The Cool Little Kids randomised controlled trial population-level early prevention for anxiety disorders

Background: The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful ‘efficacy’ trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry.
Methods/Design: This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child’s bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (costconsequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms.
Discussion: This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally.

The Resilient Families program: promoting health and wellbeing in adolescents and their parents during the transition to secondary school.

Resilient Families is a school-based prevention program designed to help students and parents develop knowledge, skills and support networks to promote health and wellbeing during the early years of secondary school. the program is designed to build within-family connectedness (parent--adolescent communication, conflict resolution) as well as improve social support between different families, and between families and schools. It is expected to promote social, emotional and academic competence and to prevent health and social problems in youth.

Does family intervention for adolescent substance use impact parental wellbeing?

Adolescent substance abuse is a prevalent problem and family interventions are increasingly used to prevent this problem and to assist family coping. The effectiveness of a prevention-focussed family intervention was evaluated within a randomised school trial for its secondary impacts on improving parental mental health and family functioning.

Psychological wellbeing among same-sex attracted and heterosexual parents: Role of connectedness to family and friendship networks

© 2015 Australian Association of Family Therapy. Increasing numbers of lesbian, gay and bisexual (LGB) adults are entering into parenthood. Previous studies indicate many of these parents receive little or no support from their families of origin due to family members' negative attitudes toward homosexuality. This study looks at the extent to which LGB parents report a lower sense of connectedness to family of origin and friendship networks than heterosexual parents and whether this has an impact on psychological wellbeing in either of these groups. Data were derived from two studies of parents: Work, Love, Play, a study of Australian and New Zealand LGB parents (n=324); and the Longitudinal Study of Australian Children, a population-based study of young children and parents (n=6460). Structural equation modelling was used to explore the relationships between: parent sexuality and family/friendship connectedness, family/friendship connectedness and psychological wellbeing, parent sexuality and psychological wellbeing. LGB parents reported feeling less connected to their families of origin but more connected to their friendship groups than heterosexual parents. Counter to previous studies, we found no difference in the psychological wellbeing of LGB parents compared to heterosexual parents when examining the direct effect of sexuality on psychological wellbeing. Clinical implications for counsellors and family therapists are discussed.

Building equitable staff-parent communication in early childhood settings : an Australian case study

International research has consistently found that good staff-parent relationships in early childhood centers benefit children, staff, and parents. Given these findings, the Australian federal government's Quality Improvement and Accreditation Scheme (QIAS) requires centers to involve parents in their programs. However, international research has also found that early childhood staff are anxious about their relationships with parents. This article describes a study in which early childhood staff in Australia were asked about their experiences with parent involvement. It draws on those interviews to consider communication strategies to create equitable relationships between staff and parents.

Parent, peer and media influences on body image and strategies to both increase and decrease body size among adolescent boys and girls

This study investigated the nature of body image and body change strategies, as well as the sociocultural influences on these variables, among a group of 1,266 adolescents (622 males, 644 females). In particular, it investigated weight gain and increased muscle, as well as weight loss. It was found that females were less satisfied with their bodies and were more likely to adopt strategies to lose weight, whereas males were more likely to adopt strategies to increase weight and muscle tone. Respondents with higher body mass index (BMI) evidenced greater body dissatisfaction and more weight loss strategies, but there were no differences between BMI groups in weight gain or strategies to increase muscles. Weight gain and strategies to increase muscles were more likely to be undertaken by older adolescents, but there were no grade level differences in weight loss. Media influences to alter weight, as well as feedback from mother, father, and both male and female peers, were greater for females. There were few grade level or BMI differences in regard to any of the sociocultural influences. The importance of these findings in terms of providing a better understanding of factors which may lead to a disturbed body image and body change disorders, particularly among adolescent boys, is discussed.

The importance of first-time parent groups for new parents

First-time parent groups are offered to all new parents in Victoria, Australia through the Maternal and Child Health Service, which is funded by state and local governments. Parents who join a group attend a series of eight sessions that emphasize parenting skills, relationship development and social support in order to increase confidence and skills in parenting. The present paper highlights the importance of first-time parent groups, claiming that these groups serve an important social support and health function amid a climate of early discharge policies and changing family structures. Although there are a number of challenges to the successful running of groups, it is argued that first-time parents benefit from participating in these groups in a number of ways: by developing social networks, gaining self confidence, and through access to relevant information on child health and parenting. Research indicates that first-time parent groups provide lasting benefits not only for families, but also for society as a whole. Maternal and child health nurses play a key role in facilitating groups for first-time parents.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Developing a national index of subjective wellbeing: the Australian unity wellbeing index

The Australian Unity Wellbeing Index has been designed as a new barometer of Australians' satisfaction with their lives, and life in Australia. It is based on, and develops, the theoretical model of subjective wellbeing homeostasis. The Index comprises two sub-scales of Personal and National Wellbeing. Data were collected through a nationally representative sample of 2,000 people in April/May 2001.Factor analysis confirmed the integrity of the two sub-scales and, confirming empirical expectation, the average level of life satisfaction was 75.5 percent of the scale maximum score. Group comparisons revealed that all age groups maintained their Personal Index score within the normal range. In addition,people in country areas were more satisfied with their personal lives than city-dwellers,but less satisfied about the national situation, and people who had recently experienced a strong positive event evidenced arise in wellbeing, whereas those who had experienced a strong negative event evidenced wellbeing in the low-normal range. It is argued that these data generally support homeostatic theory. However, an unusual result was that females were more satisfied with their own lives than males. A tentative argument is advanced that this may represent a constitutional difference. It is concluded that the Australian Unity Wellbeing Index has potential as a valid, reliable and sensitive instrument to monitor national wellbeing.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.

Caregivers as managers of subjective wellbeing: a homeostatic perspective

Background: This paper proposes that the adequacy of service delivery and caregiving to people who are disabled should be assessed using two criteria. One is the objective circumstance of living, which should be at a standard acceptable to the community at large. The other is a level of subjective wellbeing (SWB) within the normal range. Method: This latter criterion is a novel conception based on an understanding that SWB is homeostatically managed to lie normally within a narrow range of values. Results: People who have a disability are more likely than usual to have a fragile homeostatic system because of the additional life challenges imposed by their disability. Conclusions: The role of a caregiver is to provide resources and protection against strong threats to homeostasis, thereby ensuring that the person in their care has a normal-range level of SWB.

Economic deprivation and its effects on subjective wellbeing in families of people with multiple sclerosis

Background: There has been limited research on the role of financial strain on the adjustment of people with multiple sclerosis.

Aims: This study examined the financial costs of MS and the impact of financial strain on the quality of life and adjustment of people with MS and their families.

Methods: Interviews were conducted with 16 health professionals, 26 people with MS and 11 family members of people who have MS.

Results: Economic deprivation impacted on the subjective well being of many families living with MS. Concerns included adjustment to a lower income if the person with MS reduced or ceased work, and meeting the costs of home alterations, mobility equipment, and special transport. The additional cost of living with MS is a stress factor, especially for people dependent on disability support pensions.

Conclusions: It is anticipated that the findings from this study will raise the awareness of health professionals and politicians regarding the potential impact of financial stress on people with MS and their families.

Population health and wellbeing: identifying priority areas for Victorian children

Background
Population health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0–12 years living in Victoria, Australia.

Results
Qualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.

Conclusion
In contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.