Child Behavioral Health Research Articles

The effects of child maltreatment and exposure to intimate partner violence on the co-occurrence of anxious/depressive symptoms and aggressive behavior

BackgroundChild maltreatment (CM) and exposure to intimate partner violence (IPV) pose significant threats to child behavioral health, particularly for young children in toddlerhood and early childhood. Children who experience CM and/or are exposed to IPV are more likely to develop anxious/depressive symptoms and aggressive behavior. ObjectiveThis study is a three-year longitudinal examination of the effects of CM and exposure to IPV on the co-occurrence of anxious/depressive symptoms and aggressive behavior. Participants and settingThe sample included 459 children drawn from the National Survey of Child and Adolescent Well-Being II, a national longitudinal study that investigated the outcomes and well-being of children and families that were involved in Child Protective Services (CPS). MethodsLatent growth curve modeling was conducted to examine the correlation between the trajectories of anxious/depressive symptoms and aggressive behavior, and the effect of CM and IPV exposure on child behavioral outcomes. ResultsA positive correlation was observed between anxious/depressive symptoms and aggressive behavior intercepts, and the slope parameters of both growth models were also positively correlated. CM and IPV exposure was associated with worse anxious/depressive symptoms and aggressive behavior over time. ConclusionsThe findings suggest the co-occurrence of anxious/depressive symptoms and aggressive behavior among CPS-involved children and demonstrate the negative effects of CM and IPV exposure on children over time. The findings pinpoint the necessity of comprehensive methodological considerations for research and a lens of trauma-informed care for practice.

Hubungan Perilaku Kesehatan Menggosok Gigi dengan Karies Gigi pada Anak Usia Sekolah di SDN Karangsari Cianjur Tahun 2022

Background: Dental caries is the most common disease found in the oral cavity together with periodontal disease, so it is a major problem for dental and oral health. This disease occurs due to demineralization of tooth surface tissue by organic acids derived from foods that contain sugar. Purpose: This study aims to determine the relationship between tooth brushing health behavior and dental caries in school-age children at SDN Karang Sari Cianjur in 2022. This research is a chi-square study with a cross sectional study design with a total sample of 40 respondents. Results: 27 people who suffer from caries and 13 people do not suffer from caries. After conducting the chi-square test, the value of the diet is 0.001 <0.05, which means that health behavior and dental caries have a significant relationship.

A STEPwise Approach for Oral Hygiene Behavior of Schoolchildren in Romania.

This research analyzes the dental hygiene habits of schoolchildren from parents' perspectives, using the STEPS approach recommended by the World Health Organization. The key points of oral health care in children include the role of the family in encouraging and maintaining proper oral hygiene practices. This study aimed to assess the oral hygiene practices of schoolchildren with on-site dentists in Romania. Additionally, it sought to establish correlations between these behaviors and the educational levels of the adults with whom they live with. The participants were selected from the zero grade to the eighth grade, totaling 3843students. Statistical analysis involved the application of Fisher's Exact Test and Z-tests with Bonferroni correction. Multinominal and binominal logistic regression models were employed to predict the impact of parents' education on children's oral health status and behavior. The oral health status of children evaluated by parents as poor was more frequent in children whose parents had a primary or gymnasium education (p < 0.001). Female adults with a university education evaluated the gum health of their children as very good to a much greater extent (41.7%, p < 0.001). Regarding the use of auxiliary means, the majority of parents with a university education mentioned that their children use dental floss (26.4% females/27.4% males) (p < 0.001), compared to those with primary education, where the percentage was only (1.2% males/3.5% females) (p < 0.001). The results of this study highlight that the education level of the adults with whom the children live with influences the perception of the teeth and gums health status, the frequency of oral hygiene, the use of fluoride toothpaste, and auxiliary brushing aids.

The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review.

To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people. Scoping review of peer-reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases. Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families. The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants.

Selecting an Ecological Momentary Assessment Platform: Tutorial for Researchers.

Although ecological momentary assessment (EMA) has been applied in psychological research for decades, delivery methods have evolved with the proliferation of digital technology. Technological advances have engendered opportunities for enhanced accessibility, convenience, measurement precision, and integration with wearable sensors. Notwithstanding, researchers must navigate novel complexities in EMA research design and implementation. In this paper, we aimed to provide guidance on platform selection for clinical scientists launching EMA studies. Our team includes diverse specialties in child and adolescent behavioral and mental health with varying expertise on EMA platforms (eg, users and developers). We (2 research sites) evaluated EMA platforms with the goal of identifying the platform or platforms with the best fit for our research. We created a list of extant EMA platforms; conducted a web-based review; considered institutional security, privacy, and data management requirements; met with developers; and evaluated each of the candidate EMA platforms for 1 week. We selected 2 different EMA platforms, rather than a single platform, for use at our 2 research sites. Our results underscore the importance of platform selection driven by individualized and prioritized laboratory needs; there is no single, ideal platform for EMA researchers. In addition, our project generated 11 considerations for researchers in selecting an EMA platform: (1) location; (2) developer involvement; (3) sample characteristics; (4) onboarding; (5) survey design features; (6) sampling scheme and scheduling; (7) viewing results; (8) dashboards; (9) security, privacy, and data management; (10) pricing and cost structure; and (11) future directions. Furthermore, our project yielded a suggested timeline for the EMA platform selection process. This study will guide scientists initiating studies using EMA, an in vivo, real-time research tool with tremendous promise for facilitating advances in psychological assessment and intervention.

Impact of Divorce on Children in China

This review tries to detect effects of divorce and parental responsibilities on the psychological health and growth of kids. Through interaction and imitation, parents have a big impact on how their kids act, think, and behave. While some divorced parents raise their children properly, others fail to fulfill their obligations. The impacts of divorce on children's academic performance, social behavior, emotions, and mental health are all covered in detail in this study. Lower academic accomplishment, social difficulties, and intensified negative emotions are frequently caused by the loss of a parental role model and instability brought on by divorce. The study stresses understanding the outcomes of the absence of a parental role during a child's upbringing. It explores mitigating factors like parental interactions' quality and support systems. More diverse research is needed to explore the impact of parental roles on children's development. In conclusion, this review highlights parental roles and divorce's substantial influence on children's development and advocates for support for children of divorced parents.

A Complex Interrelationship of Childhood Obesity, Dental Caries and Malocclusion Amidst the COVID-19 Pandemic and Social Media Amplification: A Narrative Review

Recent research has highlighted the link between childhood obesity, dental caries, and malocclusion, and how the Coronavirus Disease - 2019 (COVID-19) pandemic and social media have worsened these health issues. Increased screentime and decreased physical activity during the pandemic have significantly contributed to these conditions among children. Studies emphasise the need to address common risk factors such as unhealthy diets, limited healthcare access, and poor public health policies to reduce their negative effects. This review explores the complex relationship between childhood obesity, dental caries, and malocclusion, with a focus on their global importance. It examines the connections and shared risk factors between these conditions, particularly in the context of the pandemic and the growing influence of social media on children. The goal is to provide insights for developing effective interventions and management strategies to improve children's health worldwide. The present review stresses the urgent need for comprehensive strategies that target both individual and collective risk factors, while also considering broader socioeconomic and digital influences on children's health behaviours. Promoting healthy lifestyles, access to nutritious foods, physical activity, and better dental care can help to alleviate these conditions. Understanding the interplay between these health issues and the digital environment is crucial to creating effective and adaptable public health interventions.

Extra help for extra needs: Family perspectives on New Mexico's supplemental child care subsidy program for families at risk for involvement with child protective services

This study examines the perspectives of a sample of parents and primary caregivers who received child care subsidies through New Mexico's at-risk eligibility designation, which is reserved for families who are or are at risk for becoming involved with child protective services (CPS). Qualifying families pay no copays, have limited documentation requirements, and are provided with additional enrollment supports by specialized eligibility workers with lower caseloads and training in trauma-informed practices. Families reported positive experiences with their eligibility workers and with the enrollment process, saying almost universally that they did not face administrative burdens to enrollment and that their caseworker was responsive and helpful. Despite positive experiences with the subsidy system, families reported difficulties finding child care that met their needs, mainly due to challenges related to non-traditional work hours, transportation, and children's behavioral health needs. The study findings are exploratory but suggest that enhanced supports from specialized eligibility workers are valued by families facing complex risk factors and may help them access child care subsidies. Access to subsidies, in turn, helps families afford and access care. However, the utility of child care subsidies remains limited without a supply of care that meets families' logistical needs and supports their children's development. Given previously documented administrative burdens and challenges families face in accessing child care subsidies, New Mexico's approach has potential implications for other states aiming to enhance equitable access to care for families at risk for CPS involvement—a population that disproportionately experiences systemic disadvantages and destabilizing circumstances.

The Impact of Maternal Emotional Regulation on Children’s Emotional and Health Behaviors: The Mediating Role of Family Emotional Expression and Maternal Age

Objectives: In this study, we explored the influence of maternal emotional regulation and familyemotional expression on the emotional regulation and health behaviors of preschool children in ruralareas. Methods: We collected data from 800 rural mothers and their preschool-aged children. SPSS 20.0software was used for analysis purpose. Results: We found that: (1) maternal emotional regulation isnegatively associated with positive emotional expressions within the family and positively associatedwith negative emotional expressions; positive emotional expressions within the family correlate withenhanced adaptability in children’s emotional regulation and health behaviors, whereas negativeemotional expressions relate to poorer adaptability; (2) positive family emotional expression acts as amediator between maternal emotional regulation and children’s adaptive emotional regulation (whichsignificantly impacts children’s health behaviors) (Model A), while negative family emotional expressionmediates the relationship between maternal emotional regulation and children’s maladaptive emotionalregulation (which negatively impacts children’s health behaviors) (Model B); and (3) maternal age playsa moderating role in the mediated relationship between maternal emotional regulation, maladaptiveemotional regulation and health behavior in children, and the negative emotional expressions observedwithin the family. Conclusions: These findings underscore the critical impact of family emotional dynamicson child development and highlight the importance of fostering positive emotional environments inrural settings to improve health behaviors among children. We suggest that an effective emotionalexpression can result in a supportive environment for children, encouraging them to participate indifferent physical activities and healthy food choices, leading to their improved health behaviors.

Implementing a Digital Child Behavioral Health Prevention Program in Faith-Based Settings in Uganda: A Feasibility Study

Background: The burden of pediatric mental disorders in low-and middle-income countries (LMICs) is tremendous, but solutions for addressing the burden remain limited. Although digital solutions have potential to improve prevention services, such solutions have not been systematically tested in these countries. Objective: This study explores the use of a digital parenting intervention tool designed for pediatric behavioral health, known as the Pediatric-Behavioral Health Digital Tool, in a preventive service model for low resource communities. We study the feasibility of implementing this new digital health service model and preliminary estimate the potential impacts on parenting and child social emotional outcomes when the program is implemented in faith-based organizations in Uganda. The Pediatric-Behavioral Health Digital Tool is a preventive intervention designed to be implemented by trained community-health-workers to facilitate caregivers’ access to the preventive mental health service in community for their young children. The tool is based on the screening, brief intervention, and referral to treatment prevention service model for promoting pediatric behavioral and mental health. Methods: The evaluation study was designed using a pre-post assessment design. The content in Pediatric-Behavioral Health Digital Tool was co-designed with local expert and iteratively adapted based on parents and caregivers as well as community-health-workers and experts who were invited to provide their feedback and suggestions for improvements in content, functions, and delivery model through a series of focus groups and workshops. This pilot evaluation focuses on the pre-post changes of the intervention families (91 families) and 10 community-health-workers. Results: We found high acceptability, appropriateness, and usefulness of the program based on the intervention families’ community-health-workers’ report. Intervention parents felt safe in using the digital toolkit. Parents felt comfortable for the CHWs asked them personal questions. In estimating the impacts, we found some expected findings on parenting and child social emotional health. Specifically, we found intervention parents become more mindful in their parenting (d=1.61, p=.049), and felt more effective in discipline their child’s misbehavior (d=1.29, p=.003) after they receive the intervention. For children, we found improvement on children’s social emotional outcomes, measured by decreased parent-child conflict (d=-1.08, p=.002) and increased child emotional regulation skills (d=1.0, p=.049) after their parents receive the intervention. Conclusions: Our Pediatric-Behavioral Health Digital Tool has potential to provide a cost-effective service solution to provide preventive mental health care in communities to promote child social-emotional and mental wellbeing in low-resource settings.

From Scientific Research to Practical Implementations: Applications to Improve Data Quality in Child Welfare.

Child welfare decisions have life-impacting consequences which, often times, are underpinned by limited or inadequate data and poor quality. Though research of data quality has gained popularity and made advancements in various practical areas, it has not made significant inroads for child welfare fields or data systems. Poor data quality can hinder service decision-making, impacting child behavioral health and well-being as well as increasing unnecessary expenditure of time and resources. Poor data quality can also undermine the validity of research and slow policymaking processes. The purpose of this commentary is to summarize the data quality research base in other fields, describe obstacles and uniqueness to improve data quality in child welfare, and propose necessary steps to scientific research and practical implementation that enables researchers and practitioners to improve the quality of child welfare services based on the enhanced quality of data.

Underinsurance Among Children With Special Health Care Needs in the United States

A rise in pediatric underinsurance during the last decade among households with children with special health care needs (CSHCN) requires a better understanding of which households, by health care burden or income level, have been most impacted. To examine the prevalence of underinsurance across categories of child medical complexity and the variation in underinsurance within these categories across different levels of household income. This cross-sectional study used data from the National Survey of Children's Health and included 218 621 US children from 2016 to 2021. All children included did not reside in any type of institution (eg, correctional institutions, juvenile facilities, orphanages, long-term care facilities). Data were analyzed from January 2016 to December 2021. The primary exposure is a categorization of child health care needs constructed using parent-reported child physical and behavioral health conditions, as well as the presence of functional limitations. The primary outcome variable is underinsurance, defined as absence of consistent or adequate health insurance. Models were adjusted for demographic and socioeconomic characteristics and stratified by household income. Multivariate logistic regression analysis of pooled cross-sectional survey data across multiple years (2016 to 2021) adjusted for complex survey design (weights). In a total sample of 218 621 children who were not in institutions and were aged 0 to 17 years from 2016 to 2021 (105 478 [48.9%] female; 113 143 [51.1%] male; 13 571 [13.0%] non-Hispanic Black children; 149 706 [51.2%] non-Hispanic White children), underinsurance prevalence was higher among the children who had complex physical conditions (3316 [37.0%]), mental or behavioral conditions (5432 [38.1%]), or complex physical conditions and functional limitations (1407 [40.7%]) or mental or behavioral conditions with limitations (3442 [41.1%]), compared with healthy children (ie, children without special health care needs or limitations) (52 429 [31.2%]). The association between underinsurance and complexity of child health care needs varied by household income. In households earning 200% to 399% federal poverty level (FPL), underinsurance was associated with children having complex physical conditions and limitations (OR, 2.74; 95% CI, 2.13-3.51) and mental or behavioral conditions and limitations (OR, 2.21; 95% CI, 1.87-2.62), compared with healthy children. In households earning 400% or more above FPL, children's mental or behavioral conditions and limitations were associated with underinsurance (OR, 3.31; 95% CI, 2.82-3.88) compared with healthy children. In this cross-sectional study, the odds of being underinsured were not uniform among CSHCN. Both medical complexity and daily functional limitations led to increased odds of being underinsured. The concentration of underinsurance among middle-income households underpinned the challenge of health care financing for families of CSHCN whose incomes surpassed eligibility thresholds for dependent Medicaid insurance.

The Use of Monitoring Cards is Effective In Improving Dental And Mouth Cleanliness and The Behavior of Deaf Children

Problem statement : The limitations that deaf children have in hearing, result in cognitive information processing disorders, namely limitations in receiving, storing, and re-disclosing information as an understanding, being able to explore and add information about something (especially about dental and oral health. The role of people Parents are very necessary in maintaining children's health, especially dental and oral hygiene because deaf children are still dependent on their parents. Method: Pre Test and Post Test Control Group Design. The study population was students of Prof. Dr. Sri Soedewi Mschjun Sofwan, SH and their parents as the intervention group and students of SLB Negeri 1 Jambi City and their parents as the control group. In the intervention group, counseling was given and Monitoring Cards, while the control group was only given counseling. The measuring instrument used is PHPM. Children's behavior is seen by using a questionnaire. Analysis of the data to see the status of oral hygiene and student behavior in maintaining oral health with a pair t-test. Scientific finding results: The results showed that dental health education using a monitoring card was more effective in improving the status of dental and oral hygiene and dental health behavior in SLB children than not using a monitoring card. A short conclusion: The recommendation from this study is for parents to be more active in motivating their children to maintain oral and dental health by using a monitoring card so that the way their children brush their teeth will be better and correct.

Mitigating the impact of intimate partner violence in pregnancy and early childhood: A dyadic approach to psychotherapy

AbstractIntimate partner violence (IPV) is often considered an adult problem despite profound consequences for the children who are exposed toviolent relational patterns. About a third of children and adolescents report past exposure to parental IPV, and a majority were first exposed as infants. Exposure to IPV during pregnancy through the first 5 years of a child's life has consequences ranging from adverse birth outcomes to diagnosable emotional problems and lasting physiological dysregulation. This article reviews risks and consequences of IPV in pregnancy and early childhood and discusses a relational psychotherapeutic treatment approach (Child–Parent Psychotherapy) applied to both developmental stages to mitigate the adverse consequences of family violence on parents and their children. Research evidence for the effectiveness of Child–Parent Psychotherapy (CPP) among IPV‐exposed families is reviewed as are specific treatment components which seek to restore relational safety following familial violence. Additionally, clinical considerations unique to families with histories of or ongoing exposure to IPV are discussed. Finally, recommendations are presented to improve the integration between medical and early childhood behavioral health systems for families at highest risk for chronic IPV.

Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study

BackgroundCOVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. MethodsThe study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020–2022. Height and weight are measured annually in 2021–2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. ConclusionFindings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Improved Perceptions of Parental Support for Physical Activity and Healthy Eating among Young Adolescents During COVID 19 pandemic

Family routines play a key role in promoting child health behaviors. This study aims to 1) describe changes in children’s perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explore the role of pandemic-related economic stressors on these changes. Children’s perceptions of family routines were assessed using four scales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Child age and sex were assessed at pre-pandemic, and household members’ employment loss and poverty levels were assessed during pandemic. Linear mixed models were used to assess changes and associated factors for each scale. Children (N=277) aged 8-13 y were enrolled pre-pandemic. Children’s perceptions of PA-policies and Diet-policies increased significantly from pre-pandemic to early-pandemic (b=0.9 and 2.4, respectively) and pre- to mid-pandemic (b=0.8 and 1.2, respectively). Diet-rules decreased significantly from pre- to early (b=-1.5) and pre- to mid-pandemic (b=-2.3), with no PA-Diet-role-model changes. Older children, compared to younger, had a faster decrease in Diet-policies from pre- to early pandemic. Females, compared to males, had a faster decrease in Diet-rules from pre- to mid-pandemic. Economic stressors were not associated with changes in perceived routines. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules to regulate child eating behaviors during the pandemic. Future mixed methods research is needed to understand how changes in parental support on family routines relate to PA and healthy eating behaviors.

The Family Environment as a Source for Creating the Dietary Attitudes of Primary School Students-A Focus Group Interview: The Junior-Edu-Żywienie (JEŻ) Project.

The family environment plays a crucial role in creating the health behaviours of children and youth. This study aimed to explore the attitudes of parents with children aged 7-12 who represent an influential environment for creating the eating behaviours of children. A qualitative study was conducted using focus-group interviews (FGI) involving 101 parents from various socioeconomic backgrounds. Three categories of parents were identified based on their level of involvement and awareness of nutrition: 'aware', 'determined', and 'relaxed'. Among parents of 10-12-year-old students, an additional category, 'distanced' parents, was identified. The study revealed that parents require support in terms of providing compelling arguments and practical recommendations related to meals and reducing or eliminating their children's consumption of sweets, snacks, fast food, and, in the case of older students, energy drinks. Parents reported that their children had a moderate understanding of the principles of proper nutrition. The majority of respondents viewed this knowledge as primarily theoretical and expressed a need for practical guidance and activities, which they believe should be offered by schools. To achieve positive outcomes in educational activities related to food and nutrition, it is essential to involve children, parents, guardians, teachers, and other school staff in these efforts.

Parental anxiety and depression are associated with adverse mental health in children with special needs during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to restrictions in various areas of life, including social life, work, leisure, health, and education. Vulnerable groups, such as children with special needs and their parents, may be at increased risk of experiencing exacerbated mental health problems during stressful periods such as the COVID-19 lockdowns. Telephone interviews were conducted with 954 parents of children with special needs. We assessed parental levels of generalized anxiety and depression using the validated GAD-7 and PHQ-8 scales. Parents were asked to rate family burden and their worry about the COVID-19 crisis, as well as their children's adverse mental health symptoms and health behaviors. Parents also reported their children's worries about the COVID-19 crisis. We conducted regressions to examine the relationship between parents' mental health problems and their children's adverse mental health symptoms and health behaviors. Qualitative data from open-ended questions were coded thematically and major themes of parental worry about the COVID-19 crisis were identified. Parental anxiety and depression symptoms predicted adverse mental health symptoms and behaviors in children with special needs. Criteria for current depression were met by 7.9% of parents of children with special needs, whereas 4.7% of the general population in Vorarlberg met the criteria for current depression according to data from the Austrian Health Interview Survey in 2019. Parental self-ratings of both depression and anxiety were highly correlated. The majority of parents reported being burdened (79.1%) or worried (67.8%) about the COVID-19 crisis. The main themes of parental worry about the COVID-19 crisis included COVID-19 infection (40.6%), economic situation (13.1%), uncertainty (8.4%), lack of social contact with family and friends (8.1%), family health status (7.5%), and school life (7.5%). Mental health symptoms in parents of children with special needs were strongly associated with increased adverse mental health symptoms and health behaviors in their children. Parents of children with special needs were more likely to be depressed during the COVID-19 pandemic than adults in 2019. We call for additional mental health support to reduce the mental health burden in families with children with special needs.

Coming Up…

The National Association for Children's Behavioral Health is holding its Emerging Best Practices conference, “Innovations on the Horizon: Exploring Programs, Technology and Services for the Future,” Nov. 28–30 in St. Pete Beach, Fla. Visit https://www.nacbh.org/emerging‐best‐practices‐conferencefor more information.

Reflecting on parental insights into healthy lifestyles: a qualitative study

BackgroundChildren living in the most deprived regions are more than twice as likely as their affluent peers to be obese. One way we can explain the social gradient of health (determined by relative position on the scale of social disadvantage or advantage) is by identifying the barriers and drivers to health that different groups of people experience. This study explored the understanding and perceptions of (and barriers and drivers to) a healthy lifestyle to investigate how commissioned services can better support residents to enable behaviour change in an area of high social deprivation. This community engagement activity was also conducted to inform commissioning decisions in children's public health services. MethodsWe used a qualitative study design with a semi-structured interview schedule. Four focus groups (5–8 participants, n=26) were conducted in an area of high deprivation in northwest England. Parents or carers were invited to attend anonymously by the Public Health Community Engagement Officer (in June 2022). The inclusion criteria were previous attendance on a weight management programme. Data were analysed using thematic analysis. Engagement activities do not require ethics approval. All participants provided written informed consent to take part. No further information was collected about personal characteristics. FindingsThe study participants demonstrated an awareness and understanding of factors affecting child and family health and health behaviours: healthy eating, exercise, mental health and emotional wellbeing, family values and attitudes towards a healthy lifestyle, cooking and budgeting, wider social connections, access to open spaces, availability of local activities, costs (including hidden costs), and structural barriers. InterpretationUsing the finding that participants recognise barriers and drivers to behaviour change beyond knowledge and skills, we reflect on why there was no take up for a commissioned intervention that aimed to address childhood obesity in the Lancashire area. These reflections inform arguments for an alternative model of service commission that relies less on established randomised trial evidence base and more on participatory codesign and a place-based approach (working with populations' existing knowledge and skills) and is particularly sensitive to people's own perception of the specific drivers and barriers they experience to behaviour change. Limitations include sampling from an area with low diversity and selection of participants who have previously agreed to uptake a weight management intervention. FundingNone.