Health: Journal Articles

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  • ItemOpen Access
    Recognition of mind and body interactions in New Zealand counselling education and practice
    (2023) Belton R; Taylor M; Barraclough, Shanee
    Using mixed-method surveys and case study interviews, thirty emerging and experienced counsellors were queried on the mind–body interactions of bodyoriented psychotherapies, nutrition, and physiological conditions relative to counselling education and practice. Participating counsellors did not consider their counselling education covered these areas well, particularly in bodyoriented psychotherapies and nutrition with only 30% and 20% of participants respectively affirmative. Counsellors reported mixed confidence in knowledge and referral competency around nutritional and physiological health interactions with mental wellbeing. Counsellors generally (97%) did not consider body-oriented psychotherapies alternative and 100% indicated they would consider future professional development in this area. The Māori health model Te Whare Tapa Whā is endorsed in Aotearoa New Zealand counselling education. This holistic wellbeing model recognises mind–body interactions. However, this research indicates inconsistent and often negligible mind–body interaction knowledge is taught in Aotearoa New Zealand counselling education.
  • ItemOpen Access
    A ‘forgotten’ whakapapa: historical narratives of Māori and closed adoption
    (Informa UK Limited, 2023) Ahuriri-Driscoll, Annabel; Blake D; Potter H; McBreen K; Mikaere A
    The era of closed stranger adoption is a significant part of Aotearoa New Zealand’s social and colonial history; some 80,000 children were legally adopted between the years 1955–1985. Māori children constituted a considerable proportion of these legal adoptions, although little attention has been given to their experiences. The relative silence surrounding this phenomenon exists alongside narratives of colonisation and a professed abhorrence by Māori to closed adoption practice, producing a narrative discrepancy. This article aims to understand and account for some of the discrepancies in public narratives by providing an accurate historical account of engagement with the 1955 Adoption Act and its 1962 amendments from a Māori perspective, and unpacking the legal, political, social and cultural aspects from a historical experience. The complexities and nuances of settler colonialism are highlighted, as well as the effects for Māori adoptees of not being publicly and historically narrated–forgotten subjects. Glossary of Māori words: Aotearoa: the Māori name for New Zealand; hapū: kinship group, clan, sub-tribe; iwi: kinship grouping, tribe; korero: to tell, say, speak, talk (verb); speech, narrative, story, discussion (noun); Māori: normal, usual, natural, common or ordinary, used to refer to indigenous New Zealanders; mokopuna: grandchild/grandchildren, descendant; Ngāpuhi: the people or tribal grouping of the Northland region; Pākehā: New Zealanders of European origin; tamariki: child/children; Te Tiriti o Waitangi: the Māori text of the Treaty of Waitangi, the founding document which enabled British settlement of Aotearoa; tikanga: culture, customs, traditions; whakapapa: genealogy, lineage, descent (noun); to place in layers (verb); whanau: family; whanaungatanga: relationship, kinship; whāngai: customary child placement, literal meaning to feed, nourish or nurture.
  • ItemOpen Access
    What innovative practices and processes are used to deliver psychosocial care in India? A qualitative case study of three non-profit community mental health organisations
    (Elsevier BV, 2023) Srinivasan V; Jain S; Kwon W; Bayetti C; Cherian AV; Mathias, Kaaren
    The global mental health field seeks to close the “treatment gap” for mental illness in low-and middle-income countries by scaling evidence-based interventions. The evidence base has often bypassed psychosocial interventions by local organizations who do not fit a biomedical approach to evidence building. In India, non-profit mental health organizations are addressing care gaps through novel approaches that emphasise social recovery and inclusion. This study seeks to better understand the nature and dynamic of this innovation by examining what was working well in the practices and processes of three such community mental health care organizations. A comparative case approach was chosen for its strength as an exploratory means for inductive theory building. Three case organizations in Kerala, West Bengal and Uttarakhand states were selected based on their diverse socio-cultural and health systems settings. Qualitative data was collected in 2018-20, to examine their practices and processes using mixed methods and data sources including interviews, focus groups, participant observation and document analysis. Common strategies observed across the three organizations, included engaging community, prioritising beneficiaries, co-opting resources, devolving care, reorganising communication and recovery and integration. These strategies were further categorized into three domains: constructing a sustainable resource base, managing knowledge and redefining meanings. In contrast with conventional problem-solving approaches, these cases used an approach that built on assets and strengths using inclusive governance which enabled coordination of the community health system. This study concludes that these organizations incorporate reflexive practice and two-way flows of knowledge to enable them to address complex social determinants of mental health by: modifying processes relating to place, relations, and processes of care; challenging existing distribution of power in biomedical care models and redefining ways of scaling innovations in health systems.
  • ItemOpen Access
    Self-report measures of parental psychosocial functioning did not predict further maltreatment of children involved with child protection services: A small cohort study
    (2023) Schluter P; Tarren-Sweeney M; Whitcombe-Dobbs, Sarah
    Aim: This prospective study explored whether self-report measures of parenting self-efficacy, mood, anxiety, stress, emotional regulation or substance use were useful in predicting subsequent notifications of harm to Child Protection Services (CPS). Methods: CPS-involved parents living in Christchurch, New Zealand were recruited to the study, all of whom retained the custody of their youngest child at the time of assessment. Comprehensive data regarding the aforementioned constructs, along with demographic data, were gathered during a baseline assessment. Notifi cations of harm were prospectively retrieved from the national child protection database. Methods of analysis included logistic regression and Receiver Operating Characteristics (ROC) analyses. Results: No individual psychological constructs, nor cumulative risk scores, were found to be associated with notifications of harm among the study sample (N = 26). The Area Under the Curve (AUC) values ranged from 0.49 to 0.65, indicating that these scores generally performed no better than chance. Two background factors predicted CPS notifications, namely: having more children and the parent reporting a personal history of neglect. Conclusion: Self-report measures of mood, emotional regulation, parenting self-efficacy and substance use are unlikely to be useful for PCA when conducted in the context of child protection casework or court assessments.
  • ItemOpen Access
    Preventing Bullying in Preschool-Age Children: Predictors of Defending Behaviour
    (2023) Blakely-McClure S; Kamper-DeMarco K; Swit, Cara
    Understanding the factors that motivate defending behaviour from an early age is crucial in informing effective intervention in bullying. However, relatively little is known about the social, emotional, and cognitive factors that predict young children’s involvement in defending behaviour. This study investigated the concurrent role of social (i.e. relational and physical aggression, prosocial behaviour, positive peer interactions, and peer rejection), emotional (i.e. anger, empathy), and cognitive (i.e. social withdrawal, inhibitory control, and attention) predictors of defending behaviour in early childhood (N =87, M age=46.74 months, SD=10.13, 56% males). Children were recruited from kindergartens located in three diverse socioeconomic communities in the South Island of New Zealand. The findings of a series of hierarchical regressions showed that, after controlling for age, lower levels of social withdrawal predicted higher levels of defending behaviour. For older children (≥46.7 months), empathy was a strong predictor of defending behaviour. Defending behaviour was positively associated with age; however, no differences were found in teacher reports of boys’ and girls’ use of defending. Implications for early prevention, intervention, and future research directions are discussed.
  • ItemOpen Access
    Effect of Clubbell Exercises on Shoulder Kinematics in Female Handball Players
    (Australian International Academic Centre, 2023) Daneshfar A; Petersen C; Noel Walter, Sibi Boycott
    Background: Clubbells were popular shoulder exercise equipment used during the 17-18th centuries. Currently there is a resurgence in the use of clubbells to strengthen the shoulder rotators, but there are no studies to prove their effectiveness on shoulder kinematics. Therefore, this study aimed to find out if clubbell exercises had any effect on glenohumeral rotational range of motion (ROM) and shoulder rotator strength. Methods: Using a randomised control study design, female handball athletes (n=15) were voluntarily recruited and were assigned randomly to either a handball training only group (HT) (n = 8, age 25±7 y, height 1.77 ± 0.11m, mass 76 ± 15 kg,) or a shoulder exercise group (SE) (n = 7, age 27±8 y, height 1.78 ± 0.12m, mass 79 ± 15 kg). The SE group underwent an exercise programme (8 weeks, 3 days/week, 20 min/day) using clubbells. The ROM and muscle strength were assessed at baseline and at the end of weeks 2, 4, 6 and 8. Results: After eight weeks, comparison between groups showed that the SE group’s dominant arm internal rotators muscle strength improved (28±5 to 33±7 Nm) significantly (p0.05). Within the SE group, internal rotation ROM, internal rotators, and external rotators muscle strength all significantly (p0.05) improved. Conclusions: Clubbell exercises increases internal rotation ROM and shoulder rotators muscle strength. Therefore, it is suggested that handball athletes could use clubbell exercises to improve their shoulder rotational ROM and strengthen the shoulder rotators whereby reducing shoulder injury risk.
  • ItemOpen Access
    Strengths of family carers: Looking after a terminally ill adult under 65 years of age
    (2022) James M; Reid, Kate
    INTRODUCTION: To learn of a terminal illness is devastating at any age. How much more so when it occurs in early or mid-adulthood, when people are busy with family and career goals. Those facing death when under 65 years of age are a group whose voice is virtually invisible in the palliative caregiving literature. Yet one in every five people die in Aotearoa New Zealand before 65 years of age. For Maori, almost half will die under the age of 65. METHODS: This qualitative descriptive research involved semi-structured interviews with eight bereaved family carers focusing on the carer’s experience of living with their spouse during their final illness. FINDINGS: Analysis of the research narratives revealed the strengths of love, hope, family, teamwork and resilience in navigating these experiences. CONCLUSION: In order to support holistic care for those who are receiving palliative care, this research advocates for strength-based assessments to support carers during the illness of their family member. This gives a different lens to the caregiving narrative which has, as its focus, the growth of human potential as well as enabling partnerships between palliative care practitioners and family carers.
  • ItemOpen Access
    The future of Māori health is here – The 2022 Aotearoa New Zealand health reforms
    (Elsevier BV, 2022) Ahuriri-Driscoll A; Kawa DT; Lovell, Sarah; MacDonald, Lindsey Te Ata o Tū; Mathias, Kaaren
    The formal launch of Te Aka Whai Ora, the new Maori Health Authority, on 1 July 2022 marks one of the most significant health system changes in Aotearoa’s recent history. The new authority joins a suite of newly created central government institutions including Te Whatu Ora (Health NZ), and Whaikaha (Ministry of Disabled People). The Hauora Maori Ministerial Advisory Committee was also created to be positioned alongside a slimmed down Manatu Hauora (Ministry of Health) focused on stewardship and incorporating a re-established Public Health Agency. Replacing the community consultation elements of the country’s disestablished District Health Boards will be new Iwi Maori Partnership Boards. Significantly, Te Tiriti o Waitangi (Te Tiriti, the Maori text of the Treaty of Waitangi) forms the basis of the health reforms, framing both the problems to be addressed and the solutions.
  • ItemOpen Access
    Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation
    (BMJ, 2022) Nayak P; Singh P; Pillai P; Goicolea I; Mathias, Kaaren
    Objective To assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India. Design This mixed methods study used the Medical Research Council framework for process evaluations of complex interventions. Setting This study was set in disadvantaged communities in urban Agra, rural Uttar Pradesh and tribal Jharkhand in India. Participants Data were collected from 86 facilitators, implementers, parents and teens who participated in the Parwarish intervention among 239 families. Intervention Couples from target communities facilitated groups of parents and teens over the 14-module structured, interactive Parwarish intervention which focused on building communication, reducing harsh parenting and building family budgeting skills. Outcome measures We assessed relevance, acceptability and feasibility of the intervention using mixed methods. Qualitative data collected included semistructured interviews and focus group discussions with implementers, facilitators, parents and young people who were transcribed, translated and thematically analysed to develop themes inherent in the data. Quantitative data which assessed attendance, fidelity to the intervention and facilitator training and coaching were analysed descriptively. Results Findings were grouped under the three domains of facilitation, community engagement and programme support with the following seven themes: (1) community-based facilitators increased contextual validity of the intervention; (2) gender relations were not only influenced by Parwarish implementation but were also influenced and transformed by Parwarish; (3) facilitator responsiveness to group concerns increased participation; (4) participation gathered momentum; (5) Parwarish's strong core and porous periphery allowed adaptations to local contexts; (6) technology that included Skype and WhatsApp enhanced implementation and (7) critical reflection with community trained coaches strengthened facilitation quality and programme fidelity. Conclusion This study found Parwarish engaging, feasible and acceptable in three diverse, low-income communities, although constrained by patriarchal gender relations. It paves the way for larger-scale implementation in other South Asian settings.
  • ItemOpen Access
    Participatory mental health interventions in low-income and middle-income countries: a realist review protocol
    (BMJ, 2022) Heap CJ; Jennings HM; Mathias K; Gaire H; Gumbonzvanda F; Gumbonzvanda N; Gupta G; Jain S; Maharjan B; Maharjan R; Maharjan SM; Mahat P; Pillai P; Webber M; Wright J; Burgess R; Mathias, Kaaren
    Introduction The launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation of communities and people with lived experience of mental health problems is argued as essential to successful interventions. However, there remains a lack of conceptual clarity around € participation' in mental health interventions with the specific elements of participation rarely articulated. Our review responds to this gap by exploring how € participation' is applied, what it means and what key mechanisms contribute to change in participatory interventions for mental health in LMICs. Methods and analysis A realist review methodology will be used to identify the different contexts that trigger mechanisms of change, and the resulting outcomes related to the development and implementation of participatory mental health interventions, that is: what makes participation work in mental health interventions in LMICs and why? We augment our search with primary data collection in communities who are the targets of global mental health initiatives to inform the production of a programme theory on participation for mental health in LMICs. Ethics and dissemination Ethical approval for focus group discussions (FGDs) was obtained in each country involved. FGDs will be conducted in line with WHO safety guidance during the COVID-19 crisis. The full review will be published in an academic journal, with further papers providing an in-depth analysis on community perspectives on participation in mental health. The project findings will also be shared on a website, in webinars and an online workshop.
  • ItemOpen Access
    Conducting research with young people at the margins – lessons learnt and shared through case studies in Cambodia, India, Sweden and Zambia
    (Springer Science and Business Media LLC, 2022) Jonsson F; Pat P; Mulubwa C; Jegannathan B; Mathias, Kaaren
    Building on the value of engaging with and enabling the participation of marginalised young people in research, the aim of this article was to profile practical and procedural issues faced when conducting studies with young people who experience some form of marginalisation. Drawing on observations and research experiences from four diverse case studies involving young people who were either imprisoned in Cambodia, living in informal urban communities in North India, residing in rural northern Sweden or attending school in rural Zambia, learnings were identified under three thematic areas. Firstly, a need exists to develop trusting relationships with stakeholders, and especially the participating young people, through multiple interactions. Secondly, the value of research methods that are creative and context sensitive are required to make the process equitable and meaningful for young people. Thirdly, it is important to flatten power relations between adults and young people, researchers and the researched, to maximise participation. These findings can inform future youth research in the field of global public health by detailing opportunities and challenges of engaging in research with young people on the margins to promote their participation.
  • ItemOpen Access
    Decentralisation; The Question of Management Capacity: A Response to Recent Commentaries
    (Maad Rayan Publishing Company, 2016) Mohammed J; North N; Ashton T
    Our article, limited in scope, employed the widely applied decision space framework in understanding Fiji’s decentralisation of a particular function, service delivery. Application of the decision space framework was suited to Fiji’s hierarchal health system, which is inherently vertical in nature.
  • ItemOpen Access
    The effectiveness of a multi-pronged psycho-social intervention among people with mental health and epilepsy problems-a pre-post prospective cohort study set in North India
    (Maad Rayan Publishing Company, 2021) Corcoran D; Pillai P; Deshpande S; Sebastian MS; Mathias, Kaaren
    Background: In low-and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy. Methods: In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients. Results: Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B =-6.94, 95% CI-7.37 to-6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B =-4.86, 95% CI-7.14 to-2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B =-5.22, 95% CI-7.29 to-3.15). Conclusion: This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was non-pharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.
  • ItemOpen Access
    New Zealand cricket injury analysis based on 12 years of Accident Compensation Corporation data
    (BMJ, 2022) King D; Hume P; Noel Walter, Sibi Boycott
    Objectives To provide epidemiological data for cricket injuries in New Zealand. Methods A retrospective analytical review using epidemiological cricket data obtained from the national Accident Compensation Corporation (ACC) for 2005-2016. Injury incidence was calculated per 1000 participants. Results There were 86 562 injuries (77 212 males and 9350 females) during the 12 years with higher injury incidence for males (64.1) than females (36.1). While cricket-related injury claims increased by 42.6%, the injury incidence decreased from 59.0 in 2006 to 42.8 in 2016. The pooled injury rate per 1000 participants was highest for hand/fingers (9.2) and lumbar (8.1) body regions, and for contact (44.7) activities. Players aged 10-20 years were more likely to experience injury. Conclusions Analysis of 12 years of ACC cricket-related injury claims showed only minimal reductions in injury incidence over the years. Therefore, cricket-related contact injuries to the hand/fingers and head need to be the focus of injury prevention programmes (eg, via promoting use of protective gear and correct technique), particularly in players aged 10-20 years.
  • ItemOpen Access
    A cross-tabulated analysis for the influence of climate conditions on the incidence of dengue fever in Jeddah City, Saudi Arabia during 2006–2009
    (2022) Alkhaldy, Ibrahim; Basu, Arindam
    Objective: Increased temperature and humidity across the world and emergence of mosquito-borne diseases, notably dengue both continue to present public health problems, but their relationship is not clear as conflicting evidence abound on the association between climate conditions and risk of dengue fever. This characterization is important as mitigation of climate change-related variables will contribute toward efficient planning of health services. The purpose of this study was to determine whether humidity in addition to high temperatures increase the risk of dengue transmission. Methods: We have assessed the joint association between temperature and humidity with the incidence of dengue fever at Jeddah City in Saudi Arabia. We obtained weekly data from Jeddah City on temperature and humidity between 2006 and 2009 for 200 weeks starting week 1/2006 and ending week 53/2009. We also collected incident case data on dengue fever in Jeddah City. Results: The cross-tabulated analysis showed an association between temperature or humidity conditions and incident cases of dengue. Our data found that hot and dry conditions were associated with a high risk of dengue incidence in Jeddah City. Conclusion: Hot and dry conditions are risk factors for dengue fever.
  • ItemOpen Access
    Electronic cigarette use among university students aged 18-24 years in New Zealand: Results of a 2018 national cross-sectional survey
    (BMJ, 2020) Wamamili B; Coope P; Wallace-bell, Mark; Richardson, Ann; Grace, Randolph
    Objectives: To examine electronic cigarette use, reasons for use and perceptions of harm among university students. Design: Cross-sectional study. Setting: University students across New Zealand. Methods: We analysed data from a 2018 cross-sectional survey of university students, weighted to account for undersampling and oversampling by gender and university size. χ 2 tests were used to compare e-cigarette use, reasons for use and perceptions of harm by age, gender, ethnicity and cigarette smoking. Participants: The sample comprised 1476 students: 62.3% aged 18-20 years, 37.7% aged 21-24 years; 38.6% male, 61.4% female; 7.9% Maori and 92.1% non-Maori. Results: 40.5% of respondents (95% CI 37.9 to 43.1) reported ever, 6.1% (4.9-7.4) current and 1.7% (1.1-2.5) daily use. Regardless of frequency, 11.5% of vapers had vaped daily for ≥1 month, 70.2% of whom used nicotine-containing devices; 80.8% reported not vaping in indoor and 73.8% in outdoor smoke-free spaces. Among ever vapers, curiosity (67.4%), enjoyment (14.4%) and quitting (2.4%) were common reasons for vaping. 76.1% (73.4-78.7) of respondents believed e-cigarettes were less harmful than cigarettes. More males than females reported vaping (ever, current, daily and daily for ≥1 month), nicotine use and belief that e-cigarettes were less harmful than cigarettes. More participants aged 18-20 years reported not vaping in outdoor smoke-free spaces, vaping out of curiosity and belief that e-cigarettes were less harmful than cigarettes, while more participants aged 21-24 years vaped daily for ≥1 month and for enjoyment. More Maori than non-Maori ever vaped. More cigarette smokers than non-smokers vaped (ever, current, daily and daily for ≥1 month), used nicotine and vaped to quit, while more non-smokers did not vape in smoke-free spaces and vaped out of curiosity. Conclusions: Our results suggest high prevalence of e-cigarette ever and current use, particularly among males and smokers. Many vaped out of curiosity and perceived e-cigarettes as less harmful than cigarettes.
  • ItemOpen Access
    Attitudes towards the New Zealand Government's Smokefree 2025 goal associated with smoking and vaping in university students aged 18 to 24 years: Results of a 2018 national cross-sectional survey
    (BMJ, 2020) Wamamili B; Richardson A; Coope P; Wallace-bell, Mark; Grace, Randolph
    Objective: In March 2011, New Zealand (NZ) launched an aspirational goal to reduce smoking prevalence to 5% or less by 2025 (Smokefree 2025 goal). Little is known about university students' awareness of, support for and perceptions about this goal. We sought to narrow the knowledge gap. Setting: University students in NZ. Methods: We analysed data from a 2018 cross-sectional survey of university students across NZ. Logistic regression analysis examined the associations between responses about the Smokefree goal with smoking and vaping, while controlling for age, sex and ethnicity. Confidence intervals (95% CI) were reported where appropriate. Participants: The sample comprised 1476 students: 919 (62.3%) aged 18 to 20 and 557 (37.7%) aged 21 to 24 years; 569 (38.6%) male and 907 (61.4%) female; 117 (7.9%) Maori and 1359 (92.1%) non-Maori. Of these, 10.5% currently smoked (ie, smoked at least monthly) and 6.1% currently vaped (ie, used an e-cigarette or vaped at least once a month). Results: Overall awareness of the Smokefree goal was 47.5% (95% CI: 44.9 to 50.1); support 96.9% (95% CI: 95.8 to 97.8); belief that it can be achieved 88.8% (95% CI: 86.8 to 90.7) and belief that e-cigarettes/vaping can help achieve it 88.1% (95% CI: 86.0 to 89.9). Dual users of tobacco cigarettes and e-cigarettes had greater odds of being aware of the Smokefree goal (OR=3.07, 95% CI: 1.19 to 7.92), current smokers had lower odds of supporting it (OR=0.13, 95% CI: 0.06 to 0.27) and of believing that it can be achieved (OR=0.15, 95% CI: 0.09 to 0.24) and current vapers had greater odds of believing that e-cigarettes/vaping can help to achieve it (OR=8.57, 95% CI: 1.18 to 62.52) compared with non-users. Conclusions: The results suggest strong overall support for the Smokefree goal and belief that it can be achieved and that e-cigarettes/vaping can help achieve it. Smoking and vaping were associated with high awareness of the Smokefree goal, but lower support and optimism that it can be achieved.
  • ItemOpen Access
    Mental health screening for children in care using the Strengths and Difficulties Questionnaire and the Brief Assessment Checklists: Guidance from three national studies
    (SAGE Publications, 2019) Goemans A; Hahne AS; Gieve M; Tarren-Sweeney, Michael
    Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services.
  • ItemOpen Access
    A narrative review of stability and change in the mental health of children who grow up in family-based out-of-home care
    (SAGE Publications, 2019) Goemans A; Tarren-Sweeney, Michael
    The present review sought to address the following questions: What evidence is there that long-term, family-based out-of-home care (OOHC) has a general, population-wide effect on children’s mental health such that it is generally reparative or generally harmful? Does entry into long-term OOHC affect children’s mental health, as evidenced by prospective changes over the first years in care? And, is the reparative potential of long-term, family-based OOHC moderated by children’s age at entry into care? Fourteen studies were identified for review. We found no consistent evidence that family-based OOHC exerts a general, population-wide effect on the mental health of children in care; or that entry into care has an initial effect on children’s mental health; or that children’s age at entry into care moderates their subsequent mental health trajectories. Instead, several longitudinal studies have found that sizable proportions of children in care manifest meaningful improvement in their mental health over both short- and long-term time frames and that similarly sizable proportions experience meaningful deterioration in their mental health. Rather than asking whether long-term, family-based care is generally reparative or harmful for the development of previously maltreated children, future investigations should instead focus on identifying the systemic and interpersonal characteristics of care that promote and sustain children’s psychological development throughout childhood—and those characteristics that are developmentally harmful (i.e., for which children is the experience of care beneficial, and for which children is it not?). The review concludes with recommendations for the design of improved cohort studies that can address these questions.