Highlights in child mental health research: June 2021

Highlights

• This article suggests that household income plays a role in the cognitive, social-behavioural development and health of children, particularly in households that started with a low income.
• Fifty-four studies from the EU and OECD that use methods appropriate to finding a causal relationship between income and children’s outcomes (through Randomised Controlled Trials, quasi experiments or longitudinal data) form the basis of this study.

Key findings

• Income level shaped outcomes that are important for children’s development, including maternal mental health, parenting and the home environment.
• A majority of studies found a link between income and children’s educational attainment and cognitive development. Evidence also exists for the relationship between income and social-behavioural-emotional outcomes and physical health outcomes, although some studies have mixed findings regarding physical health outcomes.
• There is a clear relationship between income and early birth outcomes but the relationship between income and later health measures for children is less clear.
• A limitation of the included studies is that children’s own perspective is notably absent and indicators of emotional well-being are almost exclusively based on parent or teacher reports.

Implications

• Income in the period before birth is particularly important, but effects of parental income on educational and social-behavioural outcomes are also found for older children and teenagers.
• While 45% of the studies come from the US and may not always be generalisable to other contexts, the findings suggest that policies to support household income have a key role to play in any strategy to improve life chances for children from low-socio economic backgrounds.
• These results underline the potential for income support early in a child’s life to have lasting effects.

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Highlights

• The Glenelg Shire Council (Vic) maternal child health (MCH) services developed an approach to improve engagement with Aboriginal families with children from conception to 3.5 years, who are not engaged in MCH services, or who are at risk of difficulties.
• This paper assesses an Early Assessment Referral Links (EARL) as it was trialled between 2009–2014 and reports on an improved engagement of Aboriginal families in MCH services.

Key findings

• Regular meetings between stakeholders, in consultation with the Aboriginal community, helped identify families that were not engaged in MCH services and who required further assessment, intervention, referral and/or support.
• Participation of Aboriginal women and children in MCH services was consistently above the state average during the pilot period, rising from 54% to an average of 89% (Victorian state average of 57%).
• In the pilot period, there were increases in Aboriginal children being breastfed, fully immunised and attending early start kindergarten which gives eligible children 15 hours of free or low-cost kindergarten a week. Engagement with Aboriginal women at risk of vulnerabilities also improved with a dramatic increase in referrals for family violence and child protection, and decreased episodes of out-of-home care for children.
• There was an increase in the percentage of Aboriginal children fully immunised in the Glenelg Shire from 84% before the pilot to 97% by the fourth year into the pilot (state immunisation rates in the same period were 85% and 90% respectively).

Implications

• A streamlined referral system can increase engagement with Aboriginal families.
• Increased engagement with MCH services was associated with positive outcomes including increases in Aboriginal children being breastfed, fully immunised and attending a kindergarten program.
• Elements of a co-designed, strengths-based model allow for services to learn from and integrate Aboriginal childrearing practices in mainstream service provision.

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Highlights

• This paper examines risk and protective factors for two early markers of social-emotional development: attachment security and behavioural regulation mid-infancy.
• Meta-analytic and longitudinal studies were drawn on to develop 12 indicators that could predict infant behavioural regulation and attachment status between 12 and 18 months.

Key Findings       

• Caregiving responsiveness, maternal mental health, couple relationship, and socio-economic status as a contextual factor, were key risk and protective factors.
• Beyond very low birthweight and medical risk, evidence for infant-specific factors was weaker than those related to parental factors.
• Risk and protective categories from pregnancy to 10 months of age may optimise early screening of infant social-emotional development. Example categories include those in individual, caregiver/relational and contextual domains. These include:
  • Individual: Infant low engagement, prematurity/very low birthweight with major perinatal problems or infant medical and developmental conditions.
  • Caregiver/relational: timing and sensitivity of caregiving response, maternal PTSD related to grief and loss, marital and couple conflict, maternal mental health problems and co-morbidity, parenting stress.
  • Contextual: income, education, occupation, maternal age, and unstable and multiple substitute care arrangements.

Implications

• Findings from this review have may inform the development of reliable tools for early screening of infant social-emotional development prior to 18 months old.
• New population tools need to be well accepted by parents and community health nurses, developed and tested in partnership, and easy to administer.
• To ensure effectiveness, any screening tool would need to be readily linked with relevant supports and interventions.

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Highlights

• Drawing on data from the New South Wales Child Development Study in Australia, this study assessed whether mental health vulnerability is associated with risk of criminal justice system contact during early childhood.
• A total of 79 801 children who entered full-time schooling in New South Wales in 2009 and had no police contact before January 1, 2009 were included in the study. The children in the cohort were followed up until 13 years of age.

Key findings

• Children whose teacher identified emotional or behavioural problems at school had an incidence rate of police contact (for any reason) that was twice that of children without such problems.
• Contact with police as a survivor of crime was most commonly recorded. However, the strength of the association between emotional or behavioural problems and police contact was greatest when the child was identified as a person of interest.
• Children with aggressive behaviours had an incident rate of person of interest police contact that was almost 7 times higher than the rate for children without aggressive behaviours.
• An increased incidence of police contact was seen across all indices of emotional or behavioural problems and developmental risk profiles that were evident at school entry.

Implications

• Preventing outcomes such as repeated contact with the criminal justice system, relies on identifying vulnerability early in life, including the start of police contact in a child’s life.
• The well-known association between mental health problems and contact with the criminal justice system in adults and adolescents can be identified at an earlier developmental stage and extends to any type of police contact.
• The extent to which the findings are generalisable to other jurisdictions, within Australia and beyond, is uncertain. Criminal justice policies and practices that affect patterns of police contact may differ even in otherwise comparable populations.

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