Developing empathy in school staff through emotional first aid

Anxiety problems are common in children, yet few affected children access evidence-based treatment. Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems. This study aimed to establish whether therapist-supported, digitally augmented, parent-led cognitive behavioural therapy (CBT) could increase the efficiency of treatment without compromising clinical effectiveness and acceptability. We conducted a pragmatic, unblinded, two-arm, multisite, randomised controlled non-inferiority trial to evaluate the clinical effectiveness and cost-effectiveness of therapist-supported, parent-led CBT using the Online Support and Intervention (OSI) for child anxiety platform compared with treatment as usual for child (aged 5-12 years) anxiety problems in 34 Child and Adolescent Mental Health Services in England and Northern Ireland. We examined acceptability of OSI plus therapist support via qualitative interviews. Participants were randomly assigned (1:1) to OSI plus therapist support or treatment as usual, minimised by child age, gender, service type, and baseline child anxiety interference. Outcomes were assessed at week 14 and week 26 after randomisation. The primary clinical outcome was parent-reported interference caused by child anxiety at week 26 assessment, using the Child Anxiety Impact Scale-parent report (CAIS-P). The primary measure of health economic effect was quality-adjusted life-years (QALYs). Outcome analyses were conducted blind in the intention-to-treat (ITT) population with a standardised non-inferiority margin of 0·33 for clinical analyses. The trial was registered with ISRCTN, 12890382. Between Dec 5, 2020, and Aug 3, 2022, 706 families (706 children and their parents or carers) were referred to the study information. 444 families were enrolled. Parents reported 255 (58%) child participants' gender to be female, 184 (41%) male, three (<1%) other, and one (<1%) preferred not to report their child's gender. 400 (90%) children were White and the mean age was 9·20 years (SD 1·79). 85% of families for whom clinicians provided information in the treatment as usual group received CBT. OSI plus therapist support was non-inferior for parent-reported anxiety interference on the CAIS-P (SMD 0·01, 95% CI -0·15 to 0·17; p<0·0001) and all secondary outcomes. The mean difference in QALYs across trial arms approximated to zero, and OSI plus therapist support was associated with lower costs than treatment as usual. OSI plus therapist support was likely to be cost effective under certain scenarios, but uncertainty was high. OSI plus therapist support acceptability was good. No serious adverse events were reported. Digitally augmented intervention brought promising savings without compromising outcomes and as such presents a valuable tool for increasing access to psychological therapies and meeting the demand for treatment of child anxiety problems. Department for Health and Social Care and United Kingdom Research and Innovation Research Grant, National Institute for Health and Care (NIHR) Research Policy Research Programme, Oxford and Thames Valley NIHR Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.

Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

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. …

Aims and method Community forensic mental health services (CFMHS) in England were developed to reduce reliance on hospital care for this population, but provision varies. It is unclear whether standard setting work has increased consistency. Freedom of information requests were therefore sent to 50 National Health Service Trusts in England, to examine the population, staffing, treatment provision and organisation of CFMHS. Results Data were provided for 32 CFMHS, of which 59% were part of secure hospital-based services and 41% were standalone services working in parallel with general services. There was variation in aspects including professional composition, functions, the settings from where CFMHS accept referrals and long-term approach to patients subject to special restrictions under the Mental Health Act 1983. Clinical implications CFMHS continue to vary, especially in their interface with services other than forensic hospitals. This may impede standard setting and empirical evaluation. Different approaches to centralising oversight may be needed for standardisation.

There have been several reports of inequalities for ethnic minoritised service users across National Health Service mental health services in the United Kingdom. This research aims to explore the perspectives and experiences of young people from ethnic minoritised groups accessing psychological therapy in a National Specialist Child and Adolescent Mental Health Service in England. Semi-structured interviews were conducted to investigate how young people perceived their ethnicity and how it was considered during psychological therapy. Nine young people were interviewed, and a thematic analysis was conducted. Qualitative analysis revealed five themes: (1) adolescence, ethnicity, and identity; (2) ethnicity as a meaningful part of the therapeutic intervention; (3) therapeutic alliance to facilitate dialogue; (4) aversion to ethnicity exploration; and (5) treading lightly: a fine line between sensitive and overly cautious. The study illustrated the complexity of considering ethnicity in therapy due to conflicting views and preferences and the need for further research.

This is a well-written and readable volume with contributions from psychologists, psychiatrists, social workers, solution-focused and psychodynamic psychotherapists, and others in child and adolescent mental health services in England.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

There is emerging evidence that sea swimming can have a positive impact on the mental health of adults. Less is known about how this intervention can impact young people's mental health. The aim of this study was to explore young service users and staff's perspectives on sea swimming in the child and adolescent mental health services. Fourteen participants were interviewed (eight young people and six staff members). Data were analysed using reflexive thematic analysis and five themes were identified. A preference for sea swimming was demonstrated by young people in comparison to other therapies. Young people reported an enhanced (and sustained) sense of well-being after sea swimming. They were able to relate the act of entering cold water to their recovery journey, acknowledging the importance of leaving their comfort zone. A sense of social cohesion was also described. Staff members acknowledged the risks of open sea swimming but highlighted the importance of positive risk taking, given the benefits of this novel intervention. Owing to the positive impact sea swimming can have on the physical and psychological health of young people, there is potential for this novel intervention to be used more frequently within the services.

Social media has become inseparable from every young person's life in today's digital age, especially in Generation Z. However, overexposure to standards of achievement characterized by success indicators displayed on various social media platforms can harm young people's mental and emotional health. Indicators of success on social media often create feelings of anxiety, low self-esteem, and social anxiety, especially with comparisons to others' achievements on social media that seem idealized and unattainable and worry about the future. This study aims to identify the adverse effects of social media success indicators on young people's mental health and provide a deeper understanding of the impact of these issues. The methods used in this study were questionnaires, netnographic observations, and a literature review focusing on the social media exposure of Generation Z, aged 18 - 24. The data collected revealed the behavioral patterns and perceptions of Generation Z towards expectations on social media. In addition, the results of this study can be recommended to find practical steps so that Generation Z is not easily influenced by indicators of success and achievement of others only seen on social media. By providing a perspective on the use of social media, this research seeks to help Generation Z develop their inner talents and not get hung up on the often unrealistic standards of achievement in life through educational campaigns on social media.

AimsMental health issues in children and young people are a growing concern and the benefits of intervening early are well established for many mental health problems, but existing Child and Adolescent Mental Health Services (CAMHS) are often over-stretched with variable waiting times for assessment. Many children also have problems which do not reach the referral thresholds and parents are left to find advice elsewhere. Existing resources for parents are scattered across many different websites and therefore difficult to access both for parents and professionals working with young people. With this in mind, and in consultation with CAMHS Bristol and many other stake-holders (including parents themselves) we designed an easily navigable website intended as a single comprehensive portal of resources for parents of children with mental illness and difficulties.MethodQualitative research methods were used to gather information about how the website should be designed and also to gather feedback once the website was live. Focus groups were performed with parents/carers and stakeholder discussions took place to inform the design of the website. Once the website was live, surveys via a Survey Monkey link on the website and Google Analytics were used to evaluate the website.Result60,000 users have utilised the website since the launch in March 2019. Two thirds of users are women and one third are men. Most popular webpages that are visited are primary, secondary, help-in -a-crisis and self-help for young people. Positive feedback has been collected from both parents/carers and service providers. The website has continued to develop and is now a registered charity and has received community lottery funding, which will allow for further evaluation and developments.ConclusionHappyMaps has been successful in providing a single hub of information for parents/carers, GPs, CAMHS workers and teachers. Future work involves evaluating the website and attracting interest from other CAMHS teams and professionals in other areas of the UK so that they can create HappyMaps sections for their populations.

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.

1. Mental Health Services for Children, Adolescents and Families: Trends, Models, and Current Status. Ric G. Steele and Michael C. Roberts. 2. Mental Health Services for Young Children. Diane Powell and Glen Dunlap. 3. School Psychology Services. Steven W. Lee and T. Rene Jamison. 4. Providing Services Within a School-Based Intensive Mental Health Program. Anne K. Jacobs, Camille Randall, Eric M. Vernberg, Michael C. Roberts and Joseph E. Nyre. 5. Inpatient Pediatric Consultation-Liaison: Applied Child Health Psychology. Bryan D. Carter and Renee T. von Weiss. 6. Mental Health Services for Children in Pediatric Primary Care Settings. Terry Stancin. 7. Providing a Range of Services to Fit the Needs of Youth in Community Mental Health Centers. Julianne M. Smith-Boydston. 8. Outpatient - Private Practice Model. Bernadette M. Landolf. 9. Inpatient Treatment Models. Luis A. Vargas, and Artemio de Dios Brambila. 10. Child Abuse Prevention and Intervention Services. Michelle R. Kees and Barbara L. Bonner. 11. Services to Prevent Sexually Transmitted Diseases in Adolescents. Beth A. Auslander, Mary B. Short, and Susan L. Rosenthal. 12. Treatment Services for Adolescent Substance Abuse. Beverly Pringle. 13. Targeted Prevention of Antisocial Behavior in Children: The Early Risers 'Skills for Success' Program. Michael L. Bloomquist, Gerald J. August, Susanne S. Lee, Barrie E. Berquist, and Robin Mathy. 14. Implementing Effective Youth Violence Prevention Programs in Community Settings. Patricia A. Graczyk and Patrick H. Tolan. 15. Adolescent Sex Offender Programs. William D. Murphy, Jacqueline Page, and Rebecca Ettelson. 16. Rural Mental Health Services. David L. Fenell and Alan J. Hovestadt. 17. Mental Health Services for Children with Chronic Illness. Ann M. McGrath and Ngan Vuong. 18. Psychological Services forChildren and Families who are Homeless. Mary E. Walsh and Julie Heim Jackson. 19. Telehealth/Internet Services for Children, Adolescents, and Families. Heidi J. Liss. 20. Therapeutic Camping Programs. Keri J. Brown. 21. Implementation of the Felix Consent Decree in Hawaii: The Impact of Policy and Practice Development Efforts on Service Delivery. Bruce F. Chorpita and Christina Donkervoet. 22. Emergency Services and Disaster Relief. Gilbert Reyes. 23. Program Evaluation Approaches to Service Delivery in Child and Family Mental Health. Michael C. Roberts and Ric G. Steele. 24. Large Scale Evaluations of Children's Mental Health Services: The Ft. Bragg and Start County Studies. Leonard Bickman and Shelagh Mulvaney. 25 Methodological Challenges in the National Evaluation of the Comprehensive Community Medical Health Services for Children and their Families Program. E. Wayne Holden, Robert L. Stephens, and Rolando L. Santiago. 26 Future Service Organization and Research Agenda

BackgroundSince the economic recession began in 2008 anecdotal reports suggest that mental health services in England have experienced disinvestment, but published data to test this proposition are few.MethodThis paper presents information from a wider range of official, research and grey literature sources aiming to: (1) assess whether governmental investment in publically funded mental health services has declined since the start of the economic recession in 2008; (2) to assess whether relative changes in mental health service investment over this period were or were not similar to trends in national investment in services for people with physical disorders, and (3) to interpret these findings in terms of met and unmet population levels needs for mental health care.ResultsThe key findings are that: across England social service expenditure reductions have led to a decrease of 48 % in the number of people with mental illness who receive such care, while direct NHS expenditure was reduced in some local areas by up to 32 %.ConclusionsThe results of this overview suggest that there have been substantial reductions in the resources dedicated to mental health treatment and care in England since 2008, that such reductions seem not to have been applied to physical health services, and that these findings appear to run counter to the government policy of ‘parity of esteem; for mental and physical healthcare.

Objective: This article reports some of the main findings from the recent national survey of the mental health and well-being of children and adolescents and considers its implications. Conclusions: There is a high prevalence of mental health problems in Australian children and adolescents, and these have a significant impact on sufferers and their families. We will need to collect ongoing data about child and adolescent mental health to monitor the effectiveness of our response to these problems. ADHD is surprisingly common and greater attention needs to be given to research on ADHD in Australia. The resources devoted to child and adolescent mental health services are currently not adequate or equitable and need boosting, as do efforts to increase primary mental health care for this population. Whole population and selected prevention and early intervention approaches offer the most logical method for lowering the prevalence and burden of disorder. Community education for parents, and a boost to research and training in child and adolescent mental health is required if we are to make a difference.

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used. Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents. Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis. Findings: The overall theme identified in the study consists of ‘striking a balance between strictly following the manual and meeting the students’ needs’. Three subthemes emerged: ‘doing good and sowing seeds for the future’, working with insufficient tools, and ‘personal development as a professional and as an individual’. Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.