Child Mental Health Treatment Research Articles

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.

Practitioner Review: School‐based interventions in child mental health

School-based interventions (SBIs) are well-established and effective treatments for improving child mental health. Specific school-based topics include prevention (Tier I-III) and interventions (e.g. cognitive-behavioural programmes and daily report cards). We performed a systematic literature search in five commonly used online databases (ERIC, MEDLINE, PsycARTICLES, PsycINFO and PSYNDEX) for English-language articles published between 1993 and 2015. Additional sources included reference lists of relevant articles and book chapters. We identified a number of successful behavioural or cognitive-behavioural programmes yielding moderate to strong effects for a range of emotional and behavioural problems. The implementation of these programmes and the collaboration of the involved settings (school and home) and persons are important factors for their effectiveness under real-life conditions. Effective SBIs are valuable tools for students with mental health problems if evidence-based cognitive-behavioural interventions are applied and rules of translational algorithms and implementation science are respected.

Good Enough? Interventions for Child Mental Health: From Adoption to Adaptation—From Programs to Systems

This special issue examines essential challenges and successes for developing, implementing, and disseminating evidence-based psychological interventions for child and adolescent development and mental health. The main aims are to identify what evidence is “good enough” for roll-out, if and how interventions need to be adapted to developmental diversity and contextual variation, and how they relate to complex systemic contexts. Themes of the special issue are twofold and first include questions about adoption versus adaptation, in terms of both developmental tailoring and cultural adaptation of existing intervention programs. Second, the issue tackles questions about what systems of support are needed to ensure the system readiness for child and adolescent mental health interventions. We argue that moving from simple adoption to dynamic adaptation and from programs to collaborative systems offers new perspectives for developing and implementing flexible protocols and strategies that allow adapted intervention. The special issue raises broader questions of whether current intervention programs and practices are good enough in moving us from mere adoption to innovation in system readiness, or whether we need to do more before we can claim that interventions are good enough for roll-out.

Adolescentes inseridos em um CAPSi: alcances e limites deste dispositivo na saúde mental infantojuvenil

The objective of the present study was to identify the day-by-day of adolescents in psychic suffering that attend a Center of Psychosocial Attention for Children and Adolescents (CAPSi) and to understand what the reach and limitations of this service are within the care and mental health treatment of children and adolescents. This is a qualitative case study, that involved the methodology of Ecological Insertion, grounded on the Bioecological Theory of Human Development by Urie Bronfenbrenner. Thirteen adolescents treated in a CAPSi of a large city from the State of Sao Paulo and aged between 12 and 18 years

Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment.

BackgroundChildren need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness.ObjectiveThe aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment.MethodsA tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based “e-workbook” designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics.ResultsUsability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway.ConclusionsThis study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice.Trial RegistrationClinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu)

A Family Consultation Service: Single session intervention to build the mental health and wellbeing of children and their families

Background:The Family Consultation Service (FCS) is a community mental health intervention for children and young people (CYP) which uses psychological consultation with families to address mental health concerns. In the context of increasingly constrained Local Authority finances, it was set up by educational psychologists (EPs) as a response to demands for both increased efficiency and accessibility of mental health services.Aims:This paper demonstrates how EPs can use consultation skills directly with clients within a mental health context and presents a theoretical rationale for this.Method:The FCS model is described and located within the frames of both national and local strategy. Following this, data from the first 150 referrals is analysed using descriptive statistics and the outcomes of a client survey are reported.Findings:A large majority of families referred reported that they achieved their goals after a single session with the FCS and did not take up the offer of additional involvement. This suggests that psychological consultation could potentially contribute towards a national agenda for mental health services that are responsive and preventative in focus. The model is proposed as an alternative to the established medical approaches and may be of interest to EPs and their managers who are looking for innovative ways of delivering systemically orientated psychological services within constrained financial circumstances.Conclusions:Dilemmas arising from the project are considered and subsequently addressed through the introduction of the Common Factors perspective: a paradigm which is gaining interest within the helping professions.

Parents' Use of Praise and Criticism in a Sample of Young Children Seeking Mental Health Services

Parents' use of praise and criticism are common indicators of parent-child interaction quality and are intervention targets for mental health treatment. Clinicians and researchers often rely on parents' self-reports of parenting behavior, although studies about the correlation of parents' self-reports and actual behavior are rare. We examined the concordance between parents' self-reports of praise and criticism of their children and observed use of these behaviors during a brief parent-child play session. Parent self-report and observational data were collected from 128 parent-child dyads referred for child mental health treatment. Most parents reported praising their children often and criticizing their children rarely. However, parents were observed to criticize their children nearly three times more often than they praised them. Self-reported and observed praise were positively correlated (rs = 0.32, p < .01), whereas self-reported and observed criticisms were negatively correlated (rs = −0.21, p < .05). Parents' tendencies to overestimate their use of praise and underestimate their use of criticism are discussed.

Racial/ethnic differences in parent-reported barriers to accessing children's health services.

The goals of this study were to identify whether barriers that parents perceived to using health care differed by service type (medical vs. mental health care) and whether there were racial/ethnic differences in barriers. Participants were a community sample of 275 parents (34.2% African American, 36.7% Caucasian, and 29.1% Hispanic) of children ages 9-13 years old who rated the extent to which potential barriers in 3 broad domains (stigma-related, logistical, and socioeconomic) would prevent or delay them from obtaining services. They also rated internalizing and externalizing problems exhibited by their child. Overall, parents reported greater socioeconomic and stigma-related barriers to obtaining mental health services than medical services. Hispanic parents reported socioeconomic and stigma-related barriers as more inhibiting than did African-American parents. Findings highlight the importance of strengthening relationships between mental health care providers and the community to reduce the stigma associated with seeking mental health treatment for children and better educating parents about the potential benefits of treatment. Policy focused on educating parents about their insurance options and improving insurance coverage may help to reduce socioeconomic barriers.

A Statewide Trauma-Focused Cognitive Behavioral Therapy Network: Creating an Integrated Community Response System

There is a significant body of research which demonstrates the long-term, negative consequences of early trauma exposure and its significant societal burden. It is imperative for communities to develop both a framework for the prevention of childhood trauma and an integrated response system that includes evidence-based, trauma-specific mental health treatment for children and families. The present paper briefly reviews the literature demonstrating the negative consequences of trauma exposure, describes the development and impact of a statewide trauma-focused cognitive behavioral therapy network on other child-serving systems and outlines preliminary efforts to integrate these systems into a more effective trauma informed system of care for traumatized children and their families.

A review of parent participation engagement in child and family mental health treatment.

Engagement in child and family mental health treatment has critically important clinical, implementation, and policy implications for efforts to improve the quality and effectiveness of care. This article describes a review of the existing literature on one understudied element of engagement, parent participation. Twenty-three published articles were identified. Questions asked of the literature include what terms are used to represent parent participation engagement, how parent participation engagement is measured, what are the rates of parent participation engagement reported in studies of child and family mental health treatment, whether parent participation engagement has been found to overlap with attendance engagement, what factors have been identified as associated with parent participation engagement, whether parent participation engagement is associated with improved outcomes, and what strategies have been designed to improve PPE and whether such strategies are associated with improved outcomes. Results indicate varied terms and measures of parent participation engagement, moderate overall rates, and high overlap with measures of attendance engagement. The extant literature on factors associated with parent participation engagement was somewhat limited and focused primarily on parent-/family-level factors. Evidence of links between parent participation engagement and outcome improvements was found across some outcome domains, and strategies designed to target parent participation engagement were found to be effective overall. A framework for organizing efforts to examine the different elements of engagement is described, and findings are discussed in terms of suggestions for consistent terminology, clinical implications, and areas for the future research.

Socio-contextual Determinants of Research Evidence Use in Public-Youth Systems of Care.

Recent efforts have been devoted to understanding the conditions by which research evidence use (REU) is facilitated from the perspective of system leaders in the context of implementing evidence-based child mental health interventions. However, we have limited understanding of the extent to which outer contextual factors influence REU. Outer contextual factors for 37 counties in California were gathered from public records in 2008; and child welfare, juvenile justice, and mental health system leaders' perceptions of their REU were measured via a web-based survey from 2010 to 2012. Results showed that leaders with higher educational attainment and in counties with lower expenditures on inpatient mental health services were significantly associated with higher REU. Positive relationships between gathering research evidence and racial minority concentration and poverty at the county level were also detected. Results underscore the need to identify the organizational and socio-political factors by which mental health services and resources meet client demands that influence REU, and to recruit and retain providers with a graduate degree to negotiate work demands and interpret research evidence.

Editorial Commentary: An agenda for global child mental health.

Even as mental health has become increasingly recognized as a key issue in global health, child mental health has largely remained in its shadows. This is possibly because many interventions for child mental health lie outside the realm of narrowly defined biomedical interventions and platforms, with the majority of interventions targeting psychological and social mechanisms and a strong emphasis on prevention. This situation must change, however, as child mental health interventions have potentially the greatest impact on the burden of mental disorders, and other health and social outcomes, than at any other time in the life course. There is now a growing body of evidence that indicates which interventions are ready for scale-up or show sufficient promise for further research and refinement. These are primarily delivered in community or school platforms through nonspecialist workers in partnership with parents and teachers. They include interventions to promote early child development, parenting interventions through childhood into adolescence, school interventions aimed at reengineering school environments and strengthening life skills, and interventions for the early detection and management of neurodevelopmental disorders and mental health problems through trans-diagnostic interventions based on impairments. Above all, what is needed is a population-based approach, which emphasizes the goal of coverage of evidence-based interventions for all children; with a particular focus on disadvantaged children; with seamless coordination of preventive and treatment interventions across platforms of care; and utilizing collaborative, stepped-care delivery paradigms.

Child Welfare Involved Caregiver Perceptions of Family Support in Child Mental Health Treatment

Child Welfare Involved Caregiver Perceptions of Family Support in Child Mental Health Treatment

A best-worst scaling experiment to prioritize caregiver concerns about ADHD medication for children.

The objective of this feasibility study was to develop and pilot an instrument to elicit caregivers' priorities when initiating attention-deficit hyperactivity disorder (ADHD) medication for their child. A best-worst scaling experiment was used to rank competing priorities when initiating ADHD medicine. Forty-six participants were recruited for a two-phase study involving survey development (phase 1, N=21) and the survey pilot (phase 2, N=25). Best-worst scores and 95% confidence intervals indicating the relative importance of 16 concerns were determined, and t tests were used to determine the scores' significance. The significance of best-worst scores for most concerns indicated that the choices were purposeful. Concerns about helping the child become a successful adult, having a doctor who addresses caregivers' concerns, and improving school behavior were ranked highest. The best-worst scaling method can elicit priorities for children's mental health treatment. Future work using this method will guide family-centered care.

Clinically significant behavior problems among young children 2 years after the Great East Japan Earthquake.

BackgroundOn March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake.MethodParticipants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems.ResultsRates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10–5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area.ConclusionsOne in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.

HEAD START ENROLLMENT AND CHILDREN'S MENTAL HEALTH TREATMENT

This secondary data analysis from a Head Start program examines the association between children's entry age and enrollment duration and the likelihood of mental health treatment. Study questions are as follows: (a) Do baseline characteristics differ among three groups of Head Start children? (children who enrolled at 3 years of age and stayed for 1 year [group 1], enrolled at 4 years of age and stayed for 1 year [group 2], and enrolled at 3 years of age and stayed for 2 years [group 3]); (b) Does the likelihood of children's mental health treatment differ among the groups?; and (c) Are baseline characteristics associated with the likelihood of mental health treatment? Except ethnicity and family size, other baseline characteristics did not differ across the three groups. Groups 1 and 3 received more mental health treatment than group 2. Different percentages of mental health treatment were found, depending on children's gender, ethnicity, family income, special needs, and bilingual status.

Evaluation of the known behavioral heterogeneity in conduct disorder to improve its assessment and treatment.

Conduct Disorder (CD) is among the most highly represented diagnostic problems in child and adolescent mental health treatment settings. There is a great deal of heterogeneity within the CD category, with potentially important implications for case conceptualization and treatment. The current review sought to detail forms of heterogeneity within CD, including callous-unemotional traits, comorbid Attention-Deficit Hyperactivity Disorder (ADHD), aggressive and nonaggressive antisocial behavior, and age of onset. The current review summarizes research on etiological factors, correlates, and trajectories associated with distinguishable dimensions of CD, and considers how this heterogeneity should be incorporated into the assessment and treatment of CD. Callous-unemotional traits have been associated with a more severe and persistent form of CD, as have comorbid ADHD and child-onset CD. Aggressive antisocial behavior is a stable behavioral dimension that emerges in early childhood and is associated with high levels of neuroticism. Nonaggressive antisocial behavior demonstrates specific associations with impulsivity, is most frequent during adolescence, and evidences more moderate levels of stability. Conduct disorder is a highly heterogeneous disorder. Although the clinical implications of this heterogeneity are discussed, future research is clearly needed to shore up our understanding of the clinical ramifications of the sub-dimensions within CD.

Modeling Parenting Programs as an Interim Service for Families Waiting for Children's Mental Health Treatment

Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E–Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E–Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.

School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial.

BackgroundArmed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim).MethodsWe conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention.ResultsNo main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes.ConclusionsGiven inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings.Trial registrationThe study was registered as ISRCTN42284825

Shared decision-making, stigma, and child mental health functioning among families referred for primary care–located mental health services.

There is growing emphasis on shared decision making (SDM) to promote family participation in care and improve the quality of child mental health care. Yet, little is known about the relationship of SDM with parental perceptions of child mental health treatment or child mental health functioning. The objectives of this preliminary study were to examine (a) the frequency of perceived SDM with providers among minority parents of children referred to colocated mental health care in a primary care clinic, (b) associations between parent-reported SDM and mental health treatment stigma and child mental health impairment, and (c) differences in SDM among parents of children with various levels of mental health problem severity. Participants were 36 Latino and African American parents of children (ages 2-7 years) who were referred to colocated mental health care for externalizing mental health problems (disruptive, hyperactive, and aggressive behaviors). Parents completed questions assessing their perceptions of SDM with providers, child mental health treatment stigma, child mental health severity, and level of child mental health impairment. Descriptive statistics demonstrated the majority of the sample reported frequent SDM with providers. Correlation coefficients indicated higher SDM was associated with lower stigma regarding mental health treatment and lower parent-perceived child mental health impairment. Analysis of variance showed no significant difference in SDM among parents of children with different parent-reported levels of child mental health severity. Future research should examine the potential of SDM for addressing child mental health treatment stigma and impairment among minority families.