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Braund TA, Baker STE, Subotic-Kerry M, Tillman G, Evans NJ, Mackinnon A, Christensen H, O'Dea B. Potential mental health-related harms associated with the universal screening of anxiety and depressive symptoms in Australian secondary schools. Child Adolesc Psychiatry Ment Health 2024; 18:46. [PMID: 38566202 PMCID: PMC10985850 DOI: 10.1186/s13034-024-00734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. METHODS A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. RESULTS Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. CONCLUSIONS The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821 .
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Affiliation(s)
- Taylor A Braund
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | | | - Mirjana Subotic-Kerry
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Gabriel Tillman
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Nathan J Evans
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Beames JR, Werner-Seidler A, Hodgins M, Brown L, Fujimoto H, Bartholomew A, Maston K, Huckvale K, Zbukvic I, Torok M, Christensen H, Batterham PJ, Calear AL, Lingam R, Boydell KM. Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study. JMIR Pediatr Parent 2023; 6:e42349. [PMID: 37307051 DOI: 10.2196/42349] [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: 09/01/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. OBJECTIVE The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). METHODS Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. RESULTS Staff perceived the FPP as a novel ("innovative approach") and appropriate way to address an unmet need within schools ("right place at the right time"). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution ("ways of working within schools"). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools ("reflecting on past experiences"). CONCLUSIONS Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-042133.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Michael Hodgins
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Lyndsay Brown
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hiroko Fujimoto
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Isabel Zbukvic
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Raman V, Thomas S. School Mental Health Program in India-Issues and Possible Practical Solutions. Indian J Psychol Med 2023; 45:283-288. [PMID: 37152393 PMCID: PMC10159568 DOI: 10.1177/02537176231165033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Affiliation(s)
- Vijaya Raman
- Dept. of Psychiatry, St. John’s Medical
College, Bangalore, Karnataka, India
- Vijaya Raman, Dept. of Psychiatry, St. John’s
Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.
| | - Shanti Thomas
- Dept. of Psychiatry, St. John’s Medical
College, Bangalore, Karnataka, India
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4
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Zeiler M, Kuso S, Nitsch M, Simek M, Adamcik T, Herrero R, Etchemendy E, Mira A, Oliver E, Jones Bell M, Karwautz A, Wagner G, Baños Rivera RM, Botella C, Waldherr K. Online interventions to prevent mental health problems implemented in school settings: the perspectives from key stakeholders in Austria and Spain. Eur J Public Health 2021; 31:i71-i79. [PMID: 34240156 PMCID: PMC8266540 DOI: 10.1093/eurpub/ckab039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Schools are key settings for delivering mental illness prevention in adolescents. Data on stakeholders' attitudes and factors relevant for the implementation of Internet-based prevention programmes are scarce. METHODS Stakeholders in the school setting from Austria and Spain were consulted. Potential facilitators (e.g. teachers and school psychologists) completed an online questionnaire (N=50), policy makers (e.g. representatives of the ministry of education and health professional associations) participated in semi-structured interviews (N=9) and pupils (N=29, 14-19 years) participated in focus groups. Thematic analysis was used to identify experiences with, attitudes and needs towards Internet-based prevention programmes, underserved groups, as well as barriers and facilitators for reach, adoption, implementation and maintenance. RESULTS Experiences with Internet-based prevention programmes were low across all stakeholder groups. Better reach of the target groups was seen as main advantage whereas lack of personal contact, privacy concerns, risk for misuse and potential stigmatization when implemented during school hours were regarded as disadvantages. Relevant needs towards Internet-based programmes involved attributes of the development process, general requirements for safety and performance, presentation of content, media/tools and contact options of online programmes. Positive attitudes of school staff, low effort for schools and compatibility to schools' curriculum were seen as key factors for successful adoption and implementation. A sound implementation of the programme in the school routine and continued improvement could facilitate maintenance of online prevention initiatives in schools. CONCLUSIONS Attitudes towards Internet-based mental illness prevention programmes in school settings are positive across all stakeholder groups. However, especially safety concerns have to be considered.
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Affiliation(s)
- Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Monika Simek
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Tanja Adamcik
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III, Institute of Health, Av. Monforte de Lemos, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Facultad de Psicología, Universidad de Valencia, València, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III, Institute of Health, Av. Monforte de Lemos, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Facultad de Psicología, Universidad de Valencia, València, Spain
| | - Adriana Mira
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
- Department of Pychology and Sociology, Universidad de Zaragoza. Facultad de Ciencias Sociales y Humanas., Calle Cdad. Escolar, Teruel, Spain
| | - Elia Oliver
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III, Institute of Health, Av. Monforte de Lemos, Madrid, Spain
| | - Megan Jones Bell
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Rosa Maria Baños Rivera
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III, Institute of Health, Av. Monforte de Lemos, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Facultad de Psicología, Universidad de Valencia, València, Spain
| | - Cristina Botella
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III, Institute of Health, Av. Monforte de Lemos, Madrid, Spain
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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O'Dea B, Subotic-Kerry M, King C, Mackinnon AJ, Achilles MR, Anderson M, Parker B, Werner-Seidler A, Torok M, Cockayne N, Baker ST, Christensen H. A cluster randomised controlled trial of a web-based youth mental health service in Australian schools. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 12:100178. [PMID: 34527971 PMCID: PMC8356132 DOI: 10.1016/j.lanwpc.2021.100178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Secondary schools have attempted to address gaps in help-seeking for mental health problems with little success. This trial evaluated the effectiveness of a universal web-based service (Smooth Sailing) for improving help-seeking intentions for mental health problems and other related outcomes among students. METHODS A cluster randomised controlled trial was conducted to evaluate the 12-week outcomes of the Smooth Sailing service among 1841 students from 22 secondary schools in New South Wales, Australia. Assignment was conducted at the school level. The control condition received school-as-usual. The primary outcome was help-seeking intentions for general mental health problems at 12-weeks post-baseline. Secondary outcomes included help-seeking behaviour, anxiety and depressive symptoms, psychological distress, psychological barriers to help-seeking, and mental health literacy. Data were analysed using mixed linear models. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224). FINDINGS At 12-weeks post-baseline, there was a marginal statistical difference in the relative means of help-seeking intentions (effect size=0•10, 95%CI: -0•02-0•21) that favoured the intervention condition. Help-seeking from adults declined in both conditions. There was a greater reduction in the number of students who "needed support for their mental health but were not seeking help" in the intervention condition (OR: 2•08, 95%CI: 1•72-2.27, P<•0001). No other universal effects were found. Participants found the service easy to use and understand; However, low motivation, time, forgetfulness, and lack of perceived need were barriers to use. INTERPRETATION Smooth Sailing led to small improvements in help-seeking intentions. Refinements are needed to improve its effectiveness on other mental health outcomes and to increase student uptake and engagement. FUNDING HSBC and Graf Foundation.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | | | - Catherine King
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | | | | | - Melissa Anderson
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Belinda Parker
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Aliza Werner-Seidler
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Michelle Torok
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Nicole Cockayne
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
| | - Simon T.E. Baker
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
| | - Helen Christensen
- Black Dog Institute, Hospital Road, Randwick, NSW, Australia, 2031
- Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia 2052
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6
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O'Dea B, King C, Achilles MR, Calear AL, Subotic-Kerry M. Delivering A Digital Mental Health Service in Australian Secondary Schools: Understanding School Counsellors' and Parents' Experiences. Health Serv Insights 2021; 14:11786329211017689. [PMID: 34045867 PMCID: PMC8135196 DOI: 10.1177/11786329211017689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
This study examined school counsellors’ and parents’ experiences of a school-based digital mental health service (Smooth Sailing) that screened students’ mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child’s participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, University of New South Wales Sydney, Randwick, NSW, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Catherine King
- Black Dog Institute, University of New South Wales Sydney, Randwick, NSW, Australia
| | - Melinda R Achilles
- Black Dog Institute, University of New South Wales Sydney, Randwick, NSW, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
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Collaborative Practices Among Australian School Psychologists, Guidance Officers and School Counsellors: Important Lessons for School Psychological Practice. THE EDUCATIONAL AND DEVELOPMENTAL PSYCHOLOGIST 2020. [DOI: 10.1017/edp.2018.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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8
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Te Maro B, Cuthbert S, Sofo M, Tasker K, Bowden L, Donkin L, Hetrick SE. Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4844. [PMID: 31810234 PMCID: PMC6926739 DOI: 10.3390/ijerph16234844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/09/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022]
Abstract
Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to obtain their views on the use of guidelines in their work. Twenty-six pastoral care staff from New Zealand were interviewed. Interviews were analyzed and coded using thematic analysis. Three themes emerged: The burden of the role; discrepancies in expectations, training, and experience; and the need for guidelines to support their work. This research, therefore, demonstrated a need for guidelines to support school staff to provide support around decision making and response to self-harm in the school environment.
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Affiliation(s)
- Ben Te Maro
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Sasha Cuthbert
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Mia Sofo
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Kahn Tasker
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (S.C.); (K.T.)
| | - Linda Bowden
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Liesje Donkin
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
| | - Sarah E. Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; (B.T.M.); (L.B.); (L.D.)
- Orygen The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne 3010, Australia
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O’Dea B, King C, Subotic-Kerry M, Achilles MR, Cockayne N, Christensen H. Smooth Sailing: A Pilot Study of an Online, School-Based, Mental Health Service for Depression and Anxiety. Front Psychiatry 2019; 10:574. [PMID: 31481904 PMCID: PMC6710361 DOI: 10.3389/fpsyt.2019.00574] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Schools play an important role in supporting young people's mental health, but face challenges identifying and responding to students in need of care. To assist secondary schools, the Black Dog Institute has developed an online, school-based, mental health service (Smooth Sailing). Delivered in the classroom, Smooth Sailing uses a website to screen, assess, allocate, and deliver care for depression and anxiety. The service is based on the principles of stepped care, offering treatments with varied intensity and follow-up by a school counselor when necessary. The current study aimed to evaluate the feasibility, acceptability, and safety of this new type of service among secondary school students. Methods: Between February and June 2017, a single-arm, pre-post, pilot study was conducted among students from four NSW secondary schools. Schools were given access to the service for 6 weeks. Feasibility measures (consent rates and step allocations), acceptability measures (service use and satisfaction) and safety measures (deterioration in help-seeking intention scores and mental health symptoms) were assessed at baseline and completion of the 6-week trial period. Results: A total of 59 students took part in the service pilot (mean age, 14.57 years; SD, 0.89 years; range, 13-16 years). At baseline, 18.64% of students were found to require follow-up from the school counselor, and 80% of these were new cases. Although completion of the online modules was low, service satisfaction was high. At 6 weeks, the mean scores for help-seeking, depression, and anxiety remained relatively stable or improved. Conclusions: The current study presents important findings for the development and implementation of an online mental health service that screens students' mental health and allocates care accordingly, all within the school setting. Although the findings provide some support for the feasibility, acceptability, and safety, service improvements are needed. The modifications outlined are likely to improve the quality of the service and its effectiveness. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000977370.
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Affiliation(s)
- Bridianne O’Dea
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Catherine King
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Nicole Cockayne
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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O'Dea B, King C, Subotic-Kerry M, Anderson M, Achilles MR, Parker B, Mackinnon A, Anderson J, Cockayne N, Christensen H. Evaluating a Web-Based Mental Health Service for Secondary School Students in Australia: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12892. [PMID: 31102370 PMCID: PMC6543801 DOI: 10.2196/12892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health problems are prevalent among Australian secondary school youth; however, help-seeking is low. Schools offer an ideal setting to address these concerns. The Black Dog Institute has developed a Web-based mental health service for secondary schools that is modeled on the principles of stepped care. The Smooth Sailing service aims to improve help-seeking and reduce anxiety and depressive symptoms in secondary school students. The acceptability of this service has been demonstrated in a pilot study. A full trial is now warranted. OBJECTIVE This study protocol for a cluster randomized controlled trial (RCT) aims to evaluate the effectiveness of the Smooth Sailing Web-based service for improving help-seeking intentions and behavior, and reducing depressive and anxiety symptoms, alongside other mental health outcomes, when compared with a school-as-usual control condition in secondary school youth. METHODS This RCT aims to recruit 1600 students from 16 secondary schools in regional and urban locations throughout New South Wales, Australia. Schools are randomly assigned to the intervention or school-as-usual control condition at the school level. Approximately 100 students from 1 or multiple grades are recruited from each participating school. Participants complete measures at 3 timepoints: baseline, 6 weeks post, and 12 weeks post, with the primary outcome assessed at 12 weeks posttest. Participants assigned to the intervention condition register to the Web-based service at baseline and receive care in accordance with the service model. Participants in the control condition receive school-as-usual. RESULTS The first baseline assessment occurred on February 22, 2018, with the 12-week endpoint assessments completed on Friday, June 29, 2018. Control schools are currently receiving the service, due for completion by June 30, 2019. The trial results are expected to demonstrate improved help-seeking intentions and behavior among students assigned to the intervention condition, alongside improvements in symptoms of depression, anxiety, distress, and other mental health outcomes when compared with students assigned to the control condition. CONCLUSIONS To our knowledge, this is the first time that a Web-based mental health service based on the principles of stepped care will have been integrated into, and evaluated in, the Australian school context. The findings of this trial will have implications for the suitability of this type of service model in Australian schools and for the delivery of school-based mental health services more broadly. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001539224 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821&isReview=true (Archived by WebCite at http://www.webcitation.org/77N3MDGS6). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12892.
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Affiliation(s)
- Bridianne O'Dea
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Catherine King
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Andrew Mackinnon
- Black Dog Institute, Sydney, Australia.,Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Josey Anderson
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nicole Cockayne
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Subotic-Kerry M, King C, O'Moore K, Achilles M, O'Dea B. General Practitioners' Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery. JMIR Hum Factors 2018; 5:e12. [PMID: 29572203 PMCID: PMC5889492 DOI: 10.2196/humanfactors.8913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/23/2017] [Accepted: 12/31/2017] [Indexed: 12/01/2022] Open
Abstract
Background Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured. Objective This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. Methods GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. Results A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. Conclusions GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured.
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Affiliation(s)
| | - Catherine King
- Black Dog Institute, Randwick, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Bridianne O'Dea
- Black Dog Institute, Randwick, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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