Use of Medicare Benefit Scheme mental health services in young people who experienced self-harm and/or suicidal behaviours: Data from the Young Minds Matter survey.

OBJECTIVES: To examine healthcare utilisation patterns in a sample of young people with self-reported experiences of self-harm and/or suicidal behaviours. METHODS: A national survey examining mental health in a nationally representative sample of young Australians aged 12-17 years, linked to routinely collected healthcare and dispensing data. For respondents that self-reported experience of self-harm, suicidal ideation, suicidal plan and/or suicide attempt, we assessed attendance at a Medicare Benefits Scheme (MBS) subsidised MH service or non-MH general practitioner (GP) attendance at three time periods: 1) ever, 2) in the 12 months prior to completing the survey and 3) after completing the survey until 31 Dec 2015. We also assessed correlates associated with attendance and non-attendance at a MH service. RESULTS: The study included 311 young people. MH services were attended in the 12 months before the survey by 38.3% with attempted suicide, 28.7% with a suicidal plan, 28.9% with suicidal ideation and 29.4% with self-harm. MH treatment administered by a GP was the most common MH service (25%); followed treatment by psychologist (15%) and psychiatrist (5%). Attendance at a MH service was observed highest alongside more severe self-reported depression. CONCLUSIONS: Potential underutilisation of MBS MH services by young people with self-harm and/or suicidal behaviours.

Nurse perceptions of family home-visiting programmes in Australia and England.

AIMS: Nurse home-visiting programmes are employed to enhance the functioning of disadvantaged mothers and young children. Despite the key role played by nurses, there is little empirical evidence describing the views and experiences of nurses who deliver home-visiting programmes. This study compared the views and experiences of nurses delivering home-visiting programmes in England and South Australia. METHODS: Participants were 108 nurses delivering the South Australian Family Home Visiting programme (2008-2011), and 44 nurses delivering the Family Nurse Partnership programme in England (2007-2009). Data were collected using a standard questionnaire that was completed by nurses in each country. The questionnaire asked nurses about their level of influence on programme outcomes, approaches they used to retain maternal engagement with the home-visiting programmes, barriers to effective programme delivery and the effectiveness of supervision. RESULTS: Both groups of nurses considered that their greatest influence was improving mothers' confidence with parenting skills and increasing mothers' knowledge about children's development. Each group identified quality of nurse-mother relationships as the factor most relevant to retaining maternal engagement. Other influential factors were flexibility of timing for visits and the capacity of the programmes to meet specific needs of mothers. CONCLUSION: There was consistency in the nurses' views about the home-visiting programmes delivered in England and Australia. Future studies should utilise prospective designs to identify the mechanisms by which factors influence the quality of nurse-mother relationships, approaches used by nurses to solve family problems and elements of mother-nurse relationships that have the strongest influence on programme outcomes.

Child psychiatry curricula in undergraduate medical education.

OBJECTIVE: To review the literature describing the content and time allocated to undergraduate medical education curricula in child and adolescent psychiatry and make recommendations about child and adolescent psychiatry teaching goals and curricula content. METHOD: A literature search from 1970 to February 2007 using the key words undergraduate, curriculum, teaching, education, psychiatry, child, adolescent, and medical school, was conducted using PubMed, PsycINFO, and Web of Science. RESULTS: There is limited agreement about curricula content for undergraduate child and adolescent psychiatry teaching programs in medical schools, with a wide range of objectives identified by different programs. On average, the time allowed for teaching child and adolescent psychiatry is small. There is also great variation in the time allocated by different medical schools. In many countries, the number of child and adolescent psychiatrists with academic appointments is limited, and child and adolescent psychiatry programs are developed and taught by a small number of teaching staff at each medical school. CONCLUSIONS: Medical schools should reconsider the relatively low priority given to teaching child and adolescent psychiatry to medical students. The child and adolescent psychiatry profession must identify clear learning goals for a longitudinal developmentally appropriate model of child and adolescent psychiatry education commencing at an undergraduate level in medical schools and continuing through residency and fellowships. There is a need to promote national and international standards for teaching in this area and to encourage stronger collaborations between teaching staff across different medical schools.

Use of health and school-based services in Australia by young people with attention-deficit/hyperactivity disorder.

OBJECTIVE: To examine use of health (including psychiatric) and school-based services by children and adolescents who met symptom criteria for attention-deficit/hyperactivity disorder (ADHD), the factors associated with service use, and barriers to service access. METHOD: The relationship between parents' perceptions of children's need for professional help, the impact of children's problems on children and parents, and services used during the previous 6 months were examined in a national sample of 398 children and adolescents with ADHD symptoms aged 6 to 17 years (70% response rate). Information was obtained from parents who completed the Diagnostic Interview Schedule for Children Version IV and standard questionnaires. Data collection took place between February and May 1998. RESULTS: Only 28% of those with ADHD symptomatology had attended health or school-based services. Among these, 41% had attended both health and school-based services, 39% had attended only health services, and 20% had attended only school-based services. Sixty-nine percent of parents attending health services wanted additional help. Parental perceptions that children needed professional help, children's functional impairment, the impact of problems on parents, and comorbid depressive or conduct disorders had a significant and independent relationship with service use. CONCLUSIONS: A minority of children and adolescents with ADHD symptomatology receives professional help for their problems in Australia. Counseling is the most frequent help provided, with many parents wanting additional help beyond that already provided. Factors other than children's ADHD symptomatology have a significant relationship with service attendance. Practical issues, including the cost of services and waiting lists are the most common barriers cited by parents as hindering access to services.

Effectiveness of nurse home-visiting for disadvantaged families: results of a natural experiment.

OBJECTIVE: To evaluate the effects of a postnatal home-visiting programme delivered by community health nurses to socially disadvantaged mothers in South Australia. DESIGN: The intervention group of 428 mothers lived in metropolitan Adelaide and the comparison group of 239 mothers lived in regional towns where the programme was not yet available. All participating mothers met health service eligibility criteria for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age=14.4 weeks SD=2.3), prior to programme enrolment, and again when the children were aged 9, 18 and 24 months. SETTING: State-wide community child health service. PARTICIPANTS: 667 socially disadvantaged mothers enrolled consecutively. 487 mothers (73%) completed the 24-month assessment. INTERVENTION: Two-year postnatal home-visiting programme based on the Family Partnership Model. PRIMARY OUTCOME MEASURES: Parent Stress Index (PSI), Kessler Psychological Distress Scale and the Ages and Stages Questionnaire. RESULTS: Mixed models adjusting for baseline differences were used to compare outcomes in the two groups. The mothers in the home-visiting group reported greater improvement on the PSI subscales assessing a mother's perceptions on the quality of their relationship with their child (1.10, 95% CI 0.06 to 2.14) and satisfaction with their role as parents (0.46, 95% CI -0.15 to 1.07) than mothers in the comparison group. With the exception of childhood sleeping problems, there were no other significant differences in the outcomes across the two groups. CONCLUSIONS: The findings suggest that home-visiting programmes delivered by community health nurses as part of routine clinical practice have the potential to improve maternal-child relationships and help mothers adjust to their role as parents. CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12608000275369.

Four-year prospective study of BMI and mental health problems in young children.

OBJECTIVE: To investigate prospectively the relationship between BMI and the mental health and health-related quality of life (HRQoL) of young children. METHODS: In this study we used data from the Longitudinal Study of Australian Children obtained when children were 4 to 5 and 8 to 9 years old. BMI was available for 3363 children at both waves. Mental health problems were assessed by using the Strengths and Difficulties Questionnaire (SDQ), which was completed by parents and teachers. HRQoL was assessed by using the Pediatric Quality of Life Inventory (PedsQL), which was completed by the parents. RESULTS: Logistic regression models were adjusted for children's age, gender, baseline SDQ or PedsQL scores, and maternal characteristics. A 1-SD increase in BMI in children aged 4 to 5 years was associated with increased odds of scoring in the abnormal range of the SDQ peer problems scale of 1.15 (95% confidence interval [CI]: 1.03-1.28) for parent reports and 1.20 (95% CI: 1.04-1.37) for teacher reports when these children were aged 8 to 9 years. The odds ratio for children who scored above the at-risk cutoff on the parent-reported PedsQL social problems scale was 1.17 (95% CI: 1.06-1.28) for each 1-SD increase at 4 to 5 years of age. There were also increased odds for teacher reports of childhood emotional problems. CONCLUSIONS: Higher BMI in children aged 4 to 5 years was positively related to poorer peer relationships and teacher-reported emotional problems but not to other childhood mental health problems, in these children at 8 to 9 years of age. Prospective studies are needed to determine if peer problems experienced by children with higher BMI predict subsequent mental health problems in other areas.

Evaluating population-level interventions for young people's mental health: challenges and opportunities.

AIM: To identify key issues relevant to the delivery and evaluation of population-level mental health interventions for children and adolescents. METHODS: The benefits and limitations of clinical, targeted and universal interventions were initially reviewed. Subsequently, experience gained in evaluations of targeted and universal interventions was utilized to identify key challenges that must be addressed by researchers responsible for evaluating population-level interventions and potential solutions to these challenges. RESULTS: To be effective, population-level interventions must engage large numbers of individuals in community or regional areas. Successfully evaluating population-level interventions delivered in routine services requires a clear agreement about outcomes, use of strong research methodologies, and the availability of adequate research funding. Sustaining service-research partnerships over the several-year life of typical population interventions requires careful attention to these issues. Electronic databases with the capacity to efficiently collect, store and allow retrieval of large amounts of data in electronic format are also an essential component of population-level interventions. Finally, research leaders need high-quality administrative skills to manage research teams responsible for evaluating large-scale population-level interventions delivered at a regional or national level. CONCLUSION: Population-level interventions have the potential to play an important role in reducing the incidence and prevalence of mental health problems experienced by young people in the community. However, if they are to achieve their full effectiveness, ongoing evaluations are needed.