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Hickey L, Harms L, Evans J, Noakes T, Lee H, McSwan A, Bean H, Hope J, Allison L, Price S, Harris N. Review: Improving access to mental health interventions for children from birth to five years: A Scoping Review. Child Adolesc Ment Health 2024; 29:84-95. [PMID: 37137699 DOI: 10.1111/camh.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND In spite of infants and children aged 0-5 years experiencing mental health difficulties being estimated to be in the range of 6%-18% globally, the mental health care needs for this age group are often overlooked in the design of specialist mental health services. Although there is increasing recognition of the importance of infant mental health services and treatments for younger children, access remains a barrier. Mental health services specifically designed for children 0-5 years are vital; however, little is known about how these services ensure access for infants at risk of mental health difficulties and their families. This scoping review seeks to address this knowledge gap. METHODS A scoping review methodology framework was used to search for relevant articles published between January 2000 and July 2021, identified using five databases: MEDLINE, CINAHL, PsycINFO, SocIndex and Web of Science. The selection of studies was based on empirical research about access to infant mental health services and models of care. A total of 28 relevant articles met the eligibility criteria for inclusion in this review. RESULTS Findings can be summarised under five broad themes: (1) accessibility for at-risk populations (2) the importance of early detection of infants in need of mental health services and interventions; (3) the promotion of culturally responsive services and interventions; (4) ensuring the sustainability of IMH services and programs and (5) the integration of innovative interventions to improve existing practice models. CONCLUSIONS The findings from this scoping review highlight barriers to access and provision of infant mental health services. Future infant mental health service design, informed by research, is needed to improve access for infants and young children with mental health difficulties and their families.
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Affiliation(s)
- Lyndal Hickey
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - Louise Harms
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - Jackson Evans
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - Tahnee Noakes
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - Henrietta Lee
- Department of Social Work, The University of Melbourne, Melbourne, Vic., Australia
| | - Amity McSwan
- Child and Youth Mental Health Service, Eastern Health, Box Hill, Vic., Australia
| | - Helena Bean
- Child and Youth Mental Health Service, Eastern Health, Box Hill, Vic., Australia
| | - Judith Hope
- Eastern Health Clinical School, Monash University, Box Hill, Vic., Australia
- Mental Health Program, Eastern Health, Box Hill, Vic., Australia
- Centre for Mental Health Education and Research, Delmont Private Hospital, Glen Iris, Vic., Australia
| | - Lynne Allison
- Child and Youth Mental Health Service, Eastern Health, Box Hill, Vic., Australia
- Perinatal Emotional Health Service, Eastern Health, Box Hill, Vic., Australia
| | - Sophie Price
- Child and Youth Mental Health Service, Eastern Health, Box Hill, Vic., Australia
| | - Nicole Harris
- Child and Youth Mental Health Service, Eastern Health, Box Hill, Vic., Australia
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Charpentier Mora S, Bastianoni C, Koren-Karie N, Cavanna D, Tironi M, Bizzi F. Parental Mentalizing during Middle Childhood: How Is the Adoption of a Reflective Stance Associated with Child's Psychological Outcomes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106205. [PMID: 35627742 PMCID: PMC9140343 DOI: 10.3390/ijerph19106205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
This exploratory cross-sectional study attempts to understand the mechanisms underlying the role of parental mentalizing in a child's psychological functioning during middle childhood by using Parental Reflective Functioning (PRF) and Parental Insightfulness (PI) constructs. The main aims are to examine the role of PI and PRF as processes capable of influencing a child's psychological functioning in terms of emotional-behavioral difficulties and social-emotional competencies. Eighty-six community parents (48 mothers, 38 fathers) and their 50 children in middle childhood (Mage = 10.10, SD = 1.13) participated in this study, recruited through a non-probabilistic sampling. The following measures were used to assess the aims of this study: Insightfulness Assessment, Parental Reflective Functioning Questionnaire, Child Behavior Checklist (CBCL) and Devereux Student Strengths Assessment (DESSA) questionnaires. Results showed that parental mentalizing was found to be significantly associated with both child's internalizing and externalizing symptoms and social-emotional competencies as reported by parents through the CBCL and DESSA questionnaires. This study may offer a contribution to the study of parental mentalizing during middle childhood, supporting the hypothesis that both parents' ability to understand their child's mental states could affect the child's psychological functioning. Clinical and theoretical implications are geared toward a family-based view with a specific focus on the importance of fostering in both parents a positive attitude toward mentalizing processes.
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Affiliation(s)
- Simone Charpentier Mora
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Chiara Bastianoni
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Nina Koren-Karie
- The Center for the Study of Child Development, School of Social Work, University of Haifa, Haifa 3498838, Israel;
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Marta Tironi
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
- Correspondence:
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Leyton F, Olhaberry M, Morán J, De la Cerda C, León MJ, Sieverson C, Alfaro Á, Hernández C, Alvardo R, Steele H. Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial. Trials 2021; 22:754. [PMID: 34717750 PMCID: PMC8557018 DOI: 10.1186/s13063-021-05668-w] [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] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). METHODS The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. RESULTS Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes. CONCLUSIONS VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT. TRIAL REGISTRATION ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.
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Affiliation(s)
- Fanny Leyton
- Escuela de Psicología, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile.
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile.
| | - Marcia Olhaberry
- Escuela de Psicología, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile
- Programa Salud Mental Perinatal, Red de Salud UC Christus, Santiago, Chile
| | - Javier Morán
- Escuela de Psicología, Universidad de Valparaíso, Valparaíso, Chile
| | - Cecilia De la Cerda
- Departamento de Psicología de la Facultad de Ciencias Sociales de la Universidad de Playa Ancha, Valparaíso, Chile
| | - María José León
- Milenium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Catalina Sieverson
- Programa Salud Mental Perinatal, Red de Salud UC Christus, Santiago, Chile
| | - Ángela Alfaro
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile
| | - Camila Hernández
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Subida Leopoldo Carvallo, 200, Valparaíso, Chile
| | - Rubén Alvardo
- Program of Mental Health, School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Howard Steele
- Center for Attachment Research, Psychology Department, New School for Social Research, New York, USA
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Bustamante Loyola J, Perez Retamal M, Morgues Nudman MI, Maturana A, Salinas Gonzalez R, Cox H, González Mas JM, Muñoz L, Lopez L, Mendiburo-Seguel A, Simó S, Palau Subiela P, Guedeney A. Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17943. [PMID: 32589156 PMCID: PMC7394375 DOI: 10.2196/17943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised. Results Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID) DERR1-10.2196/17943
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Affiliation(s)
- Jorge Bustamante Loyola
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile.,Doctoral Programme in Clinical and Health Psychology, Universitat de Valencia, Valencia, Spain.,Spain Association for Infant Mental Health Since Gestation, Valencia, Spain.,Neonatology Unit, Hospital San Jose, Santiago, Chile
| | | | | | - Andres Maturana
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile.,Faculty Development Office, Universidad del Desarrollo, Santiago, Chile
| | | | - Horacio Cox
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Lucia Muñoz
- Neonatology Unit, Hospital San Jose, Santiago, Chile
| | - Lilian Lopez
- Neonatology Unit, Hospital San Jose, Santiago, Chile
| | | | - Sandra Simó
- Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | | | - Antoine Guedeney
- Hospital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris 7, Paris, France
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The Primary Care-Video Intervention Therapy for Growth-Vulnerable Infants. A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051796. [PMID: 32164247 PMCID: PMC7084751 DOI: 10.3390/ijerph17051796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
Perinatal growth vulnerability (e.g., Small for Gestational Age, SGA) poses the goal to not overlook subtle developmental susceptibilities and their impact on the parent–infant relationship. In this case study, we examined the application of a video-feedback intervention program to support parenting, the Primary Care-Video Intervention Therapy (PC-VIT), specifically developed to fit pediatric care characteristics. The case presentation details the principal steps of the intervention with the family of an SGA infant from birth up to toddlerhood. Findings for this family highlighted initial worries about the infant’s growth. Along sessions, PC-VIT held maternal anxiety and sustained parents’ abilities to recognize and talk about the infant’s developmental skills and regulatory abilities. The PC-VIT shows the powerful opportunity to limit the impact of infant growth vulnerability on the parent–child relationship and socio-emotional development. Pediatricians can prevent vulnerable developmental milestones from clinical outcomes by implementing timely and effective strategies embracing mental health and parenting-related issues.
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Leyton F, Olhaberry M, Alvarado R, Rojas G, Dueñas LA, Downing G, Steele H. Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial. Trials 2019; 20:268. [PMID: 31088531 PMCID: PMC6515604 DOI: 10.1186/s13063-019-3310-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service. Methods This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed. Discussion This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial. Trial registration ClinicalTrials.gov, NCT03374904. Registered on 14 December 2017 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s13063-019-3310-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fanny Leyton
- School of Psychology, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile. .,Department of Paediatrics. Faculty of Medicine, Universidad de Valparaíso. Subida Leopoldo Carvallo 200. Hospital Psiquiátrico del Salvador, Valparaíso, Chile.
| | - Marcia Olhaberry
- School of Psychology, Pontificia Universidad Católica, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Rubén Alvarado
- Institut of Health Sciences, Universidad de O'Higgins, Rancagua, Chile.,Unit of Mental Health, School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Graciela Rojas
- Departamento de Psiquiatría y Salud Mental, Clínica Psiquiátrica Universitaria, Universidad de Chile, Santiago, Chile
| | - Luis Alberto Dueñas
- Department of Paediatrics. Faculty of Medicine, Universidad de Valparaíso. Subida Leopoldo Carvallo 200. Hospital Psiquiátrico del Salvador, Valparaíso, Chile
| | | | - Howard Steele
- Psychology Department, New School for Social Research, New York, USA
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