Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

Background: The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment. Methods: The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention. Results: Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC. Limitations: The small sample size and lack of an active control group were the major limitations of this study. Conclusions: This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country

Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

Background: The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment. Methods: The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention. Results: Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC. Limitations: The small sample size and lack of an active control group were the major limitations of this study. Conclusions: This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country

Effectiveness of the Super Skills for Life (SSL) programme in enhancing children’s emotional wellbeing, emotional regulation and cognitive control: a randomized controlled trial study in Mauritius

Background: Emotional problems in childhood and adolescence are serious global health care issues in today’s society (Merikangas et al., 2010). According to numerous recent epidemiology studies, emotional problems such as anxiety and depression are the most common mental health problems in childhood and adolescence (Costello et al., 2003), affecting 15 to 32 % of children and adolescents (e.g. Essau et al., 2000; Merikangas et al., 2010). This high prevalence of emotional problems among children and adolescents is concerning. When left untreated, emotional problems that begin early in life tend to be chronic and have a negative course (Kessler et al., 1994) and serve as a risk factor for other mental disorders in later life (Essau et al., 2014). This picture is even more complex for children who are looked after by the state. Higher rates of mental health problems and emotional and behavioural difficulties have consistently been found in looked after children (Minnis et al., 2006; Sempik et al., 2008). The number of children admitted in childcare institutions in low- and middle- income countries (LMICs) is increasingly alarming (UNICEF, 2009). There’s strong evidence that institutionalisation not only affects the child’s mental health and wellbeing, but can have a detrimental effect on a child’s ability to form attachments and relationships and thus affect their emotional and mental health further (Arrons et al., 2010; Leathers, 2002). Nonetheless, availability and access to youth mental health services in both non-clinical and clinical settings in LMICs are limited and grossly inadequate (Saxena et al., 2011). Evidence-based treatment approaches for these young people in LMICs have received little empirical attention. Various anxiety and depression prevention programmes based on cognitive behavioural therapy (CBT) have been evaluated in high incomes countries, however, there are no such programmes in the low-income island of Mauritius. Aim(s): Therefore this study will use an established transdiagnostic anxiety and depression prevention programme called Super Skills for Life (SSL; Essau et al., 2014) which involves social skills training, behavioural activation, video feedback and cognitive preparation to measure factors that predict and mediate treatment outcome among children and adolescents in institutional care settings. A recent feasibility study of the SSL programme for children in institution care settings has been found to be feasible to the Mauritian children and adapted to their individual cultural and social backgrounds. A randomized controlled trial (RCT) with waitlist control group design to measure the effectiveness of the SSL intervention was used to establish the intervention as an evidence-based treatment for emotional problems in children and adolescents in care institutions in Mauritius. Methods: 100 young people aged between 9 to 15 years from six institutional care settings in Mauritius were randomly assigned to the 8 sessions of the SSL intervention programme (n=50) or to a waitlist control group (n=50). The waitlist group received the intervention after the experimental group completed the intervention. Participants in both groups were assessed before, after and 3 months post the SSL intervention programme. The primary outcomes measured psychological difficulties in five sub-scales of emotional symptoms, conduct problems, hyperactivity/inattention, peer-relationship problems, and prosocial behaviour. Levels of anxiety and depression were measured using the revised children’s anxiety and depression scale which produced a total anxiety and low mood score and separate scores for each of the subscales of separation anxiety; social phobia; generalised anxiety; panic; obsessive compulsive; total anxiety; and, low mood. Secondary outcomes included measures of self-esteem and cognitive emotion regulation strategies and online tasks measuring reaction time were used to assess cognitive inhibitory control and emotional attention bias. Results & Conclusion: Data analysis is still in process, however based on previous finding of SSL (Essau et al., 2014, 2019), reductions in anxiety and depression related symptoms and improvements in cognitive control and emotional regulation strategies at post treatment are expected. This RCT study is powered to detect the effectiveness of an anxiety and depression intervention programme, and will contributed to the evidence base for mental health provision for children and adolescents in Mauritius. It will have implications for stakeholders, including policy-makers, institutions for child welfare, practitioners working with children and most importantly to young people of Mauritius. Data analysis and writing up of this RCT study are currently being carried out