Highlights in child mental health research: September 2024

This month’s highlights include:

The wellbeing needs of Aboriginal and Torres Strait Islander children in out-of-home care in Australia

This systematic review examined the wellbeing needs of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) and the features of care required to improve their wellbeing. The authors found that Aboriginal and Torres Strait Islander children in OOHC have wellbeing needs beyond their need for safety, security and health.

Early childhood education and care services and mental health at school entry

This study examined whether the availability and quality of early childhood education and care services are linked to children’s mental health at school entry in Melbourne. The authors found some evidence that geographic availability of high-quality preschools was associated with improvements in child mental health, but the findings varied dependent on where in Melbourne the children lived.

Non-clinician trauma-based interventions for school-age youth

The authors systematically reviewed evidence from 25 studies for the efficacy of non-clinician delivered trauma-based interventions to improve the mental health of children (aged 4–18 years) who had experienced adverse childhood experiences. Interventions that incorporated elements of Cognitive Behavioural Therapy (e.g. problem-solving, relaxation and breathing, developing a trauma narrative), mindfulness and art-based approaches delivered by non-clinicians emerged as promising interventions for improving the mental health of school-aged children.

The impact of housing insecurity on the health and wellbeing of children and young people

The authors conducted a systematic review of 59 qualitative studies exploring the impacts of housing insecurity on children’s health and wellbeing. They found that children experiencing housing instability often faced significant mental health challenges, including anxiety and depression. Protective effects were sometimes provided by supportive social connections, staying at the same school, having a hopeful mindset and positive parenting practices.

Why is this important?

• Understanding the wellbeing needs of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is important because they are disproportionally represented in OOHC.
• This review paper investigated the wellbeing needs of Aboriginal and Torres Strait Islander children in OOHC and the features of care required to improve their wellbeing.

What did they do?

• The authors systematically reviewed 35 peer-reviewed and grey literature sources that provided insights into the wellbeing needs of Aboriginal and Torres Strait Islander children in OOHC.
• The review included the perspectives of Aboriginal and Torres Strait Islander children in OOHC, Aboriginal and Torres Strait Islander adults with lived experience of OOHC, carers, caseworkers and Aboriginal and Torres Strait Islander community members with relevant lived and/or professional experience with OOHC.

What did they find?

• The authors found that Aboriginal and Torres Strait Islander children in OOHC have wellbeing needs beyond the need for safety, security and health.
• The researchers identified six overarching wellbeing needs of Aboriginal and Torres Strait Islander children in OOHC:
  • ‘being seen, being heard’ (children gain a sense of autonomy and agency when they feel valued and adults listen to them prior to making decisions about their care)
  • a sense of stability (a sense of consistency and belonging linked to a sense of identity, placements that facilitate and maintain key relationships with carers, caseworkers, friends and family, community, Country and culture and access to consistent supports)
  • holistic health support (ongoing support that comprises physical, emotional and social health in addition to fulfilling basic needs)
  • social and cultural connections (the importance of maintaining and building relationships to family, kinship networks, community, Country and culture)
  • culturally safe and supportive OOHC services (including the cultural safety and quality of care provided and support by OOHC organisations trusted by Aboriginal and Torres Strait Islander Peoples)
  • preparation for transitioning out of care (including the need for effective planning, preparation and focus on family reunification and independent living skills for life after OOHC).

What does this mean for practice?

• The unique wellbeing needs of First Nations children affect the way they experience OOHC and impact on their care outcomes.
• Professionals should provide culturally safe and supportive care for Aboriginal and Torres Strait Islander children in OOHC. This includes considering ways to ensure children feel socially and culturally connected to community, Country and culture throughout their care.

Why is this important?

• Living close to quality early education and care services (ECEC) can improve children’s opportunities for participation and some developmental outcomes. However, little is known about the links between the geographic availability of ECEC and early mental health outcomes.
• The study examined whether the availability and quality of local early childhood education and care services are linked to young children’s mental health at school entry.

What did they do?

• The authors used data from the Australian Early Development Census – Built Environment (AEDC–BE) 2015 dataset to analyse linked geospatial and cross-sectional mental health data for all school entrants in Melbourne, Australia. The study also used teacher reports of children’s mental health.
• They linked children’s home addresses to the data on the location and quality of ECEC as assessed by the Australian Children’s Education and Care Quality Authority. Examples of ECEC included preschools, long day care and outside of school hours care.
• They then analysed the cross-sectional associations between the availability of services in different geographical areas and child mental health outcomes.

What did they find?

• Results varied depending on urbanicity (meaning whether children lived in Melbourne’s inner, middle, outer or growth areas).
• The availability of ECEC services varied based on neighbourhood disadvantage and the educational level of mothers. Children living in more disadvantaged neighbourhoods (according to the Australian Bureau of Statistics’ SEIFA Index for Relative Socio-economic Disadvantage) had poorer access to high-quality ECEC and preschool services than their peers in more advantaged neighbourhoods.
• Children with more high-quality preschool services within three kilometres of home had lower odds of developing mental health difficulties and higher odds of demonstrating mental competence.

What does this mean for practice?

• The findings highlight the potential long-term benefits of available and high-quality ECEC services on children’s mental wellbeing. However, more research is needed to understand these links.

Why is this important?

• Exposure to adverse childhood experiences (ACE) can contribute to children developing mental health problems. There is increasing demand for support for children who have experienced ACEs to be delivered within non-clinical settings such as schools (delivered by school staff).
• Trauma-based mental health programs and interventions specifically address ACE-related trauma recovery and mental health improvement.

What did they do?

• The authors systematically reviewed 25 studies from 2013–2023 where the primary recipient of the program or intervention was aged 4–18 years and had experienced one or more ACEs.
• The authors specifically reviewed evidence for the efficacy of non-clinician delivered trauma-based interventions for improving mental health. They included interventions delivered in school, educational, community, residential and care settings.

What did they find?

• The review highlighted the diversity of interventions available to support the children who had experienced ACEs but noted the need for more high-quality research evidence. Only nine out of 25 studies were evaluated as being of strong or moderate quality.
• Interventions that incorporated elements of trauma-focused Cognitive Behavioural Therapy (CBT), but were delivered by non-clinicians, resulted in some improvements in anxiety, depression and post-traumatic stress (PTSD) symptoms in school-aged children. The common elements of successful CBT-based interventions included problem-solving, relaxation and breathing, and developing a trauma narrative (i.e. making meaning of the negative life events).
• Interventions that involved carers in some or all sessions of CBT showed better outcomes for supporting children’s mental health than when carers were not included at all.
• Mindfulness and art-based approaches delivered by non-clinicians also emerged as promising interventions to support the mental health of school students.

What does this mean for practice?

• Interventions that involve non-clinicians (teachers and carers) can be useful in supporting the mental health of children exposed to ACEs in school and educational settings. However, more research and evaluation of interventions, including longer-term follow-up, are needed to grow the evidence base.

Why is this important?

• Exposure to housing insecurity has been shown to negatively impact children and young people’s health and wellbeing. However, the links between housing and children’s health and wellbeing are complex and poorly understood.

What did they do?

• Housing insecurity was defined in this paper as experiencing or being at risk of multiple house moves that are not through choice and are related to poverty.
• The authors conducted a systematic review of 59 qualitative studies exploring the impacts of housing insecurity on children’s health and wellbeing.
• They included studies conducted in the United Kingdom that examined the experiences of children and young people, and those close to them, living in unstable housing conditions.
• Data from these studies were extracted and thematically analysed to identify common themes and insights.

What did they find?

• The various forms of housing insecurity that children and young people experienced included eviction or a forced move, temporary accommodation, exposure to problematic behaviour, overcrowded/poor-condition/unsuitable property, and making multiple moves.
• The authors found that housing insecurity can negatively affect physical health, school performance, psychological health, financial wellbeing and family wellbeing.
• Children experiencing housing instability often faced significant mental health challenges, including anxiety and depression.
• Frequent moves and poor living conditions were linked to physical health issues such as respiratory problems and poor nutrition.
• The lack of stable housing negatively affected children’s educational outcomes, contributing to lower academic performance and school attendance.
• The negative impacts of housing insecurity were lessened by supportive social connections, staying at the same school, having a hopeful mindset and positive parenting practices.

What does this mean for practice?

• Practitioners can be mindful when supporting children and families that frequent moves and poor living conditions can lead to significant mental and physical health challenges for children.
• Supportive social relationships and networks can mitigate some of the adverse effects of housing insecurity for children and young people.