Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review.

Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness

New Frontiers in the Treatment of Perfectionism

Perfectionism can present as a clinical problem in its own right or it can interfere with the successful treatment of Axis I disorders. In the past 15 years, a cognitive behavioral analysis of “clinical perfectionism” has been proposed. This approach and the measurement of the construct of clinical perfectionism have proved controversial. Nevertheless, the approach has experimental support and clinical utility; the derived treatment has been shown to lead to significant improvement on both measures of perfectionism and Axis I disorders. The cognitive behavioral intervention for perfectionism has been evaluated in a range of formats (group, individual, face-to-face, and online) and all show promise. Further work is required to address clinically important questions such as when to treat clinical perfectionism if it occurs in the context of single and multiple Axis I disorders

A Randomized Controlled Trial Evaluating the Effectiveness of Face-to-Face and Digital Training in Improving Child Mental Health Literacy Rates in Frontline Pediatric Hospital Staff

Background: Children with chronic physical health conditions are up to six times more likely to develop a mental health condition than their physically well peers. Frontline pediatric hospital staff are in a good position to identify mental health problems and facilitate appropriate support for patients. To date, no evaluation of mental health literacy training has taken place with this professional group to enable early identification of difficulties. It is also not known whether face-to-face or digital training is more effective or preferable in this setting. To improve the skills of frontline hospital staff, a face-to-face and digital mental health literacy training course was delivered using MindEd content and evaluated in a randomized controlled trial. / Method: Two-hundred and three frontline staff across different professions from a tertiary pediatric hospital were randomized to a face-to-face (n = 64), digital (n = 71), or waitlist control group (n = 68). Face-to-face training was two and a half hours and digital training took ~1 h. The effects of training were evaluated pre- and post-training and at two-week follow-up. Questionnaires assessed mental health knowledge, stigma, confidence in recognizing concerns and knowing what to do, actual helping behavior, as well as training delivery preference, completion rate, and satisfaction. / Results: Both face-to-face and digital training increased mental health knowledge, confidence in recognizing mental health problems and knowing what to do compared to waitlist controls. Digital training increased actual helping behavior relative to the waitlist controls and stigma decreased across all groups. Staff were satisfied with both delivery methods but preferred face-to-face training. / Conclusions: The results provide promising findings that digital content is an effective way of improving mental health literacy in frontline pediatric hospital staff. Providing digital training could be a time-efficient way of upskilling non-mental health professionals to identify mental health needs in a pediatric population and facilitate access to appropriate care

Child mental health literacy training programmes for professionals in contact with children: A systematic review

AIMS: There has been a surge in child mental health literacy training programmes for non-mental health professionals. No previous review has examined the effectiveness of child mental literacy training on all professionals in contact with children. METHODS: Studies were identified through a systematic literature search of the Cochrane, EMBASE, Medline, and PsycINFO databases in February 2019. The review included studies that delivered training to professionals who have regular contact with young people aged 0 to 19 in the context of their role and at least one component of mental health literacy; (a) knowledge, (b) attitudes, (c) confidence in helping, (d) intention to help and (e) actual helping behaviour. The quality of papers was reviewed using the Cochrane revised Risk of Bias Tool for randomized controlled trials (RCTs) and the Integrated Quality Criteria for the Review of Multiple Study Designs for non RCTs. RESULTS: Twenty-one studies met eligibility criteria (n = 3243). There was some evidence that global and specific child mental health literacy training improved professionals' knowledge and stigma-related attitudes towards mental health. Few studies investigated the impact of training on actual helping behaviour. CONCLUSION: There may be value in providing child mental health literacy training to professionals in contact with children, however there is a need for studies to evaluate the long-term impact of such training, particularly on subsequent access to appropriate support. Findings raise concerns about the quality of the studies reported in the systematic review and recommendations are made for future studies

The transdiagnostic process of perfectionism

The transdiagnostic approach to theory and treatment of psychological disorders is gaining increasing interest. A transdiagnostic process is one that occurs across disorders and explains their onset or maintenance. The purpose of this review is to provide evidence that perfectionism is a transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessive compulsive personality disorder and somatoform disorders. Data are also reviewed to show that perfectionism can explain aetiology as it is a prospective predictor of depression and eating disorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxiety disorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism. Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitive behavioural therapy which results in reduction in psychopathologies. Clinical guidelines are outlined to assist in treatment planning for individuals with elevated perfectionism

An investigation into the psychosocial impact of therapeutic recreation summer camp for youth with serious illness and disability

OBJECTIVES: This study aimed to evaluate the impact on emotional, social, physical and educational functioning of a therapeutic recreation camp provided by ‘Over The Wall’, a UK charity for children and young people with chronic illness or disability. METHOD: Two hundred and sixty four people registered to attend camp were sent the Pediatric Quality of Life Inventory version Child Self-Report Scale before camp, immediately after camp, 1 month after camp and 3 months after camp. RESULTS: Of those invited to participate, 178 children completed the pre-camp survey (67% response rate). Of those, 105 completed both the post-camp 1 and pre-camp questionnaires (59% of pre-camp respondents), and 60 of those participants subsequently completed the 1-month post-camp questionnaire as well (34% of pre-camp respondents). Only 32 participants completed the 3-month follow-up data (18% of pre-camp respondents). Across the first three timepoints (pre-Camp, post-Camp and 1 month follow-up), a repeated measures ANOVA indicated a significant improvement in emotional and social functioning, but not physical or school functioning (p < 0.05). Post-hoc analyses on pre-camp and post-camp scores revealed small-medium effect sizes of 0.317 and 0.272 for emotional and social functioning, respectively. DISCUSSION: The therapeutic recreation summer camp provided for children and young people with health challenges had a significant, positive impact on emotional and social functioning. Such camps can therefore be considered as having empirical support for their aims. Further work is warranted to increase the response rate to establish the longer term impact of the camps and the wider impact of the camps on the wider family

What factors influence healthcare professionals to refer children and families to paediatric psychology?

Objectives: This study aimed to investigate factors influencing referral of children with physical illness to paediatric psychology. Due to high rates of mental health problems within this population, studies have shown that referral to paediatric psychology should be increased. However, few studies have examined factors shaping healthcare professionals’ referral behaviour. Methods: The current study used the theory of planned behaviour to develop a questionnaire which explores factors influencing the referral of children and families to paediatric psychology. Psychometric properties of the questionnaire were examined. Results: The questionnaire was found to have good reliability and validity. The main constructs of the theory of planned behaviour were useful in predicting intention to refer to paediatric psychology. Specific beliefs about referral were shown to influence intention to refer. Conclusions: Findings suggest that individual attitudes and beliefs can impact healthcare professionals’ referral behaviour, indicating that multidisciplinary interventions and inter-professional education relating to the psychological aspects of illness are required

An Investigation of the Information Provided to the Parents of Young People with Mental Health Needs on an Internet Forum

Background: Access to Children and Adolescent Mental Health Services (CAMHS) can be difficult, with lengthy wait times. Many of the young people and their parents are not signposted to any form of support during their wait for initial assessment or treatment and people are increasingly turning towards web-based resources for help and advice. However, there are some concerns about the quality of the information shared online. Research on the use and quality of information shared on online platforms for mental health inquiries is limited. Aims: We aimed to investigate the content and quality of the responses shared by forum users on an online forum for parents of young people with mental health needs (Mumsnet ‘Talk’). Forum users were primarily parents, but 8 posts were written by posters identifying as a healthcare worker, teacher, or autism spectrum specialist. Methods: Qualitative methodology was adopted for this study. Forum content from Mumsnet was extracted in an anonymised form and thematic analysis was conducted to explore the content. Information shared in the online forum was assessed for quality by comparing the responses with clinical guidelines. Results: Thread topics related to 16 mental health problems. “Autistic Traits/Autism Spectrum Disorder”, “Obsessions and Intrusive Thoughts/ Obsessive Compulsive Disorder” and “Comorbid Anxiety and Depression” were the most prevalent thread topics, consisting 38.3% of the extracted content. The investigation focused on “Information Offered” as the general dimension. Based on the thematic analysis, there were four second-order themes regarding the information offered by forum users; referral, advice, anecdotal information and opinion on case. The quantitative assessment of responses found that 58.3% of the knowledge exchange on Mumsnet was congruent with evidence-based clinical guidelines. Conclusions: Themes indicate that parents of children and young people with mental health needs seem to use online fora for informational support. It is promising that a significant proportion of the information shared within the extracted forum content is congruent with evidence-based knowledge. However, further investigation is needed to generate better understanding of the overall quality of mental health information available on online platforms

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research