Addressing Gaps in Pediatric Mental Healthcare by Removing Barriers: A School‐Based Integrated Model for Group Art Therapy

Background: Group programmes are a common component of treatment in inpatient child and adolescent mental health service (CAMHS) units. There is evidence for specific group interventions, however, comparison across a multidisciplinary group programme is under-explored. Aims: This research examines young people's experiences of, and satisfaction with, a multidisciplinary group programme on an acute inpatient CAMHS unit. Methods: Weekly surveys were distributed to young people, and 37 responses were gathered across four months in 2018. Rates of attendance, enjoyment and perceived helpfulness of groups were calculated. Content analysis was used to explore key themes in qualitative responses. Results: Young people rated a creative activities and games group (54.05%) and the art therapy group (48.95%) as the two most enjoyable groups. Art therapy was reported to be the most helpful group overall (45.65%). Young people also expressed their dislike for verbal psychotherapy groups (43.24%), finding these confronting relative to other modalities in the programme. Conclusions: Art therapy and arts-based groups received the highest positive feedback relative to predominantly verbal psychotherapy groups. A multidisciplinary group programme which integrates art therapy and other creative modalities has the potential to enhance engagement in acute inpatient settings which may result in improved mental health outcomes for young people. Implications for future research and practice: Future research should aim to foreground young people's perspectives and experiences of therapeutic programmes, and provide opportunities for clinicians to redevelop programmes responsively to service user feedback. Survey findings support advocacy for consistent art therapy roles and services within inpatient CAMHS units.

BackgroundThe aim of the study was to evaluate the feasibility of the Strengths and Difficulties Questionnaire (SDQ).MethodFollowing the administration of the SDQ in medical check-ups of 4–9 year-old children (n = 2 682) the involved parents, teachers and public health nurses were asked to complete a feedback questionnaire of the SDQ.ResultsParents took a maximum of 10–15 minutes to complete the SDQ, and only the public health nurses reported that its use was rather burdensome. The SDQ was an age-appropriate method and it was helpful in increasing information and agreement about the child's mental health and need for support. Using the SDQ was a positive experience for parents, but they expected more dialogue with the professionals about the child's situation. The respondents criticised the questionnaire somewhat for being difficult to interpret and complete.ConclusionsThe SDQ was found to be a feasible method for screening children's mental health in primary health care together with parents, teachers and public health nurses. Using the SDQ was a positive experience for parents. However, they reminded the professionals of the importance of sensitive dialogue when assessing the mental health of the child.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Supporting youth mental health during the COVID-19 pandemic.

BackgroundThe positive effect of physical activity (PA) on mental health in adults is well-established, but less is known about this relationship in young children. The aim is to explore the...

BackgroundChild and adolescent mental health problems are urgent health issues in low- and middle-income countries. To promote child and adolescent mental health services, simple validated screening tools are helpful. In Mongolia, the Strengths and Difficulties Questionnaire (SDQ), an internationally used child and adolescent mental health screening tool for children aged 4–17, was translated but not yet validated. To use the questionnaire appropriately, validation is necessary.MethodsChildren at 4th year at elementary school (community sample) and children visited psychiatric outpatient service (clinical sample) were recruited and their parental version of the SDQ was compared. The discriminating ability of the parental version of the SDQ was examined using Receiver Operating Characteristics (ROC) analysis on the SDQ total difficulties score. The area under the ROC curve (AUC) was used as a measure. Cut-off score was determined by normative banding that categorizes children with the highest 10% score range as abnormal and the second highest 10% as borderline following the original method; this cut-off score was compared with the cut-off score candidates with good balance between sensitivity and specificity using ROC analysis.ResultsWe included 2301 children in the community sample, and 429 children in the clinical sample. Mean age was 9.7 years (SD 0.4, range 8.3–12.0) among the community sample and 10.4 years (SD 3.8, range 4.0–17.8) among the clinical sample. The mean total difficulties score was 12.9 (SD 4.8) among the community sample and 20.4 (SD 6.2) among the clinical sample. A total of 88.8% of the community sample and 98.8% of the clinical sample answered the SDQ. Using ROC analysis, the AUC was 0.82 (95% confident interval 0.80–0.85), which meant moderate discriminating ability. Using normative banding, the borderline cut-off score was 16/17 and abnormal cut-off score was 19/20. For cut-off scores of 16/17 and 19/20, sensitivity was 71.9 and 53.8% and specificity was 78.5 and 90.5%, respectively. The cut-off score candidates by ROC analysis were 16/17 and 17/18.ConclusionsThe parental version of the SDQ had moderate discriminating ability among Mongolian school-age children. For the screening of mental health problems among community children, cut-off score of 16/17 is recommended.

AimsChildren in Care (CIC) have a higher prevalence of emotional, behavioural and mental health diagnoses. The Department of Health UK guidance requires annual screening assessment of these children using the...

BackgroundPrevious research has documented mental health status among rural-to-urban migrant children (labeled as “migrant children” henceforth) and urban children. However, the findings remain unclear. In addition, far less attention has been paid to rural children’s psychological outcomes. The purpose of this study was to compare mental health status among migrant, urban and rural school-age children in Guangdong Province, China.MethodsThis was a cross-sectional study involving 372 migrant, 254 urban and 268 rural children selected respectively from 3 private schools, 4 public schools and 2 village schools in Guangdong Province, China. Participants provided their socio-demographic information and completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health. One-way analyses of variance (ANOVAs) and Bonferroni post hoc test were used to evaluate SDQ scores differences. A multiple linear regression analysis was conducted to measure mental health differences among children after controlling for socio-demographics. Chi-square analyses were used to assess differences in the prevalence of mental health problems among children.ResultsBonferroni post hoc test showed that migrant and rural children reported significantly higher scores than urban peers in emotional symptoms, hyperactivity/inattention and total difficulties score (p < 0.01). In addition, migrant children reported a higher peer problems score compared to urban children (p < 0.001). In multiple linear regression analysis, rural and migrant children reported significantly a higher total difficulties score than urban children (p = 0.046 and 0.024, respectively). Additionally, female gender, having insurance, seldom communicating with parents, and higher monthly household income were negatively associated with a higher total difficulties score. Conversely, children’s father with secondary education was positively associated with a higher total difficulties score. The prevalence of mental health problems among rural, migrant and urban children were 26.5, 18.8 and 15.0% (χ2 = 11.41, p = 0.003), respectively.ConclusionsRural and migrant children reported poorer mental health than urban children. Female gender, having insurance, seldom communicating with parents, and higher monthly household income were associated with better mental health of children. However, children’s father with secondary education was associated with poorer mental health of children. Given the different effects of socio-demographics, further support might be provided accordingly to improve the mental health of school-age children.

Background Research on social isolation in refugee youth is important because it affects their sense of belonging, mental health and wellbeing; integration and acculturation into a new country; education; and future employment opportunities. There is limited art therapy research in Australia in this area, leaving a compelling gap in understanding the effectiveness of collaborative and side-by-side artmaking in group art therapy to connect refugee youth with their peers. Aims This study aimed to explore whether collaborative and side-by-side artmaking in group art therapy would connect youth more effectively; alleviate their social isolation from trauma, displacement and re-settlement experiences; provide a safe environment and platform to express themselves; and improve their mental health and wellbeing. Methods The triangular mixed-methods approach used standardised scales and semi-structured interviews to gather information from youth, teachers and art therapists. Mixed-method data analysis was applied using the Reliable Change Index, line graphs, descriptive statistics, and thematic analysis. Results Refugee youths’ self-esteem and confidence seemed to increase through collaborative and side-by-side artmaking. Results highlighted the importance of social connection, self-esteem, confidence and a sense of safety for making positive connections during artmaking. Conclusions Findings indicate potential benefits of opportunities for refugee youth to connect with their peers in the school environment and of group art therapy. Implications for practice and future research Opportunities could be achieved through collaborative and side-by-side artmaking in group art therapy. A larger study, longer programme and mixed populations in the school setting are recommended for future research. Plain-language summary The research aimed to examine if there was an effect of a six-week art therapy programme on social isolation for five 14–15-year-old female refugee youth. This research is important because social isolation affects youth’s mental health and wellbeing. Through creating art individually and next to each other (side-by-side artmaking), and creating artworks together (collaborative artmaking), the programme aimed to reduce social isolation and increase connections between youth during the sessions and in the school environment. The research was conducted in an early intervention creative therapies service onsite at a Queensland English-language transition secondary school. The service is provided by accredited art therapists and uses creative methods to support culturally diverse refugee youth in resettling, learning and recovering from trauma and stress. During the research, youth participants engaged in art activities, such as drawing and painting, while listening to music. Interventions were designed to establish group bonds, build self-esteem and resilience, and empower youth in a safe and supportive environment. Art therapists and teachers observed youth during the research period, completed standardised scales before and after the programme and participated in semi-structured interviews. The youth participants also completed standardised scales and were interviewed before and after the programme. The results showed that after the six-week programme, youths’ wellbeing and connections to each other increased. Three central themes were identified: (1) social connection is important within the school environment; (2) self-esteem and confidence are related to connecting to others and social isolation; and (3) there is a sense of safety in artmaking individually and collaboratively with peers. The study found that the art therapy programme positively affected youth mental health and wellbeing. This suggests the programme effectively reduced participants’ social isolation, potentially offering positive opportunities to connect other youth at risk of social isolation.

Integrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care. To explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care. This cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients' parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021. GPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control). Primary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period. Overall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients' mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, -1.07 to 2.22] and -0.08 [95%CI, -1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (-3.6 points; 95% CI, -6.7 to -0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs. In this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children's access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes. ClinicalTrials.gov Identifier: NCT03144739.

Quality of life mapping methods such as "Transfer to Utility" can be used to translate scores on disease-specific measures to utility values, when traditional utility measurement methods (e.g. standard gamble, time trade-off, preference-based multi-attribute instruments) have not been used. The aim of this study was to generate preliminary ordinary least squares (OLS) regression-based algorithms to transform scores from the Strengths and Difficulties Questionnaires (SDQ), a widely used measure of mental health in children and adolescents, to utility values obtained using the preference-based Child Health Utility (CHU9D) instrument. Two hundred caregivers of children receiving community mental health services completed the SDQ and CHU9D during a telephone interview. Two OLS regressions were run with the CHU9D utility value as the dependent variable and SDQ subscales as predictors. Resulting algorithms were validated by comparing predicted and observed group mean utility values in randomly selected subsamples. Preliminary validation was obtained for two algorithms, utilising five and three subscales of the SDQ, respectively. Root mean square error values (.124) for both models suggested poor fit at an individual level, but both algorithms performed well in predicting mean group observed utility values. This research generated algorithms for translating SDQ scores to utility values and providing researchers with an additional tool for conducting health economic evaluations with child and adolescent mental health data.

Background Sri Lankan government had a war against terrorism for thirty years in North and East of Sri Lanka. There were villages in the North-East border that the LTTE held territory and the community living in those villages faced frequent attacks during those three decades. The present study was conducted to compare the mental health of children in a war affected border village, with the mental health of same aged children from a village not directly affected by the war. Methods Grade 8 and 9 students (n=148) from a government school were selected as subjects and a self-administered questionnaire and the validated Sinhalese version of the Strengths and Difficulties Questionnaire (SDQ) were completed. Age matched 138 students were selected as the comparison group, from an area which is socioeconomically similar but not affected by the war as a border village. Same questionnaires were completed by the comparison group. Results Subject group consisted of 76 (51%) males and 72 (49%) females. Age ranged from 12-16 years (median 14, IQR 13-14). Majority (n=85, 57.0%) of children living in the border village experienced some kind of an extremely terrifying incident related to the war. Nearly one fifth (n=26, 17.6%) living in the border village, had lost at least one immediate family member due to terrorist attacks. Majority of the border village children (n=94, 63.5%) believed that the war produced a significant negative impact on their lives. Children living in the border village showed 2.5 fold excess risk for a mental health problem (OR 2.5, 95% CI 1.4 to 4.5. Living in a border village carried 3 times excess risk for conduct problems (OR 3.1, 95% CI 1.6 to 6.0). Children living in the border village showed 2 fold excess risk for peer relationship problems (OR 1.9, 95% CI 1.1 to 3.2). Living in a border village carried 2 fold excess risk for hyperactivity/inattention problems (OR 2.3, 95% CI 1.2 to 4.2). Conclusions Majority of the children living in border village reported different exposures related to the civil war that can cause considerable and long-lasting psychological impact. Children from the border village had a significantly higher risk of showing borderline abnormal values on the SDQ, compared to children not from a border village. It is probable that this is due to the effect of war and its impact on the mental health of the children of the border village.

Background: Early recognition of children's mental health problems calls for structured methods in front line services. The Strengths and Difficulties Questionnaire (SDQ) is a commonly used short questionnaire in screening child's mental difficulties. Aim: To test the reliability and descriptive properties of the SDQ in a community sample of Finnish 4–9-year-old children (n = 4178). Methods: Both parents, two teachers in day-care or a teacher at school completed the SDQ. To control for possible bias, public health nurses rated their concern about every child's mental health, including non-participants. Results: The internal consistencies of the SDQ total score in all informants’ reports were satisfactory to good. Agreement (Spearman rho) in total scores between parents was 0.65, between parent and teacher 0.43 and between two teachers in day-care 0.81. The stability in parent's reports over 12 weeks was good. The distributions of the informant-rated scores indicated significant and clinically important gender differences, and the 80th and 90th percentiles were generally below the international cut-off points. Public health nurses reported emotional or behavioural difficulties more commonly in non-participants (12%) than in participants (7%; p < 0.001). Conclusions: The results supported earlier findings of good internal consistency, inter-rater and cross-informant agreements and test–retest of the method. However, the gender and age of the child, the number of informants and cultural differences in reporting styles affected the results and thus confirmed the need to re-evaluate the SDQ in the culture and population in question.

Background: Creating ‘art-alongside’ in peer art therapy groups: connection, trust, and power dynamics. Practice Contexts: Online, private practice; peer-focused PATh group and PATh group with people within the LGBTQA + community. Face-to-face, non-government organisation; art therapy groups with people living with cancer. Approach: Peer art therapists enter therapeutic spaces alongside their own Lived Experience of mental-health challenges. In PATh, art therapists create art-alongside participants in group art therapy. Outcomes: Through creating art-alongside peer art therapists can demonstrate embodied understanding of and modelling of surviving mental ill-health experiences as well as deliver authentic empathy for participants with current struggles. Art-alongside can be a mutually-connecting, co-learning, beneficial practice for participants and therapist. Creating art-alongside in PATh groups can create safer spaces for participants and provide grounded therapist-as-peer role modelling. Conclusions: Creating art-alongside participants in PATh applies peer-work and art therapy understandings and skills. It dismantles therapist/participant power locations of traditional art therapy and can be a process of mutuality and connection for participants and therapist. Implications for Research: Co-produced research with participants and therapists on the experience of art-alongside in PATh groups and co-produced research across ‘companion art’, ‘reflection-art’ and art-alongside in PATh, evidencing the impact of therapist-articulated Lived Experience. In addition, research is needed into the inclusion of an art-alongside PATh model in art therapy training. Plain-language summary Peer Art Therapy (PATh) is the framework used for practitioners who are trained and experienced in both art therapy and mental health peer work. Peer work is the practice of using our own Lived Experiences to support someone also living with similar ones and being equals within our spaces. In our context we specifically mean ‘experiences of mental health issues’. It combines the theories, skills, tasks and practices of both fields to work alongside and responsively to clients. Peer art therapists – the authors included – share with clients, aspects of their own personal experiences of living with mental health challenges. In this article, we talk about the practical application of this approach and how peer art therapists create ‘art-alongside’ the participants in their groups. This practice can benefit both the participants and therapists and creates strong connected relationships where both are learning. Our article discusses the concepts and theories of this approach and the positive responses it creates, including: building safer spaces, peer/role modelling, increased empathy for and understanding and survival of complex mental health challenges. The authors use personal examples of art created alongside from our clinical settings – online peer-focussed peer art therapy group and peer art therapy group with LGBTIQA + clients and art therapy groups in a non-government organisation, with people living with cancer. Our work also dismantles the need for therapist as expert in the practice of art therapy. We recommend a number of areas for future research about the value of peer art therapists making art alongside clients - research that includes both clients and therapists.