Highlights in Child Mental Health Research: October 2020

Highlights:

• Virtual mental healthcare (VHMC) is the delivery of “telemental health services directly to patients’ homes” (Doan et al., 2020, p. 1). During the COVID-19 pandemic, VMHC has aimed to provide continuation of care for children and families.
• This article discusses the advantages and disadvantages of VMHC services, acknowledging that little evidence or guidelines currently exist for delivery services in this format.
• To address this gap, the authors propose a new framework for delivering virtual mental healthcare to children and families. The framework is based on a combination of research evidence and expert consultations.
• This new framework will support practitioners who deliver VMHC to children and families, offering key factors to consider when optimising service delivery.
• The framework is based on six pillars (see Figure 1 on p. 2):
  • Patient/caregiver environment (i.e. optimising the environment, including the assessment space, availability of support persons, technology and security).
  • Patient/caregiver factors (i.e. considering patient/caregiver factors, such as preference/ability to engage with VMHC and whether VMHC is appropriate for the purpose/goals of care).
  • Provider environment (i.e. ensuring that the providers environment is private and appropriate, including with regards to the workspace, technology and security).
  • Provider factors (e.g. adequate training/skills in VMHC, being open to VMHC).
  • Safety planning (i.e. ensuring safety protocols are in place to address potential patient risks, such child maltreatment, aggression or suicidal risk).
  • Legal/regulatory (i.e. ensuring that legal and professional standards are upheld in relation to the unique context of VMHC, such as consent, privacy and confidentiality).
• Potential advantages of VMHC include reduced time, reduced costs, increased staff efficiency, greater convenience, and an ability to reach families in a variety of settings.
• Potential disadvantages of VMHC include various issues related equity and access. For example, VMHC might not be possible for some families due to housing instability, living in an environment that is unsafe, or not having access to internet/technology.

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Highlights:

• This study used data from the New South Wales Child Population Health Survey (2013-2014) to explore the relationship between healthy lifestyle behaviours and children’s psychological wellbeing.
• 2,665 parents of children aged 5 to 15 years old were asked about their children’s diet, physical activity and screen-time Psychological outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ).
• Healthy lifestyle behaviours were based on the Australian Dietary Guidelines (for diet) and Australia’s Physical Activity and Sedentary Behaviour Guidelines (for physical activity and screen-time).
• Key findings included:
  • Engaging in recommended levels of screen-time was associated with better psychological health and a reduced risk of mental health problems.
  • Excessive screen-time was most strongly associated with poor mental health for children and adolescents (compared to other healthy lifestyle behaviours in the study).
  • Children who ate the recommended intake of fruit and vegetables had significantly better psychological health.
• Overall, children who engaged in healthy lifestyle behaviours (e.g. appropriate levels of screen-time, healthy diets) were more likely to have better psychological wellbeing. This highlights the need for policies and programs that target improvements in children’s diets and appropriate levels of screen-time.
• Through encouraging and supporting families to strive for healthy lifestyle behaviours, practitioners and services providers can promote the mental health and wellbeing of Australian children.

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Highlights:

• The American Academy of Child and Adolescent Psychiatry has produced a new clinical practice guideline (CPG) for assessing and treating children with anxiety disorders, highlighting the current state of evidence.
• This guideline is based on a recent systematic review by the Mayo Clinic Evidence-based Practice Center with the Agency for Healthcare Research and Quality. It provides practitioners with evidence-based guidance on early intervention, diagnosis and treatment of children and young people presenting with symptoms of anxiety.
• The guideline describes diagnostic assessment of anxiety as an essential element of treating anxiety. It provides clinical guidance (including recommended screening instruments and interview schedules) regarding:
  • Identification
  • Mental status examination
  • Psychiatric comorbidities
  • Medical comorbidities
  • Clinical formulation
  • Differential diagnosis
  • Safety and treatment planning.
• Treatment statements based on evidence and best practice are also provided, including regarding the use of various medications. Treatment statements were only developed when there was sufficient evidence to support a recommendation.
• Lastly, the guidelines emphasise the importance of accurate assessment and diagnosis of anxiety disorders to achieve effective treatment.

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Highlights:

• This review investigated the “effect of exposure to domestic violence (DV) on internalising symptoms” (such as anxiety, depression, emotional control) in children and adolescents (Carter et al., 2020, p. 1).
• The researchers also explored additional factors that might influence this effect (i.e. mediators and modifiers). That is, factors that might influence the likelihood of a child experiencing internalising problems following DV. Factors could be related to the individual, the family, or the community.
• Data from 12 studies conducted in the United States were analysed.
• All included studies focused on primary school-aged children (age 5-11 years), with four additional studies including adolescents (age 12-18 years).
• The review identified multiple factors that increased a child’s risk of internalising problems after exposure to DV. These included:
  • low levels of social support for the family
  • emotional dysregulation in the child (e.g. difficulties with regulating emotions, reduced awareness of one’s own emotions)
  • negative parenting behaviours (e.g. harsh parenting, poor child-parent communication)
  • parenting stress (e.g. stress related to fulfilling their role as a parent).
• Children’s emotional intelligence was found to be a protective (mediating) factor that influenced the relationship between exposure to DV and internalising problems. This refers to a child’s ability to identify, manage, and regulate their emotions.
• These findings have implications for practitioners who support children or families exposed to domestic violence. Examples include:
  • Providing interventions that target children’s emotional awareness and regulation may act as a buffer to help protect children from developing internalising problems
  • Supporting parents/caregivers to increase positive parenting behaviours and refrain from negative parenting behaviours (e.g. harsh discipline) can promote child wellbeing
  • Encouraging children to participate in extracurricular activities, such as groups or classes, can be a protective factor.

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Highlights:

• This study explored the impact of prolonged grief disorders in refugees on parenting behaviours and, in turn, child mental health.
• Prolonged grief disorder was defined as “persistent yearning for the deceased together with associated emotional pain, difficulty in accepting the death, a sense of meaningless, bitterness about the death, and difficulty engaging in new activities” (Bryant et al., 2020, p.2)
• 178 children and 110 parents from the Building a New Life in Australia (BNLA) study participated (BNLA is a nationally representative cohort study of refugees resettled in Australia). All families included in the analysis had experienced bereavement (i.e. the death of someone close to them).
• The psychological wellbeing of children was assessed using the Strengths and Difficulties Questionnaire. Adults were assessed for trauma history, post-migration difficulties, parenting style, and grief and post-traumatic stress disorders.
• Key findings included:
  • Approximately one-third (37%) of parents/caregivers reported having probable prolonged grief disorder.
  • Prolonged grief disorder in parents/caregivers was associated with emotional difficulties in their children. Prolonged grief disorder may impact on children through a variety of mechanisms, including a parent’s mood, social withdrawal and shifts in focus from family functioning to the deceased person.
  • Harsher parenting (e.g. negativity, discipline that is physical, rigidly enforcing rules) was associated with greater problems in child wellbeing, particularly behavioural problems.
• These findings will be of interest to practitioners who support families from a refugee background who have experienced bereavement. In particular, they highlight the importance of identifying and supporting parental mental health (including grief reactions), as this can also have positive flow-on effects for children’s wellbeing.

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