Technology matters: AI-driven tools in children's mental healthcare: perspectives from young people and parents.

Since the growth of research into neighbourhood effects on young people's health in the 1980s, there have been major societal changes and scientific methodological advancements. In this systematic review we will, therefore, discuss the recent (>2009) literature on the association between neighbourhood deprivation and young people's (0-19 years old) mental health and well-being. We focus on whether neighbourhood deprivation effects exist, and how and for whom the neighbourhood matters. Together, the thirty studies included in the review indicate that overall there are neighbourhood effects on young people's mental health and well-being. The comparison of results from these studies suggests that such associations were more commonly found for well-being and externalising problem behaviour rather than internalising problem behaviour. Also, mental health and well-being seemed to be more often associated with the neighbourhood social environment than neighbourhood socio-economic status and neighbourhood disorder. Studies investigating mediating processes between the linkage between neighbourhood deprivation and mental health and well-being were rare although there was some evidence that processes within the family and peer context are important mechanisms in this linkage. Inconsistent evidence was found regarding the moderating role of age, gender, and ethnicity. There are ongoing challenges of researching the how and for whom neighbourhoods are important. We should work towards rigorous theory and evidence on how different features of residential contexts matter and on differential exposure and vulnerability to these contexts.

As half of all mental health problems manifest before the age of 14, access to treatment can seriously affect on long-term health outcomes. Heidi Crompton and Sheila Hardy describe how they prepared general practice staff to better manage young people's mental health Background: It is estimated that half of all mental health problems manifest before the age of 14, with 25% enduring mental health conditions up to the age of 24. However, less than 50% receive treatment at the time. The aim of this project was to prepare staff so that they could improve access to treatment for young people with mental health problems presenting in a general practice setting. Method: Staff at a practice in Dorset, UK, were given training to enable them to recognise when a young person may have a mental health problem and know what actions to take. A computer template was developed to assist them to carry out a safe, detailed assessment of a young person's mental health in a timely manner, and self-help materials were provided. Communication was set up with other organisations, such as Child and Adolescent Mental Health Services, school nursing, and counselling, to address the gap in services that patients experience. Results: Training was received positively. Staff demonstrated increased knowledge and confidence following the session and reported that they would use the template. Use of the template was checked and it had been used eight times in the 4 weeks following the training. A survey carried out 4 months after the training showed that staff thought they were more likely to ask a young person about their mental health and provide them with supportive materials. Conclusion: Staff at the practice felt prepared to manage young people's mental health. There is a need to measure the effect of the interventions on the young people with mental health problems using the service. The plan is to continue and expand the project.

In this Papers Podcast, Ari Peters-Corbett, Dr. Sheryl Parke, Dr. Holly Bear, and Dr. Tim Clarke discuss their co-authored CAMH review paper 'Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care – a systematic review'.

Teenpath COVID is a mixed-methods, participatory study exploring the experiences of young people in Ireland since the COVID-19 pandemic and its impacts on existing health inequalities. As part of an exploratory sequential research design, we conducted a stakeholder analysis, online survey, and participatory arts programme evaluation to identify cross-cutting issues impacting the health and well-being of young people in Dublin and across Ireland. Interviews conducted with stakeholders spanning youth service, public health, and education sectors, and young people aged 16-25 explored individuals’ experiences of the pandemic; adaptations to working and maintaining engagement online; key concerns about young people's health and wellbeing; and priorities for future research and policy. Thematic analysis identified impacts of the pandemic on health inequalities with potential policy implications. This informed a subsequent online survey exploring young people's mental health since the pandemic, and an ethnographic case study of a participatory arts programme exploring key issues important to young people in Dublin. Our findings suggest the pandemic has impacted predominantly on young people's mental health and access to youth mental health services; disruption to work, education and social and peer support networks; and health behaviours. Protective measures, from accessing and maintaining social support networks, to developing coping strategies were important for young people's mental health. However the extent to which these were possible was shaped significantly by individuals’ personal circumstances at the time. These findings show the importance of social participation and support for young people in navigating the uncertainties and difficulties of growing up in a pandemic. Participatory approaches can be a pathway for aligning healthy priorities and policy that contributes unique and rich insights into community health, and places young people at the centre of change. Key messages • Young people in Ireland have experienced significant impacts to their mental health since the COVID-19 pandemic began, particularly regarding disruptions to education and social support networks. • Participatory approaches to research and youth engagement with young people is important for gathering high quality and diverse data on complex topics such as mental health and health inequalities.

The novel coronavirus (COVID-19) pandemic in Canada has increased attention and concern paid to young people's well-being and mental health. Narratives of isolation, exacerbated inequalities, and potential unequal recovery for young people, in particular, have been presented as a result of school closures across the country. Through these narratives, young people are framed as vulnerable, passive recipients of adult decisions and interpretations of their experiences. This research examines these narratives by conducting ethnographic fieldwork with a group of young people living in a rural Ontario town through the pandemic. This thesis presents and analyzes these young people's experiences of the pandemic related to mental health and well-being to reveal the missing nuances of adult narratives and to propose suggestions for future inclusive, accessible, rights-respecting programs for young people's mental health and well-being post-pandemic based on young people's accounts. Keywords: ethnography, COVID-19 pandemic, rural young people, mental health and well-being, children's rights

British Journal of School NursingVol. 13, No. 10 RepresentationSchool nursing's potential to have an impact on the prevention agenda and mental health outcomes: A position statementSharon WhiteSharon WhiteSearch for more papers by this authorSharon WhitePublished Online:18 Dec 2018https://doi.org/10.12968/bjsn.2018.13.10.514AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Youth Council. Our School Nurse: Young people's views on the role of the school nurse. 2011. BYC Google ScholarDay P. Motivating Teen Spirit: Early metal health intervention. BJSN. 2016;11(2): 93 Link, Google ScholarDepartment of Health. Healthy Child Programme: 5 to 19 years old. 2009. https://bit.ly/2rk8dmA Google ScholarDepartment of Health. Chief Medical Officer annual report 2012: children and young people's health. 2013. https://bit.ly/1iTKqlz Google ScholarDepartment of Health. Future in mind—Promoting, protecting and improving our children and young people's mental health and wellbeing. 2015. https://bit.ly/2Kr7RTn Google ScholarDepartment of Health, Department for Education. Transforming Children and Young People's Mental Health Provision: a Green Paper. 2017. https://bit.ly/2H51qGU Google ScholarDepartment of Health, Public Health England. Maximising the school nursing team contribution to the public health of school-aged children—Guidance to support the commissioning of public health provision for school aged children 5–19. 2014. DH, PHE Google ScholarDepartment of Health and Social Care. Prevention is better than cure: our vision to help you live well for longer. 2018. https://bit.ly/2SLpZvG Google ScholarDepartment of Health and Social Care, Public Health England. Overview of the 6 early years and school aged years high impact areas. Health visitors and school nurses leading the Healthy Child Programme. 2018. https://bit.ly/2AqfGVG Google ScholarKay CM, Morgan DL, Tripp JH, Davies C, Sykes S. To what extent are school drop-in clinics meeting pupils self-identified health concerns? Health Education Journal. 2006;65(3):236–251 Crossref, Google ScholarKelly N, Greaves C, Buckland L, Rose J. ‘School nurses: well placed to address challenging behaviour’. Community Practitioner 2005;78(3):88–92 Google ScholarMarmot. Fair society, healthy lives: The Marmot Review: strategic review of health inequalities in England post-2010. 2010 Google ScholarMasters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health. 2017 Aug;71(8):827-834. doi: https://doi.org/10.1136/jech-2016-208141 Crossref, Google ScholarPublic Health England. All Our Health: about the framework. 2018. https://bit.ly/2qipnAM Google ScholarRoyal College of Nursing. 2017. The Best Start: The Future of Children's Health: Valuing school nurses and health visitors in England. https://bit.ly/2Rwu2uG Google Scholar FiguresReferencesRelatedDetailsCited byExtending the mental health expertise of school nurses: Evaluating a training programmeStephen Abbott, Rosamund Bryar, Ruth Cohen, Jane Gibbons, Lucy Marks15 November 2019 | British Journal of School Nursing, Vol. 14, No. 9 2 December 2018Volume 13Issue 10ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 18 December 2018 Published in print 2 December 2018 Information© MA Healthcare LimitedAcknowledgments:Thanks go to Kate Murdock, children's health service manager, South Locality—Trafford Division, and Sallyann Sutton, professional lead—school nursing, for leadership in pulling together this position statement on behalf of SAPHNA.PDF download

Young people's mental health globally has been in decline. Because of their low perceived need, young people's services tend to be the first cut when budgets are reduced. There is a lack of evidence on how a reduction in services and opportunities for young people is associated with their mental health. Additionally, how this may be magnified by place and the assets and challenges of place. The aim of this study is to explore trends in young people's mental health measured by GHQ-12 over time in the twelve regions of the UK. We estimated an interrupted time series model using 2010 as a break point from which there was a shift in government policy to a prolonged period of large reductions in central government funding. Repeated cross-sectional data on young people aged 16–25 is used from the British Household Panel Survey and its successor survey UK Household Longitudinal Survey. Results showed a statistically significant reduction in mental health for young people living in the North East, Wales, and the East of England. The North East was the region with the largest reduction in funding and saw the greatest reduction in young people's mental health. Next, we look at how reductions in local government expenditure related to services for children and young people: children's social services, education, transportation, and culture; explain the observed decline in mental health. We employ a Blinder-Oaxaca Decomposition approach comparing young people's mental health between 2011 and 2017. Results show a marginally statistically significant decrease in young people's mental health over this time. Unobserved factors related to transport spending and children's social services explain some of this gap. Area level factors such as deprivation, infrastructure, and existing assets need to be considered when distributing funding for young people's services to avoid exacerbating regional inequalities in mental health.

IntroductionThe mental health of young people (aged 16–25 years) is a growing public health concern in the United Kingdom due to the increasing numbers of young people experiencing mental health difficulties, with many not in contact with mental health services. To design services that meet the needs of all young people, a diversity of young people must be involved in mental health research, beyond being participants. This Delphi study aimed to identify different types of ‘involvement’ and to define and describe ‘under‐representation’ in young people's involvement in mental health research.MethodsTwenty‐seven experts in young people's mental health research completed a series of online questionnaires. The experts were academic researchers, patient and public involvement (PPI) professionals and young ‘experts by experience’. Round 1 generated panellists' views on ‘involvement’ and ‘under‐representation’. Round 2 summarised panellists' responses from Round 1 and sought consensus (minimum 70% agreement) in nine question areas. Round 3 validated the findings of the previous rounds.ResultsConsensus was achieved in eight out of nine areas, resulting in a matrix (with definitions) of the different types of young people's involvement in mental health research, from being advisors to involvement ambassadors. The findings generated an agreed‐upon definition of under‐representation, an identification of when in the research process there is under‐representation and the characteristics of the young people who are under‐represented. Experts further agreed on demographic data that should be collected to improve reporting on involvement.ConclusionsThis study adds to our understanding of involvement and under‐representation in the context of young people's mental health research through expert consensus. It provides a practical resource for researchers considering involving young people in the research process and suggests the data that should be collected to improve reporting on the diversity of the young people involved.Patient and Public ContributionA research oversight group of five young people advised on this study. They contributed throughout the project—from endorsing the research question to commenting on the findings and dissemination. Two of the group reviewed all participant materials and piloted the initial questionnaire.

Good mental health is the foundation of children and young people's emotional and intellectual growth, underpinning the development of confidence, independence and a sense of self worth which is vital to their future. However, today one in 10 children aged between five and 16 years have a clinically diagnosable mental health problem and research shows that these children and young people have the poorest life chances of any group of young people.The most recent national survey of mental health among children and young people in Britain was carried out over a decade ago. The 2004 report by the Office for National Statistics, published by the Health and Social Care Information Centre,1 revealed high levels of mental health problems, including depression, stress and anxiety, psychosis, eating disorders and self-harm.The period of time that has elapsed since this last survey suggests that, despite the worrying statistics it contains, insufficient attention has been paid to the mental health of this age group. The government's recent pledge of £1.25 billion by 2020 to support improvements in children and young people's mental health and wellbeing, along with £150 million for eating disorder services, is evidence of a sea-change.The ambition over the next five years for children and young people's mental health, according to National Health Service (NHS) England, is to support clinical commissioning groups (CCGs) to work with partners to build effective, evidence-based outcome-focused Child and Adolescent Mental Health Services (CAMHS), working in collaboration with children, young people and families.Meanwhile, according to the Mental Health Foundation,2 one of the 'most obvious, yet under-recognised factors in the development of major trends in mental health is the role of nutrition'. The charity points to a body of evidence 'growing at a rapid pace' suggesting that good nutrition is essential for mental health and that a number of mental health conditions may be influenced by dietary factors.It says,As well as its impact on short and long-term mental health, the evidence indicates that food plays an important contributing role in the development, management and prevention of specific mental health problems such as depression, schizophrenia, attention deficit hyperactivity disorder.The Foundation adds that nearly twothirds of those who do not report daily mental health problems eat fresh fruit or fruit juice every day, compared with less than half of those who do report daily mental health problems. This pattern is similar for fresh vegetables and salad. Those who report some level of mental health problem also eat fewer healthy foods (fresh fruit and vegetables, organic foods and meals made from scratch) and more unhealthy foods (chips and crisps, chocolate, ready meals and takeaways).Rethink Mental Illness3 further suggests that the increase in use of many additives, food colourings and processed foods - alongside the general rush to eat meals, often while running between different activities - have all played a role in unhealthy eating. These changes, it says, have been linked to some people experiencing mood changes, being irritable and being unable to concentrate.While both the findings of the Mental Health Foundation and Rethink are referring to the population at large, rather than children and young people specifically, a 2012 systematic review of 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents found evidence of a 'significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents'.4 The authors observed a consistent trend for the relationship between good-quality diet and better mental health and 'some evidence for the reverse'.While healthy eating has been shown to impact positively on the mental health of children and young people, the relationship between physical activity and general aspects of psychological wellbeing, self esteem and the management of anxiety and depression and behaviour is also well documented. …

There is an increasing focus on structural and social determinants of inequalities in young people's mental health across different social contexts. Taking higher education as a specific social context, it is unclear whether university attendance shapes the impact of intersectional social identities and positions on young people's mental health outcomes. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was used to predict the odds that mental distress during adolescence, sex, socioeconomic status, sexual identity, ethnicity, and their intersections, were associated with young people's mental health outcomes at age 25, and whether this differed based on university attendance. Data from the Longitudinal Study of Young People in England cohort study were analysed with the MAIHDA approach, and the results did not reveal any evidence of multiplicative intersectional (i.e., aggravating) effects on young people's mental health outcomes. However, important main effects of social identities and positions (i.e., an additive model) were observed. The findings suggested that being female or identifying as a sexual minority increased the odds of young people experiencing mental health problems at age 25, although the odds of self-harming were half the size for sexual minorities who had attended university. Black and Asian individuals were less likely to declare a mental illness than White individuals. Young people who grew up in a more deprived area and had not attended university were more likely to experience mental health problems. These findings imply that mental health interventions for young people do not necessarily have to be designed exclusively for specific intersectional groups. Further, university attendance appears to produce better mental health outcomes for some young people, hence more investigation is needed to understand what universities do for young people, and whether this could be replicated in the wider general population.

Providing the growing number of children and young people seeking mental health support with timely access to care poses a significant challenge. Increased use of digital technology in the delivery of children and young people's mental health services has been proposed as a means of increasing access to treatment. We conducted three interrelated studies to provide multi-perspective insights into the use of digital therapeutic interventions within children and young people's mental health services in the UK. Study 1 used semi-structured interviews and an online survey to collect the views of digital therapeutic interventions of families who self-identified as facing additional barriers to accessing mental health support (n=13). Study 2 involved eight focus groups with children and young people's clinicians, service managers, commissioners, and policy leads (n=28), exploring participants' views and experiences of implementing and sustaining digital therapeutic interventions. Study 3 was a consensus exercise which aimed to identify actions needed to bridge the gap between the development and use of digital therapeutic interventions for children and young people's mental health through focus groups with parents/carers and professionals (n=17), and three Delphi-survey rounds. Our findings revealed considerable enthusiasm for the increased use of digital mental health interventions for children and young people across stakeholder groups, but also identified key barriers to their implementation. Actions perceived to facilitate more effective implementation included: a) co-producing interventions, commissioning decisions and implementation plans with children and parents/carers, b) enhancing national guidance and local leadership, c) integration of digital offers within existing clinical pathways, and d) efforts to ensure accessibility and inclusivity. Digital therapeutic interventions offer a promising solution to the challenge of improving access to mental health support for children and young people. Strengthened guidance and leadership, sustained funding and further evidence-generation are urgently needed to enable this promise to be realised.

Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.

This study aimed to investigate coaches' awareness of mental health in youth sport, as well as their perceived role breadth and ability to support young people's mental health. Interviews were conducted with 13 sports coaches of young people aged 12–18 from Canberra, Australia. Interview transcripts were analysed using a combination of inductive and deductive qualitative content analysis. Coaches recognised that their role breadth allows them to be a useful source of support for young people's mental health by way of identifying concerns, facilitating help-seeking behaviour and promoting engagement in sports. Further training in mental health would boost coaches' ability to assist confidently and effectively, leading to benefits for young people's mental wellbeing and sporting experience. Coaches are in a position to positively impact young people's mental health, and set expectations for themselves to actively support young people in this way. Supporting mental health may be an area of future growth for the role of a youth sports coach.

Health in children and young people (CYP) has been impacted by the COVID-19 pandemic. Restrictions in mobility and social contacts limited children and young people in their social development and led to adverse psychological impact. Rising rates of poverty because of lockdowns have been shown to particularly impact families with children, which may exacerbate already existing health inequalities. Containment policies have decreased access to health services and decreased support for CYP from health and social care professionals during the pandemic, which have posed a significant threat to children and young people's physical health, mental and emotional health. To ensure that policies aimed at mitigating the impact of the pandemic on CYP are relevant, it is vital that the voices of CYP are heard. Article 12 of UNCRC establishes the right of a child to express their views in all matters affecting them and for those to be given appropriate consideration. This is a right that is largely not upheld in policymaking, and therefore it is important that the public health sector as advocates for children and young people (CYP) lead on this.The aims of this skill building workshop are to: Showcase positive examples of engagement of CYP in policymakingGain knowledge on the practicalities to make engagement with CYP a mutually beneficial experience Workshop Format The session will be chaired by a young person to role-model the inclusion of CYP, this workshop advocates for.Professor Sonia Saxena, President of the EUPHA section on Child and Adolescent Public Health, will open the session with key points on the importance of engaging CYP in policy making during the COVID-19 pandemic and beyond.A further two presentations will be delivered by young people who will reflect on their own experience of engagement with policy/research and utilise the lessons learnt to improve CYP engagement in the future.This will be followed by a presentation by a paediatric doctor reflecting on their role in engaging with children and young people to develop a national healthcare patient experience guideline.This series of short presentations will be followed by an interactive case scenario on CYP engagement during the C-19 pandemic. The case study will aim to discuss some of the key practicalities to consider when engaging children and young people in policy making.The session will close with a short panel discussion with the presenters and consensus vote by attendees of next steps to take the learning from the workshop forward. Workshop proceedings will be written up and submitted for publication in a peer-reviewed journal. Twitter hashtags will be devised to allow attendees to share work they embark upon within an online community. This community will also be fostered through meetings supported by EUPHA where members can share best practice and solutions to problems encountered.Speakers/Panelists Sonia Saxena Imperial College London, London, UK Rakhee Shah Imperial College, London, UK Gabrielle Mathews Imperial College London, London, UK Bea Albermann University of Zurich, Zurich, Switzerland Jinane Ghattas UCLouvain, Saint-Josse-ten-Noode, Belgium Key messages COVID19 will have a large impact on children and young people’s health.Engaging children and young people to co-produce policies that affect them, when planning for recovery from the pandemic is crucial in ensuring our policies and research are most impactful.

From the barber-surgeons of the Middle Ages to the digitally enabled clinical interventions of today, the role of nonspecialists in delivering accessible health care remains relevant and important. Their contribution in developing and supporting appropriate interventions and care pathways in the community can make a big difference for the overwhelming majority of children and young people with diagnosable mental health conditions who are not eligible for specialist treatment or do not seek help. Even if resources for specialist services were unlimited, there are independent benefits in involving nonspecialists in mental health care, albeit not without limitations and concerns. The natural shift over time in the boundaries of specialisms, the omnipresence and omnipotence of digital media in our lives and the vision of 'no wrong door' for service users, mean that it is not a question of whether, but of how, nonspecialists should be involved. We need to get past the point of considering them just as alternative providers of mental health interventions and services. Instead, they are best placed to protect children and young people's mental health through ubiquitous everyday actions, which counter the negative and maximise the positive elements in current practices, environments and interactions that influence families and communities.