Preventing mental health problems in children : the families in mind population-based cluster randomised controlled trial.

Background

Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
Design

Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months. Participants: Families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care. Intervention: (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems. Analysis: Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
Discussion

This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.

The influence of families on early adolescent school connectedness : evidence that this association varies with adolescent involvement in peer drinking networks

School connectedness is central to the long term well-being of adolescents, and high quality parent–child relationships facilitate school connectedness. This study examined the extent to which family relationship quality is associated with the school connectedness of pre- and early teenagers, and how this association varies with adolescent involvement in peer drinking networks. The sample consisted of 7,372 10–14 year olds recruited from 231 schools in 30 Australian communities. Participants completed the Communities that Care youth survey. A multi-level model of school connectedness was used, with a random term for school-level variation. Key independent variables included family relationship quality, peer drinking networks, and school grade. Control variables included child gender, sensation seeking, depression, child alcohol use, parent education, and language spoken at home. For grade 6 students, the association of family relationship quality and school connectedness was lower when peer drinking networks were present, and this effect was nonsignificant for older (grade 8) students. Post hoc analyses indicated that the effect for family relationship quality on school connectedness was nonsignificant when adolescents in grade 6 reported that the majority of friends consumed alcohol. The results point to the importance of family-school partnerships in early intervention and prevention.

Sibling incest within violent families : Children under 12 years seeking nurture.

This article will draw on theories of childhood and current sociological debates of shame to explore and understand the formation of sexual identity in children who experience a violent family. Children have limited resources available to them and in violent family situations may turn to their siblings for nurture. Contextualising this type of dependency within the usual processes of childhood sexual development, including exploration and experimentation, may increase the likelihood of sibling incest.

Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed preintervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.

How doctors and lawyers can help vulnerable patients

Medical-legal partnerships have broken down the barriers to accessible legal services for people experiencing health issues in the United States. Such programs demonstrate the health benefits of effective legal advocacy on behalf of patients and Australia could learn from this model to improve access to justice and deliver better health outcomes.

Keeping connected: the design and overview of the research

The special issue Keeping Connected: Identity, Social Connection and Education for Young People opens with a paper that discusses the research design and overview of a three-year project by a Melbourne (Australia)-based multi-disciplinary team. Over 2007–2009, the Keeping Connected team of 10 researchers investigated the lives of adolescents with ongoing health conditions. The project centrally is developed by the young people's perspectives, their identity and wellbeing, relationships with others and engagement within changing contexts and their altered opportunities in the world. The research design includes image production underpinned by visual methods and a narrative-informed approach to interview and interpretation of images. The study, which crosses the health and education interface, set out to highlight differences of perspectives adopted by 31 young people, their families and the professional groups, such as teachers and health professionals. The special issue discusses key project findings and contributes a body of scholarship that expands our knowledge of evidence-based research across the education and health interface. The longitudinal study highlighted two themes of importance for education, and poorly catered for in current policies and guidelines: that the situation of these young people needs to be addressed by schools as a process over time (including prospectively); and that the young people's identity is strongly marked by a desire to be seen and treated as ‘normal’ combined with an awareness of being vulnerable.

Sustainable farm families : future directions

The health and wellbeing of all Australians is pivotal for economic and social success of the nation. Current data reveals that the health status of people living in rural and remote populations is poorer than their metropolitan counterparts. However there is a lack of understanding of the specific health statistics of rural farming populations.

The Sustainable Farm Families (SFF) Future Directions program aims to fill this gap by providing ongoing evidence-based information and support to Australia’s agricultural industries, to gain insight into the health, wellbeing and safety of Australia’s rural farming populations.

The role of social support in families coping with childhood brain tumor

Previous studies suggest that support from social networks is a protective factor buffering the negative effects of stressful events, such as having a child with a chronic illness. The literature highlights the need for more systematic examination of parents’ social support networks across the disease trajectory, to obtain a more complete understanding of how a family's support system affects adjustment over time. This was attempted in this study of 88 parents of children with brain tumors, recruited from hospitals in Australia, Singapore, and New Zealand. It employed a longitudinal design, tracking families for 2 years postdiagnosis to examine the relationship between social support and coping. As in previous research this study showed that different types of support are needed at different stages in the illness trajectory. The study also identified the use of various coping strategies by families, directed at the maintenance and enhancement of existing supports and the securing of new supports. The study failed to establish a statistically significant relationship between level of coping and social support, however, suggesting that parents were using primarily “internal” familial modes of coping, including preexisting patterns of coping, with external social support being an adjunct to their coping rather than being a major contributor.