Highlights in child mental health research: March 2023

This month’s highlights include:

• Children with intellectual and developmental disabilities in out of home care

Children with intellectual and developmental disabilities are more likely to experience maltreatment, and to be placed in out of home care (OOHC). It is likely that foster carers and biological parents are not well supported (through resources or training) to adequately provide care and meet the needs of children with intellectual and developmental disabilities.

• Healthcare utilisation of young people with a history of self-harm or suicidality

This study highlighted an underutilisation of mental health services by young people who had experienced self-harm or suicidality in the past year. Less than 1 in 3 young people (aged 12-17 years) had accessed subsidised mental health services.

• Effectiveness of a preschool emotional education program

This study found that pre-schoolers (2-5 years) who participated in an emotional education programme in Spain had significantly greater increases in emotional competence scores following the program’s completion than those who did not participate. Length in program and level of engagement further increased emotional competence scores.

• Health and wellbeing of children who experienced immigration detention

This study analysed medical records from the Royal Children’s Hospital Immigration Health Service and demographic data on 277 children who had experiences with Australian locked immigration detention. The study explored various mental health, wellbeing, and developmental outcomes. The findings indicated that 62% of children had a mental health diagnosis and 75% had a developmental concern.

Why is this important?               

• Children with intellectual and developmental disabilities (IDD) are over-represented in child protection and out-of-home care (OOHC), but research on their experience is limited.
• This study aimed to review the available literature on children with IDD in OOHC to identify trend, gaps, and future research directions.

What did they do?

• The review analysed 18 studies published between 2010-2021. Studies were mostly from the USA, UK, and the Netherlands, with a small number from Canada, Spain, Israel, and India.

What did they find?

• Compared to children with no disabilities, children with IDD are more likely to experience maltreatment and have greater risk of entering OOHC. Children with IDD are also more likely to be voluntarily placed in OOHC by their birth parents.
• Children with IDD also have poorer outcomes whilst in care, compared to children with no disabilities. For example, they are more likely to be placed in institutional or residential care than home-based care, more likely to experience frequent placement change, and less likely to achieve reunification with birth families.

What does this mean for practice?  

• Parents and carers of children with IDD often experience financial strain and challenges accessing appropriate healthcare for their children’s complex needs.
• Greater support for families caring for children with IDD may reduce the risk of maltreatment, child protection involvement and OOHC placement.
• Foster carers are often inadequately supported to care for children with complex needs. Therefore, greater support, training, and resources should also be provided to carers of children with complex needs, including IDD, in OOHC.

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Why is this important?

• This study aimed to better understand how young people with experiences of self-harm and/or suicidal behaviours in Australia are using healthcare services.

What did they do?

• This study linked data from Young Minds Matter (Australian Child and Adolescent Survey of Mental Health and Wellbeing) and Australia’s Medicare Benefits Scheme (MBS).
• The MBS and PBS health service use of 311 young people (aged 12-17 years) with any experience of self-harm or suicidality was analysed.

What did they find?

• More than75% of young people who had self-harmed or experienced suicidality (in the last 12 months) had accessed a GP in the last 12 months.
• Of those who had self-harmed or experienced suicidality (in the last 12 months), 25% had accessed mental health treatment from a GP, 15% from a psychologist, and 5% from a psychiatrist.
• Accessing  MBS-funded mental health treatment was highest in those who had a previous suicide attempt (38.4%), but considerably lower for those with suicidal ideation (28.7-29.4%) and those who self-harmed (29.4%).

What does this mean for practice?  

• The findings suggest an underutilisation of MH services by young people who require support. Young people infrequently access psychologists and psychiatrists in the year prior to experiencing self-harm and suicidality.
• There is a need for more early intervention and outreach support for young people, to provide mental health support prior to crisis.
•  Young people frequently access GP services in the year prior to self-harm and/or suicide attempt. GPs should assess for self-harm and suicidality in young people and ensure young people are supported.

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Why is this important? 

• Early intervention education programs for pre-schoolers could prevent social or emotional, and/or behavioural challenges.
• This study evaluated the effectiveness and implementation of an emotional education program for pre-school children.

What did they do?

• The sample included 1,586 pre-school children (aged 2-5 years) in Spain.
• The study analysed pre- and post- intervention measures for emotional competence (as assessed by teachers) across three groups: (1) children who participated in the program for three years of preschool, (2) children who participated for one year, and (3) children who did not participate.

What did they find?

• All children experienced significant increases in teacher-reported emotional competence, including those who did not participate in the program.
• Those who participated in the program experienced significant improvements over those who did not.
• Greater improvements were seen for those who participated for the complete three years of the program.
• Higher post-intervention emotional competence scores were also found in children who engaged with the program more extensively (e.g., completing more classroom activities for each unit, and engaging with family activities relating to the program).

What does this mean for practice?  

• The implementation of emotional programs for pre-school aged children hold promise, in particular, programs which build emotional awareness, regulation, positive coping strategies, problem solving, and/or interpersonal skills.

Read the full abstract

Why is this important? 

• Between 2012 and 2018 asylum seeker children who came to Australia by boat were held in Australian Immigration Detention Centres (IDCs), and offshore Regional Processing Centres (RPCs) on Nauru and Manus Island, Papua New Guinea.
• Concerns for the health and wellbeing of children in immigration detention were raised within Australia and internationally during this time. This study aimed to better understand the physical and mental health impacts of Australian immigration detention on children and families.

What did they do?

• The study used a retrospective cohort design to analyse the records of children who had attended the Royal Children’s Hospital (RCH) Immigrant Health Service (IHS) between 2012 and 2021.
• 277 children had direct or indirect (parents were detained) experience of immigration detention in Australian IDCs (including Christmas Island) or RPCs (on Nauru or Manus Island). 239 children experienced detention directly (were detained themselves), including 47 who were held in RPCs.

What did they find?

• Prior to their journey to Australia and detention, 62% of children had experienced a traumatic event including the death of family member and war-related conflict.
• The median age of children when placed in detention was 5 years. At their time of release most children had spent almost a quarter (21%) of their lives in detention. 
• During their time in detention, children were frequently separated from their parents and witnessed self-harm and violence. Eight per cent of children were referred for sexual assault concerns whilst in detention.
• Health screening revealed health and wellbeing concerns were common: 60% of children had a nutritional deficiency (commonly vitamin D deficiency), 28% had an infectious disease (commonly latent tuberculosis) and 75% had a developmental concern.
• Mental health issues were common with 62% of children having a mental health diagnosis, including PTSD (30%), anxiety (44%), depression (32%) and attachment disorders (25%).
• Mental health issues were significantly higher for children who had been in offshore RPCs compared to children held in Australian IDCs: 82% of children in offshore RPCs had a mental health issue. Half of these children had PTSD (49%), depression (54%), or attachment disorders (48%). The increased risk for mental health challenges in these children may reflect longer durations of detention, and poor conditions in RPCs.

What does this mean for practice?  

• Evidence from this study is consistent with previous studies that highlight the severe negative health and mental health impacts of detention on children. 
• Asylum seeker children and families often have complex mental health challenges that are compounded by time in immigration detention. Despite this, the findings suggest a lack of screening and health supports in immigration detention facilities.
• Children and families with histories of immigration detention should be provided with additional screening, assessment and support for health and wellbeing concerns.

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