studies (12.5%) were mostly Asian Americans (e.g., Chinese, Vietnamese). Based on the socio-ecological framework, 21 studies (65.6%) identified adolescent-related barriers and facilitators of mental health service use, including biological (e.g., age, gender), clinical (e.g., symptom severity), behavioral (e.g., drug/alcohol use), and psychological characteristics (e.g., internal asset) of minority youth. Ten studies (31.3%) identified parents-related factors that influenced minority adolescent mental health service use, including parental perceptions and beliefs, family and parenting issues, and demographic characteristics. Primary factors at the therapist level included ethnic match between patient and practitioner, relationship with healthcare practitioners, and patient-therapist co-endorsement of etiological beliefs. Fifteen studies (46.9%) identified factors influencing minority adolescent mental health service use at the contextual/structural level, including household income, insurance status, and family structure. Lastly, acculturation and school experiences were major factors at the social/cultural level that influence minority adolescent service use. Conclusion: More empirical studies are needed to understand the mechanism underlying minority adolescents' unmet mental health service needs. Culturally competent interventions are warranted to engage minority adolescents with mental disorders into treatment.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, City University of New York, New York, NY, United States
| | | | | | - Miguel Muñoz-Laboy
- School of Social Welfare, Stony Brook University, New York, NY, United States
| | | | - Lei Xu
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States
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194
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Creswell C, Leigh E, Larkin M, Stephens G, Violato M, Brooks E, Pearcey S, Taylor L, Stallard P, Waite P, Reynolds S, Taylor G, Warnock-Parkes E, Clark DM. Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study. Health Technol Assess 2021; 25:1-94. [PMID: 33759742 PMCID: PMC8020199 DOI: 10.3310/hta25200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD. OBJECTIVES To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used. DESIGN During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads. SETTING Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts. PARTICIPANTS Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews. INTERVENTIONS Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A). MAIN OUTCOME MEASURES Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians' logs. RESULTS Nine out of 12 participants achieved good outcomes across measures (r ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context. LIMITATIONS Findings were based on a small, homogeneous sample and there was no comparison arm. CONCLUSIONS CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation. FUTURE WORK Further work is needed to ensure that CAMHS can incorporate and test CT-SAD-A. Alternatively, CT-SAD-A should be delivered and tested in other settings that are better configured to treat young people whose lives are held back by SAD. The new schools Mental Health Support Teams envisaged in the 2017 Children's Mental Health Green Paper may provide such an opportunity. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme. Individual funding was also provided for Cathy Creswell, David M Clark and Eleanor Leigh as follows: NIHR Research Professorship (Cathy Creswell); Wellcome Senior Investigator Award (Anke Ehlers and David M Clark); and the Wellcome Clinical Research Training Fellowship (Eleanor Leigh).
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Affiliation(s)
- Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma Brooks
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Samantha Pearcey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lucy Taylor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Paul Stallard
- Child and Adolescent Mental Health Service, Oxford Health NHS Trust, Bristol, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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195
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Fawole OA, Reed MV, Harris JG, Hersh A, Rodriguez M, Onel K, Lawson E, Rubinstein T, Ardalan K, Morgan E, Paul A, Barlin J, Daly RP, Dave M, Malloy S, Hume S, Schrandt S, Marrow L, Chapson A, Napoli D, Napoli M, Moyer M, Delgaizo V, Danguecan A, von Scheven E, Knight A. Engaging patients and parents to improve mental health intervention for youth with rheumatological disease. Pediatr Rheumatol Online J 2021; 19:19. [PMID: 33622346 PMCID: PMC7901209 DOI: 10.1186/s12969-021-00503-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders are common in youth with rheumatological disease yet optimal intervention strategies are understudied in this population. We examined patient and parent perspectives on mental health intervention for youth with rheumatological disease. METHODS We conducted a mixed methods cross-sectional study, via anonymous online survey, developed by researchers together with patient/parent partners, to quantitatively and qualitatively examine youth experiences with mental health services and resources in North America. Patients ages 14-24 years with juvenile idiopathic arthritis, juvenile dermatomyositis, or systemic lupus erythematous, and parents of patients ages 8-24 with these diseases were eligible (not required to participate in pairs). Participants self-reported mental health problems (categorized into clinician-diagnosed disorders vs self-diagnosed symptoms) and treatments (e.g. therapy, medications) received for the youth. Multivariate linear regression models compared patient and parent mean Likert ratings for level of: i) comfort with mental health providers, and ii) barriers to seeking mental health services, adjusting for potential confounders (patient age, gender, disease duration, and patient/parent visual analog score for disease-related health). Participants indicated usefulness of mental health resources; text responses describing these experiences were analyzed by qualitative description. RESULTS Participants included 123 patients and 324 parents. Patients reported clinician-diagnosed anxiety (39%) and depression (35%); another 27 and 18% endorsed self-diagnosed symptoms of these disorders, respectively. 80% of patients with clinician-diagnosed disorders reported receiving treatment, while 11% of those with self-diagnosed symptoms reported any treatment. Patients were less comfortable than parents with all mental health providers. The top two barriers to treatment for patients and parents were concerns about mental health providers not understanding the rheumatological disease, and inadequate insurance coverage. Over 60% had used patient mental health resources, and over 60% of these participants found them to be helpful, although text responses identified a desire for resources tailored to patients with rheumatological disease. CONCLUSION Self-reported mental health problems are prevalent for youth in this sample with rheumatological disease, and obstacles to mental health treatment include disease-related and logistic factors. Strategies are needed to improve acceptance and accessibility of mental health intervention, including routine mental health screening and availability of disease-specific mental health resources.
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Affiliation(s)
- Oluwatunmise A Fawole
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Julia G Harris
- University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, MO, USA
| | | | - Martha Rodriguez
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Erica Lawson
- University of California San Francisco, San Francisco, CA, USA
| | - Tamar Rubinstein
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Kaveh Ardalan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Duke University Medical Center, Durham, NC, USA
| | - Esi Morgan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Anne Paul
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Judy Barlin
- Lupus Foundation of America, Washington, D.C, USA
| | - R Paola Daly
- Lupus Foundation of America, Washington, D.C, USA
| | | | | | | | | | | | - Angela Chapson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Donna Napoli
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Napoli
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miranda Moyer
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vincent Delgaizo
- Patient-Centered Outcomes Research Institute, Washington, D.C, USA
- The Childhood Arthritis and Rheumatology Research Alliance, Milwaukee, WI, USA
| | - Ashley Danguecan
- Division of Rheumatology, Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | | | - Andrea Knight
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- University of Pennsylvania, Philadelphia, PA, USA.
- Division of Rheumatology, Hospital for Sick Children, Toronto, ON, M5G1X8, Canada.
- University of Toronto Faculty of Medicine, Toronto, ON, Canada.
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196
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Fehr KK, Leraas BC, Littles MMD. Behavioral Health Needs, Barriers, and Parent Preferences in Rural Pediatric Primary Care. J Pediatr Psychol 2021; 45:910-920. [PMID: 32766670 DOI: 10.1093/jpepsy/jsaa057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/05/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine modifiable factors related to health disparities by exploring the role of predisposing, need, and enabling characteristics on mental/behavioral health treatment-seeking behaviors in a rural sample. Parental treatment preferences and knowledge about treatment options were also examined. METHODS One hundred eighteen parents completed questionnaires assessing demographics, child prior psychological treatment, child psychological symptoms, barriers to care, mental health stigma, and willingness to seek services across settings. Questions also assessed preferences for treatment, awareness of behavioral/mental health services, and knowledge of community treatment options. RESULTS Prior treatment use and stigma significantly predicted willingness to seek services in a doctor's office after controlling for predisposing (demographic) and need characteristics (psychological symptoms). Symptom severity and barriers significantly differentiated between parents who previously sought treatment or reported an unmet treatment need from those who reported no prior treatment and no treatment need. Families overwhelmingly (94%) reported a preference for individual versus group treatment, and up to 10 sessions were most commonly reported (38%) as the ideal number of sessions. Forty percent of respondents reported no knowledge of treatment options in their community. CONCLUSIONS These results highlight the role of enabling characteristics (i.e., stigma, barriers to care, psychological symptoms) and prior service use in understanding parental treatment seeking in a rural sample. Overall, these results support integrated behavioral health in rural settings. Understanding modifiable factors and parent treatment preferences and knowledge may be important to increase access to services and reduce health disparities in rural areas. Future research directions are discussed.
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Affiliation(s)
- Karla K Fehr
- Department of Psychology, Southern Illinois University
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197
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Radez J, Reardon T, Creswell C, Lawrence PJ, Evdoka-Burton G, Waite P. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry 2021; 30:183-211. [PMID: 31965309 PMCID: PMC7932953 DOI: 10.1007/s00787-019-01469-4] [Citation(s) in RCA: 273] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/31/2019] [Indexed: 11/28/2022]
Abstract
Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a systematic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies; 22 provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were identified. Almost all studies (96%) reported barriers related to young people's individual factors, such as limited mental health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to social factors, for example, perceived social stigma and embarrassment. The third theme captured young people's perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the complex array of internal and external factors that determine whether young people seek and access help for mental health difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to reduce perceived public stigma and improve young people's knowledge of mental health problems and available support, including what to expect from professionals and services.
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Affiliation(s)
- Jerica Radez
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tessa Reardon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Georgina Evdoka-Burton
- Slough Community Mental Health Team, Berkshire Healthcare NHS Foundation Trust, Slough, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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198
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A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs. Child Psychiatry Hum Dev 2021; 52:141-153. [PMID: 32367194 DOI: 10.1007/s10578-020-00998-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.
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199
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Parent-perceived barriers to accessing services for their child's mental health problems. Child Adolesc Psychiatry Ment Health 2021; 15:4. [PMID: 33514400 PMCID: PMC7847149 DOI: 10.1186/s13034-021-00357-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS. METHOD In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child. RESULTS The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking. CONCLUSION Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.
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200
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Cohen KA, Stiles-Shields C, Winquist N, Lattie EG. Traditional and Nontraditional Mental Healthcare Services: Usage and Preferences Among Adolescents and Younger Adults. J Behav Health Serv Res 2021; 48:537-553. [PMID: 33474642 PMCID: PMC7817073 DOI: 10.1007/s11414-020-09746-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
In recent years, nontraditional mental healthcare services and tools (e.g., mobile apps, peer counselors, online support groups) have been developed to increase access to and utilization of behavioral health services. This study investigates how adolescents and younger adults use and perceive various nontraditional mental healthcare services in comparison to traditional services and in comparison to each other. A questionnaire-based study was conducted that included 203 participants between the ages of 17 and 37 (M = 25.01, SD = 5.04). Results showed that while usage rates of nontraditional mental health services were considerably high, the highest rates were reported for traditional services. Similarly, participants reported high levels of willingness to use nontraditional services, yet the highest levels of willingness were reported for traditional services. These findings suggest that the integration of nontraditional services with traditional services may be particularly impactful for young people.
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Affiliation(s)
- Katherine A Cohen
- Department of Preventive Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Nathan Winquist
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Emily G Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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