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Improving access to evidence-based mental health treatment for children and adolescents

Cathy Creswell, Jennie Hudson, Victoria Ingram, Rachel Hayes, Tamsin Ford, Laura Pass, Shirley Reynolds Speaker

Only a minority of children and adolescents with mental health problems receive treatment.  This symposium consists of four papers that have a common goal of improving access to evidence-based mental health treatment for children and adolescents. An improved understanding of barriers to help-seeking can inform targeted approaches to promoting treatment access. The first paper will present findings from a UK community survey on the frequency and type of help-seeking, support received, and barriers among parents of children with elevated anxiety (n=222). Stigma associated with mental health problems presents one barrier to help-seeking.  The second paper will present findings from a cluster Randomised Controlled Trial (RCT) that examined the impact of the contact-based programme ‘batyr@school’ in reducing stigma and promoting help-seeking for mental health problems in young people in Australia (n=399).  There is a growing policy focus on the role of schools in the delivery of mental health interventions. The third paper will present results of the STARS cluster RCT that evaluated the effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme on children’s mental health (n=2075). The fourth paper will focus on a brief structural behavioural intervention for depressive symptoms in adolescents, designed to be delivered by a range of healthcare professionals.  This paper will present an overview of the Brief Behavioural Activation (Brief BA, Pass & Reynolds 2014) approach and current outcomes from a study evaluating delivery of Brief BA in secondary schools in the UK.

Chair: Tessa Reardon, University of Reading, UK

Paper 1: Tessa Reardon (1)  Professor Cathy Creswell (1). 
Paper 2:  Professor Jennie Hudson (2) Victoria Ingram (2). 
Paper 3:  Professor Tamsin Ford (3).
Paper 4: Dr Laura Pass (1) Professor Shirley Reynolds (1)

(1) School of Psychology and Clinical Language Science, University of Reading, UK.
(2) Centre for Emotional Health, Macquarie University, Australia.
(3) University of Exeter Medical School, Exeter, UK

 

 

1. Seeking and accessing professional support for child anxiety in a community sample

 Tessa Reardon, Kate Harvey, Cathy Creswell

School of Psychology and Clinical Language Sciences, University of Reading, UK

 There is a lack of current UK data on help-seeking, and barriers to accessing professional support for child anxiety disorders. This study aimed to provide current data on the frequency and type of i) parental help seeking, ii) professional support received, and iii) parent reported barriers/facilitators in the context of child anxiety.  We conducted a survey of help seeking in parents of 222 children (aged 7-11) with elevated anxiety symptoms identified through screening in schools, 138 children of whom met diagnostic criteria for an anxiety disorder.  64.5% of parents of children with an anxiety disorder reported seeking professional help; 38.4% reported that their child had received support to help manage and overcome their anxiety difficulties; and 2.2% reported receiving CBT.  Frequently reported parental barriers related to difficulties identifying anxiety problems, a lack of help-seeking knowledge, negative attitudes towards help-seeking, and limited service provision. Findings identify the need for i) tools for parents and professionals to help identify children who may benefit from professional support; and ii) increased evidence-based provision for child anxiety disorders, including delivery within school settings and direct support for parents.

 

2. Efficacy of the batyr@school program in reducing mental health stigma and promoting help-seeking in young people

 

Professor Jennie Hudson & Victoria Ingram

Centre for Emotional Health, Macquarie University

 

Stigma associated with mental health problems can negatively influence intentions to seek help in young people. Evidence has suggested that contact interventions involving personal stories from individuals with lived experiences of mental health problems, may reduce stigma. Using a cluster randomised controlled trial, the present study examined the impact of a contact-based program ‘batyr@school’, in reducing stigma and promoting help-seeking for mental health problems in young people.  A total of 399 students across six schools were randomly allocated to the intervention condition or waitlist. The program was found to significantly reduce stigma and increase participants’ intentions to seek help from formal sources. The program did not significantly alter intentions to seek help from informal sources. Amongst students as ‘at risk’, due to high levels of psychological distress, the intervention did not significantly impact help-seeking intentions. This study demonstrates the potential of universal contact-based programs in reducing stigma and increasing intentions to seek help from formal sources for mental health problems.

 

3. The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: results of the STARS cluster randomised controlled trial

Tamsin Ford Professor of Child and Adolescent Psychiatry at Exeter University Medical School and Honorary Consultant at Devon Partnership Trust

Background There is a growing policy focus on the role that schools play in children’s mental health. We evaluated the effectiveness and cost-effectiveness of the Incredible Years® (IY) Teacher Classroom Management (TCM) programme on children’s mental health.

Methods A two-arm, pragmatic, parallel group, superiority, cluster randomised controlled trial recruited three cohorts of schools (clusters) between 2012 and 2014, randomising them to TCM (intervention) or Teaching As Usual (TAU – control). TCM was delivered to teachers in six whole-day sessions, spread over six months. Schools and teachers were not masked to allocation. The primary outcome was teacher-reported Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score. Random effects linear regression and marginal logistic regression models using Generalised Estimating Equations were used to analyse the outcomes. Trial registration: ISRCTN84130388.

Results Eighty schools (2075 children) were enrolled; 40 (1037 children) to TCM and 40 (1038 children) to TAU. Outcome data were collected at 9, 18 and 30-months follow-up for 96%, 89% and 85% of children, respectively. Unless our results are still embargoed, we will present the findings of this trial. If we are unable to do this, we will present the lessons learnt and the qualitative findings of the study.

Funding NIHR Public Health Research Programme

 

4. Brief Behavioural Activation (Brief BA) in secondary schools: A feasibility study

Dr Laura Pass & Professor Shirley Reynolds, University of Reading, UK

Depression in adolescence is a common and serious mental health problem.  In the UK, access to evidence based psychological treatments is limited and training and employing therapists to deliver these is expensive.  Brief Behavioural Activation (Brief BA, Pass & Reynolds 2014) was developed as a brief, structured behavioural intervention for depressive symptoms in adolescents, designed to be delivered by a range of healthcare professionals.  Brief BA focuses on helping the young person identify their personal values then make small, practical changes in behaviour to increase valued activities, by ‘doing more of what matters to you’.  This talk will present an overview of an ongoing feasibility study evaluating delivery of Brief BA in secondary schools for adolescents with depression symptoms. Students are identified by school staff or self-referrals via a school survey of emotional health, if depression symptoms were endorsed and the student requested help with low mood. Brief BA treatment is delivered by Psychological Wellbeing Practitioners (PWPs) during the school day, with additional clinical input as required (e.g. liaison with school staff/parents, referrals to specialist services). The challenges of embedding a mental health intervention within the school setting will be discussed, as well as the opportunities this presents.