Abstract
BackgroundDespite the well-established link between childhood adversity and mental health problems, there is a dearth of evidence to inform decision making about the most acceptable and feasible interventions for preventing mental health problems for children experiencing adversity. Expert consensus is an important input into evidence-informed policy and practice but is often employed at the national level which misses important local contextual factors shaping decision making. This study aimed to: (1) reach consensus on local priority interventions for preventing mental health problems for children living with adversity in Wyndham, Victoria; and (2) understand the enabling factors and barriers to implementing these interventions.MethodsThis study employed six online modified nominal group technique (NGT) workshops with 19 stakeholders; intersectoral service providers from health, social and education sectors and caregivers of children aged 0–8 years.ResultsThree interventions reached consensus among the mixed stakeholder groups as being a high or very high priority for implementation in Wyndham: nurse home visiting, parenting programs and community-wide programs. Key rationales were the ability for these interventions to act as a gateway for families to increase their knowledge about topics immediately relevant to them (i.e. parenting), increase their knowledge about available supports and build relationships with service providers.ConclusionsLocal priorities for preventing mental health problems for children living with adversity emphasized relational approaches to service provision and were shaped by the availability of existing interventions and supports in the locality. The NGT was found to be an effective method for prioritising evidence-based practice interventions in health settings, engaging local stakeholders, and identifying enablers and barriers to implementation.
Highlights
Despite the well-established link between childhood adversity and mental health problems, there is a dearth of evidence to inform decision making about the most acceptable and feasible interventions for preventing mental health problems for children experiencing adversity
Key rationales were the ability for these interventions to act as a gateway for families to increase their knowledge about topics immediately relevant to them, increase their knowledge about available supports and build relationships with service providers
Local priorities for Wyndham emerged based on interventions that can act as a gateway for families to increase their knowledge about topics immediately relevant to them
Summary
Despite the well-established link between childhood adversity and mental health problems, there is a dearth of evidence to inform decision making about the most acceptable and feasible interventions for preventing mental health problems for children experiencing adversity. There is a significant social gradient of mental health burden, with a much higher prevalence of mental health problems among children and young people experiencing adversity because of their socio-economic, health, geographic and/or family circumstances. An expanded definition of ACEs includes childhood maltreatment (e.g. physical, verbal or sexual abuse), household dysfunction (e.g. parental divorce, family substance abuse, parental mental illness, maladaptive parenting), community dysfunction (e.g. witnessing physical violence) and peer dysfunction (e.g. stealing, discrimination, bullying) and socio-economic adversity [5,6,7]. These can be viewed as family adversity. The high prevalence of ACEs [13, 14], coupled with the increasing evidence of their significant contribution to most classes of mental disorders [14, 15], suggests that interventions to prevent or reduce the impact of ACEs could mitigate a substantial population burden of mental disorders [15]
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