Highlights in child mental health research: July 2024

This month’s highlights include:

The role of playgrounds in promoting children’s health

This scoping review aimed to describe published research about playground use and physical, mental or social health benefits for children (0–17 years). The authors identified 247 studies, the majority of which described physical health outcomes. Over half of the included studies referred to playgrounds in school settings. Only 52 studies were intervention studies, with most of these studies examining the effects of a new or renovated playground on health.

Australian school-based interventions addressing child and adolescent mental health conditions

This systematic review summarised the evidence for the effectiveness of school-based mental health interventions in Australia. The authors found that effective programs included multidisciplinary care and social and emotional learning. Emerging therapies such as mindfulness, music, animal therapy and nature walks showed promise in supporting child and adolescent mental health.

Young peoples’ and professionals’ views about personalised mental health support

This study examined young people and professionals’ views on personalised mental health support and explored how these preferences vary across different sociocultural contexts. The authors found that young people with anxiety and/or depression prefer mental health support tailored to their individual needs. Their cultural context had less influence on their preferences. Supportive, trusting relationships with family, friends and professionals were found to be key elements of effective mental health support for young people.

Exploring the barriers and enablers to implementing Child and Family Hubs policy into practice in NSW

This qualitative study investigated the views and experiences of policy professionals and community health service managers about the barriers and enablers to effective implementation of Child and Family Hubs in New South Wales. The hubs aim to support families experiencing adversity. The authors found that key enablers of effective implementation included flexibility and adaptability to meet local needs, strong leadership and collaborative partnerships. Key barriers included limited support for evaluation and service integration.

Why is this important?

• Active outdoor play is crucial for children’s health and development, but the specific health benefits of playground use are unclear.
• This review aimed to establish the links between playground use and health benefits for children (0–17 years).
• Playgrounds were defined as ‘places designed or designated to facilitate play’ both indoors and outdoors, public and private.

What did they do?

• The authors conducted a scoping review to identify published literature about the relationship between playground use and children’s health benefits. They searched four databases for publications from 2000 to 2023.
• They included studies that examined positive physical health outcomes (e.g. physical activity, motor skills and weight status), mental health (e.g. well-being, self-esteem and cognitive health), or social health outcomes (e.g. interactions with peers, social network) related to playground use. They excluded studies exploring negative health outcomes such as injuries, bullying or sun exposure.
• The authors summarised the findings from studies that examined the effects of playgrounds on health.

What did they find?

• The authors found 247 studies that met the criteria. Included studies were mostly from high-income countries (93%) (47% from Europe, 33% from North America and 13% from Oceania).
• Of the 247 included studies, only 52 studies were intervention studies and reported on the effects of playground use on child health. Most of these intervention studies were pilot or feasibility studies. The remaining studies were descriptive or exploratory.
• The types of interventions studied were the effects of free outdoor play, the impact of a new playground structure, markings or loose sports equipment (e.g. balls, rackets), activities or staff training. Other studies explored the addition of natural elements (greening) to school playgrounds.
• Despite the limited quality and varied intervention designs, the researchers found that there is evidence that playgrounds can have physical health benefits. The authors identified that the quality and accessibility of playgrounds influenced the extent of health benefits, with well-maintained and inclusive playgrounds offering greater positive impacts.

What does this mean for practice?

• Playgrounds that are well designed and safe can lead to various positive health outcomes for children. Designing playgrounds as engaging and interesting places for children’s play can facilitate health benefits.
• Incorporating natural elements in playground spaces may enhance children’s social and mental health, though it may not always increase physical activity.
• More research is needed to establish the effects of successful playground interventions and their broader health impacts.

Why is this important?

• Mental health issues are prevalent globally and can have significant impacts on Australian children and adolescents’ educational outcomes and overall well-being.
• Understanding the effectiveness of school-based mental health interventions in Australia, key success factors and gaps in current programs may help to improve future intervention implementation and outcomes.

What did they do?

• The authors undertook a systematic review of studies about Australian school-based mental health interventions published from 2010–2022.
• The review focused on interventions addressing mental health disorders, specifically, anxiety (separation anxiety disorder, generalised anxiety disorder), major depressive episode, social phobia, attention-deficit/hyperactivity, obsessive-compulsive and conduct disorders) and reported the effect on mental health outcomes.

What did they find?

• 32 intervention studies met the inclusion criteria, including 10 randomised controlled trials (RCTs) (10%), 14 cluster RCTs (65%) and 6 quasi-experimental designs (22%). They involved 21,330 participants aged 5–18 years.
• Most of the included school-based interventions (n=17, 83%) were delivered by trained and untrained school staff. Three interventions were delivered by school psychologists and 9 by qualified student psychologists or researcher-psychologists.
• Anxiety was the most commonly reported mental health condition. Anxiety was the target of 17 interventions.
• 17 out of 32 studies (which accounted for one third of intervention participants) found a statistically significant improvement in one or more mental health outcomes.
• Key findings for types of school-based mental health interventions included:
  • Successful interventions often involved multidisciplinary care, integrating family, government agencies and local community organisations.
  • The use of Cognitive Behavioural Therapy (CBT) led to improvements in the mental health of students in some studies but not in others.
  • Programs focusing on social and emotional learning were effective in improving mental health outcomes.
  • Emerging therapies such as mindfulness, animal therapy, music and nature walks also showed promise in supporting child mental health.

What does this mean for practice?

• These findings highlight the importance of diverse, integrated approaches to effectively address mental health issues in school settings. Practitioners should collaborate with families, government agencies and community organisations to provide comprehensive support for children and adolescents with mental health challenges.
• Practitioners could consider integrating emerging therapies such as mindfulness, animal therapy, music and nature walks into mental health interventions offered in schools.

Why is this important?

• Research shows that 1 in 10 young people experience anxiety and/or depression worldwide and the prevalence of these challenges is increasing. Many are not accessing the mental health supports available.
• This paper aimed to understand what aspects of personalised mental health support are effective and how these preferences vary across different sociocultural contexts.

What did they do?

• The authors conducted participatory action focus groups with 120 young people (aged 14–24 years) with self-identified lived experience of anxiety and/or depression and with 63 professionals working in youth mental health across eight countries. The countries were selected based on their existing partnerships and included: Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey and the UK.
• The focus groups (of 2–3 hours each) were structured around discussing participants’ views from a pre-determined list of 26 aspects of personalised support for anxiety and/or depression considering cultural contexts and individual preferences. Data were then analysed thematically.
• Participants were recruited through local NGOs and academic institutions. Focus groups were conducted both face-to-face and online, depending on the country’s COVID-19 guidelines.

What did they find?

• Participants agreed that young people with anxiety and/or depression prefer support tailored to their individual needs. Personalised support was identified as key to their potential engagement and intervention effectiveness. This included having a say in their care plans with guidance from families and professionals.
• There were some cultural specificities in how young people prioritised the specific care elements that were important to them, but the individual preferences appeared stronger influencers of care preferences than the cultural context. Cultural contexts influenced the relevance of certain support aspects, such as the role of religion or stigma about the use of antidepressants.
• Supportive, trusting relationships with family, friends and professionals were found to be key elements of effective mental health support.

What does this mean for practice?

• Young people experiencing anxiety and/or depression should be involved in decisions about their mental health support, with families and mental health professionals providing guidance where appropriate. This can improve outcomes and ensure support is relevant and acceptable.
• Professionals should tailor mental health support to individual needs, considering cultural contexts and personal preferences. This approach can enhance engagement with interventions and their effectiveness.

Why is this important?

• Adverse childhood experiences (ACEs) are traumatic experiences during childhood and include childhood maltreatment, poor parenting practices, household dysfunction, violence and socio-economic adversity. ACEs can have significant impacts on lifelong physical and mental health, yet they are complex to address for children and families.
• One policy-based approach to support families experiencing adversity implemented across New South Wales is Child and Family Hubs (Hubs). This is a program designed to provide families with access to a wide range of supports and services across health, education and social care, all in one place.

What did they do?

• The authors conducted online semi-structured interviews with 11 NSW government policy professionals and 13 NSW community health service managers. Interviewees worked in child and family policy and planning or child and family community-based services.
• The interviews explored stakeholder views and experiences regarding the barriers and enablers to implementing the Hubs in practice.
• Data were analysed using inductive and deductive framework analysis to identify key themes related to the implementation of the Hubs model of care.

What did they find?

• Key enablers of the effective implementation of Child and Family Hubs included flexibility and adaptability to meet local needs, strong leadership, formal change management processes, community engagement and strong collaborative partnerships between service providers.
• Barriers to effective establishment and operation of the Hubs included limited support for the evaluation and integration of services, inadequate funding for a Hub coordinator and unrealistic timeframes for implementation.
• The findings indicated some potential misalignment of policy directives and on-the-ground practices which could lead to inconsistencies in service delivery and outcomes.
• Participants highlighted the need to increase cultural competence in services, particularly to meet the needs of the Aboriginal and Torres Strait Islander people and culturally diverse communities.

What does this mean for practice?

• Being able to adapt to local needs and co-design of services are key for the successful implementation of the Hubs model across policy and practice. This means investment in physical and digital infrastructures to facilitate collaborative ways of working.
• Practitioners should focus on building strong partnerships to support children and families experiencing adversity.