The Interactive Child Distress Screener: development and preliminary feasibility testing

Background Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. Objective The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. Methods This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. Results In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. Conclusions The ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children

Does diagnostic complexity predict response to online interventions for youth anxiety?

Purpose: There is now substantial evidence to demonstrate the efficacy of online, cognitive-behavioural therapy (CBT) for the treatment of youth anxiety disorders. However, approximately 30% of youth will retain an anxiety diagnosis at 12-months following treatment. There has been some suggestion that internet-based interventions may not be suitable for more complex diagnostic presentations, however, there has been no empirical examination of predictors of outcome for youth receiving online CBT. The aim of this paper was to determine whether diagnostic profile predicted response to online CBT for youth anxiety. Methods: Participants were 154 youth (aged 7 to 18 years) diagnosed with a principal anxiety disorder who participated in an online cognitive-behavior intervention (BRAVE-ONLINE) as part of two randomized controlled trials. Measures included diagnostic interviews as well as a number of self-report measures of anxiety. Youth receiving online CBT were assessed prior to treatment, at 12 weeks following baseline assessment, and at 12-month follow-up. Diagnostic profile at baseline is described by type of principal anxiety diagnosis, severity of anxiety and presence of comorbid anxiety and non-anxiety. Treatment outcome was conceptualized as treatment 'response' (loss of primary diagnosis) and as 'remission' (loss of all anxiety diagnoses/ symptoms). Results and Conclusions: Results indicate that the majority of youth respond well to online CBT at 12-month follow-up. Comorbidity with other anxiety disorders was the most robust predictor of poorer response and remission, however only for those youth with 3 or more comorbid anxiety disorders. While youth with comorbid anxiety do respond to internet interventions, it seems that the presence of multiple anxiety disorders may limit its impact. The findings of this study have the potential to identify the types of patients for whom online CBT may be most appropriate and the circumstances under which it should not be offered as first line of treatment

Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies.

Background There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. Objective This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. Methods Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). Results In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. Conclusions The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials

Stories from Queensland farmers: 'why we don't seek help for mental health'

Farming as an occupation and lifestyle has many inherent stressors and farmers demonstrate suicide rates twice that of the general population (Arnautovska, McPhedran, & De Leo, 2014). There are also reports that indicate farmers may show fewer help-seeking behaviours, although research to date has failed to uncover clear reasons for this. Mental health help-seeking includes behaviours directed towards seeking help from health professionals for issues relating to mental health or distress (Rickwood & Thomas, 2012); if this occurs in a timely manner then negative consequences may be minimised. There is an urgent need to identify factors specific to farmers that make mental health help seeking difficult. The research presented here is part of a program of research aiming to understand the barriers and facilitators of mental health help-seeking in farmers from regional communities. The present research draws on findings from semi‐structured interviews with 10 farmers residing in Queensland. The interviews were analysed drawing on the techniques of Braun and Clarke (2006). Several key factors were identified as having the potential to directly or indirectly influence mental health help-seeking including, the weather (with a strong focus on drought), finances, support, health services, mental health literacy and stigma. This paper discusses these factors from the farmer perspective. The findings from this study advance knowledge in understanding what factors may influence mental health help-seeking in Queensland farmers. The outcomes have implications for developing and providing intervention to reduce barriers, and reinforce or strengthen facilitators of mental health help-seeking in farmers

Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: a randomised controlled trial

Background All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder (HFASD) and therefore it is unknown whether these programs might be beneficial to HFASD children. The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder. Methods Forty-two HFASD children, aged 8–12 years, with an anxiety disorder, and their parents, were randomly assigned to either the BRAVE-ONLINE condition (NET) or a waitlist control (WLC). Diagnostic interviews and parent/child questionnaires were completed at pre-treatment, post-treatment and 3-month follow-up. Results At post- assessment, compared to children in the WLC condition, children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms, as well as significantly greater increases in overall functioning. However, loss of primary diagnosis in this sample was lower than in previous studies. Limitations The small sample size, coupled with attrition rates, makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators, moderators and predictors of outcomes. Conclusions The BRAVE-ONLINE program may be useful in reducing anxiety symptoms in HFASD children, although the effects are less strong than those found in neurotypical children for a variety of reasons

Implementation Strategies for Interventions Aiming to Increase Participation in Mail-Out Bowel Cancer Screening Programmes: A Realist Review

Background Bowel cancer is the third most commonly diagnosed cancer and the third most common cause of cancer-related death with 1,849,518 new cases of bowel diagnosed, and 880,792 deaths reported globally in 2018 alone. Survival can be improved through early detection via national mail-out bowel cancer screening programs; however, participation remains low in many countries. Behavior change is therefore required to increase participation. This realist review aims to (a) identify the behavior change techniques (BCTs) used in each intervention, (b) understand the mechanisms of action responsible for the BCTs effectiveness, and (c) apply a behavior change model to inform how behavior change techniques and mechanisms of action (MoA) can be combined to increase screening participation. Methods We systematically reviewed the literature for interventions aiming to increase participation in mail-out bowel cancer screening. We used a four-stage realist synthesis approach whereby; (1) interventions were extracted from each study; (2) BCTs applied in each intervention were identified and coded using the BCT taxonomy-v1; (3) the Theory and Techniques tool was used to link BCT to their mechanisms of action; and (4) BCT and MoA were categorized according to their effectiveness and what Health Action Process Approach (HAPA) stage of change they would affect. Results We identified 68 intervention trials using 26 unique BCTs and 13 MoA to increase participation. Sixteen BCTs and 10 MoA were identified within the interventions that successfully increased participation rates. Interventions targeting both stages of the HAPA model had a higher success rate (80%) than those targeting one stage of change (51%). When targeting only one stage, interventions targeting the volitional stage had a higher success rate (71%) than interventions only targeting the motivational stage of change (26%). Conclusion Importantly, this review identified a suite of BCTs and MoA that are effective for increasing participation in mail-out bowel cancer screening programs. With increased participation in bowel cancer screening leading to improved survival, our findings are key to informing the improvement of policy and interventions that aim to increase screening using specific strategies at key stages of health decision-making

Deciding to enrol in a cancer trial: A systematic review of qualitative studies

© 2020 Viljoen et al. Background: Clinical trials are essential for the advancement of cancer treatments; how-ever, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods: A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results: Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion: Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears simila-rities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials

Does diagnostic profile predict outcome for online CBT for youth anxiety?

Examine potential predictors of response to online CBT for youth anxiety •  Focus on diagnostic profile, Examine whether youth with more complex diagnostic profile are more likely to show poorer outcomes at 12-month follow-up, Is online therapy suitable for everyone

Farmers aren't seeking help for mental health: their partners tell us why

There are many stressors that impact on farmers and recent research has found that Queensland farmers’ rate of suicide is twice that of the general population (Arnautovska et al.,2014). It is reported that mental health help-seeking behaviour is lacking in farmers. Seeking help for mental health is seeking services from a health professional for distress or mental health issues (Rickwood & Thomas, 2012). Farmers’ partners reportedly have a role in the help-seeking of farmers, such as facilitation and support, and may also be able to offer insight into their mental health help-seeking behaviour (Doherty & Kartalova-O’Doherty, 2010; Kolves et al., 2012). There is an urgent need to identify factors specific to farmers that make mental health help seeking difficult, including those outside their awareness. The research presented is part of a program of research exploring the barriers and facilitators of mental health help-seeking in farmers from regional Queensland. The present research draws on semi-structured interviews with 10 partners of farmers, where the farmer resides in Queensland with farming as their occupation. The interviews were analysed drawing on the techniques of Braun and Clarke (2006). Several key factors were identified as having the potential to directly or indirectly influence mental health help-seeking, including the weather, mental health literacy, stigma, health services, farming lifestyle and ‘culture’, finances and coping mechanisms. Further, the key role partners play in the farmers’ help-seeking processes was also identified. This paper discusses these factors from the farmer’s partners’ perspective. The findings from this research advance the understanding of the factors that influence the mental health help-seeking of farmers, by including additional insight from a source close to the farmers. The implications of this research include that interventions could be developed and provided to reduce the barriers and reinforce or strengthen the facilitators of mental health help seeking in farmers, including factors that farmers themselves may not be aware of

Do family and maternal background matter? A multilevel approach to modelling mental health status of Australian youth using longitudinal data

Purpose: Most previous research place great importance on the influence of family and maternal background on child and adolescents’ mental health. However, age of onset studies indicates that the majority of the mental health disease prevalence occurs during the youth years. This study investigates the relationship of family and maternal background, as well as individual circumstance on youth mental health status. Method: Data from 975 participants and 4632 observations of aged cohort 15 to 19 years in the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal study were followed for 10 years (2007-2017). Multilevel logistic regression models were used to analyse the impact of youth circumstances on mental health status. Results: The findings suggests that not all dimensions of family and maternal background (especially maternal education) have impacts on youth mental health. We found low household income (AOR: 1.572, 95% CI: 1.017-2.43) and adverse living arrangement (AOR: 1.586, 95% CI: 1.097-2.294) significantly increases mental disorder odds whereas maternal education or occupation fixed effects were not significant. Individual level circumstances have much stronger impact on youth mental health. We found financial shock (AOR: 1.412, 95% CI: 1.277-1.561), life event shock (AOR: 1.157, 95% CI: 1.01-1.326), long term health conditions (AOR: 2.855, 95% CI: 2.042-3.99), smoking (AOR: 1.676, 95% CI: 1.162-2.416), drinking (AOR: 1.649, 95% CI: 1.286-2.114) and being female (AOR: 2.021, 95% CI: 1.431-2.851) have significant deteriorating effects on youth mental health. Conclusions: Our finding is in contrast to the majority of studies in the literature which give a preeminent role to maternal characteristics in child and youth mental health status. Mental health interventions should consider heterogeneity of adverse youth circumstances and health-related behaviours