Highlights in child mental health research: March 2020

Highlights:

• This review synthesises existing knowledge on two key components of child maltreatment prevention: antecedents (i.e. risk factors) for child maltreatment and preventative interventions.

• The study reviewed and synthesised 19 meta-analyses that included almost 1.5 million participants (an umbrella synthesis approach was used). Meta-analyses over a 5-year time-period ending in December 2018 were included.

• The review identified the following categories of risk factors for child maltreatment from a total of 11 meta-analyses:
  • Parents having experienced child maltreatment themselves during childhood i.e. “intergenerational transmission of maltreatment” (p. 279).
  • Parental exposure to intimate partner violence
  • A parental personality that was that was aggressive and dependent.
  • Families being of a low socio-economic status

• “The intergenerational transmission of child maltreatment…[was] one of the most robust effects emerging” from the synthesis (p. 282). But it is important to highlight that “many parents maltreated in childhood escape this cycle of abuse” (p. 282).
• From their review of 5 meta-analyses, the researchers found modest effectiveness for interventions targeting families at-risk of child treatment or families with self-reported child maltreatment.
• While the study identified multiple risk factors for child maltreatment, the researchers nevertheless highlight the need for further research given ongoing large knowledge gaps in this area.
• van IJzendoorn and colleagues (2020) also argue that additional research is needed to develop effective interventions, especially those that break the cycle of child maltreatment. They emphasise the need to develop preventative interventions for the prenatal period, especially given that parenting can begin from pregnancy.

• The risk factors identified in this study may assist practitioners, service providers, and policy makers in targeting interventions to optimise child well-being and prevent child maltreatment.

• The article proposes the need to experimentally test preventative interventions that target socioeconomic circumstances of low-income families, particularly given that this appears to be a strong risk factor for child maltreatment. Proposed examples include universal healthcare, making education more affordable, providing parental leave that is paid, and increasing the numbers of available jobs with increased income.
• van IJzendoorn and colleagues (2020) suggest that policy (both social and economic) can play an important role in addressing socio-economic factors to reduce child maltreatment.

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Highlights:

• This small, qualitative study sought the views of looked after children and young people (i.e. children in out-of-home care) on what makes them feel happy or unhappy and what they view as contributors to their well-being.
• The study also sought to compare the views of children with the views of professionals on the above themes.
• Focus groups were conducted separately with children (14 participants) and professionals (11 participants).
• Professionals included frontline practitioners (social and health care), managers, and policy-makers.
• The children who participated (aged 11 to 18 years) were currently in care or were about to leave care. All children were members of the local Looked After Children Council (LAC).
• Key findings from the children’s focus group included:
  • Children identified an extensive range of hobbies, activities and behaviours that made them feel happy.
  • “By far the greatest source of happiness and unhappiness identified by children (and professionals) was the young person’s relationship with family in its widest sense, going beyond parents and carers” (e.g., grandparents, uncles, aunts, cousins).
  • Networks and relationships with friends were also important sources of happiness.
  • Feelings of unhappiness were also strongly associated with change, including placement disruptions/moves and moving schools.
• Overall, “the study found significant differences between the views of children and professionals in both the range and emphasis of what is seen as important” (p. 20). One example of differing views was that children talked extensively about their activities and hobbies as a source of happiness, which was very different to professionals’ emphasis on stability as a source of children’s happiness.
• Assumptions made by adults were often not tested through discussions with children themselves when important decisions were being made. That is, decisions appeared to be about children rather than occurring with children.
• Given that the small qualitative nature of this study, it must be recognised that the generalisabilty of the current findings to the broader population of children in out-of-home care is Nevertheless, the study does offer some important practice implications for consideration (p. 34):
  • Children in out-of-home care and professionals can have different views on what makes children happy – and which of these factors are most important. Hence it appears critical that practitioners engage in meaningful discussions with children about the factors that contribute to their happiness and well-being.  This may also assist with identifying potential strategies to optimise mental health.
  • Practitioners may wish to consider incorporating activities and hobbies identified by children into their care plans to promote well-being. Strategies that aim to support and preserve networks with friends and wider family could also be considered.
  • More generally, this study adds further support for upholding the rights of children and young people to actively and meaningfully participate in discussions, plans, and decisions about their lives. This includes children in out-of-home care.

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Highlights:

• This systematic review synthesises evidence for various occupational therapy interventions targeting children and youth who have, or who are at risk of, mental health concerns.

• The interventions were either occupation-based or activity-based; that is, they consisted of “active participation” of children (Cahill et al., 2020, p. 1). Included interventions were also required to address concerns of children and youth that were related to mental health, social participation, and behaviour (i.e. the outcomes of interest).

• 62 studies from January 2010 to March 2017 met criteria for inclusion in the review. Study participants were aged 5 to 21 years.

• Key findings included:
  • There was moderate evidence to support the use of yoga across all outcomes (i.e. mental health, positive behaviour, and social participation).
  • There was moderate evidence to support the use of creative arts to improve mental health. There was also moderate evidence for the use of productive occupations and life skills training (e.g. self-care, organisation, graded engagement in occupations).
  • There was strong evidence supporting the use of sports to improve social participation and moderate evidence for positive behaviour. Evidence for mental health was of low-strength.
  • There was low-strength evidence for the use of meditation, computer and video games, and outdoor groups and camps to improve mental health outcome.

• The researchers conclude that their review contributes “additional support for the use of activity-and occupation-based interventions to improve the behaviour, social participation, and mental health of children and youth” (Cahill et al., 2020, p. 1).
• Cahill and colleagues (2020) suggest that occupational therapists should carefully determine the most appropriate intervention for individual clients based on the target outcome to ensure that the most effective support is delivered.

• While these interventions are not unique to occupational therapy practice, occupational therapists can certainly use them, including to assist with appropriately incorporating them into children’s daily lives.
• This study highlights the potential for interventions that do not involve psychotherapy or pharmacotherapy to also have positive effects on children’s mental health, as well as on their social and behavioural functioning.

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Highlights:

• ‘Think-family’ approaches to paediatric healthcare are those that treat child and parent/carer “health, well-being and behaviour…[as] inter-related” (p. 21). That is, both the child and parent/carer are considered in assessments of need, service provision, and intervention.
• ‘Think-family’ approaches are also referred to as ‘family-centred’, ‘whole-family’ or ‘child-centred’ approaches (p. 21).
• This scoping review of ‘think-family’ approaches synthesised data from 62 studies in order to produce a ‘think-family’ typology (i.e., types of approaches).
• The review identified “three key mechanisms” as underpinning think-family interventions and these were often combined together. These mechanisms were:
  • Screening of children and/or parents to assist with needs detection – This was predominantly used to detect family and domestic violence, parental mental health needs, and parental substance misuse.
  • Promotion of health literacy through giving parents educational information to support them with understanding and managing their child’s health and their own.
  • Focusing on relationships and communication at the “heart of the intervention,” as well as considering relationships as a potential mechanism for change. Examples of relationships include parent-professional, family-professional, and parent-peer.

• While the researchers acknowledge that “helping the child through addressing parental psychosocial health needs may be a good starting point for policy-makers and practitioners…care should be taken to ensure that the adult’s needs do not eclipse and obscure those of the child” (p. 32).
• Woodman and colleagues (2020) also highlight the need for careful consideration of other unintentional potential harms that may arise from ‘think-family’ approaches, such as “pathologising parents,” responding in a way that may be “discriminating and punitive” towards some parent groups, and “scaring” parents away from services (p. 32).
• Despite the above considerations, it still appears pertinent that practitioners, organisations, and policy-makers develop and evaluate strategies that aim to incorporate therapeutic practitioner-parent relationships into healthcare, including child mental health care.

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