Self-harm and suicidal behaviors in children: perspectives of mental health clinicians.

OBJECTIVE: Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children. METHODS: 26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis. RESULTS: Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem. CONCLUSIONS: Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.

Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community.

BACKGROUND: Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program. METHODS: Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data. RESULTS: Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink. CONCLUSIONS: Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program. TRIAL REGISTRATION: The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention.

Purpose: This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention. Methods: We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention. Results: Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores. Conclusion: Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

Borderline personality disorder and stigma: Lived experience perspectives on helpful and hurtful language.

Borderline personality disorder (BPD) is a severe mental health disorder that is subject to significant stigmatisation. With language being a key reinforcer of stigma, this co-produced study aims to explore the language use regarding BPD and its effect on those with BPD and carers. Recommendations to reduce stigmatisation are provided for both clinicians and researchers. Participants with BPD (consumer n = 33) and those supporting someone with BPD (carer n = 30) discussed their experience of hurtful and helpful language. Reflexive thematic analysis was used to analyse written and verbal responses into core conflictual relationship themes (CCRT) reflecting how different words were heard and experienced. All consumers and carers in the study reported experiences with stigmatising language. Feelings of inadequacy and frustration were common amongst consumers, specifically when they perceived others as trivialising their needs or not seeing them as a unique individual. Carers often reported feelings of frustration when they perceived others as blaming them or not acknowledging their needs. Both consumers and carers reported helpful language as being connecting, validating and accepting. Unhelpful communication patterns have negative consequences for the person's self-understanding (i.e., self-stigma) and their relationships with others, including the therapeutic alliance. A consideration of these communication patterns may foster the use of reflective positive language that is compassionate and hopeful.

Difficult Toddler Temperament - Prevalence and Associated Factors at 18-Month Follow-Up of a Birth Cohort.

Purpose: Difficult temperament coupled with other risk factors may lead to mental health problems in childhood and have long-lasting effects in adolescence and adulthood. This study aimed to investigate the prevalence of parental perception of difficult temperament in toddlers and identify significant factors associated with individual and family-level sociodemographic risk factors. Patients and Methods: The prevalence of parental perception of difficult temperament was derived from items in the 18-month follow-up questionnaire within the Watch Me Grow (WMG) longitudinal birth cohort study in a multicultural and socioeconomically disadvantaged community in Sydney, Australia. Data was available for 500 children and their parents. Descriptive analysis was used to calculate the participant characteristics and the prevalence of parental perception of difficult temperament, whereas multivariable logistic regression analysis was used to assess significant risk factors associated with a difficult temperament. Results: Parental perception of difficult temperament in the cohort was 7.3% (n = 492). Findings of the multivariable logistic regression showed that screen time >2 hours a day (AOR 2.43, 95% CI: 1.2, 4.9), child not being read to (AOR 3.92, 95% CI: 1.8, 8.5), and family history of mental health problems (AOR 2.69, 95% CI: 1.1, 6.5) significantly increased the odds of having a difficult temperament. Conclusion: Toddlers with difficult temperament were less likely to have received stimulatory experiences, and their families were more likely to be under greater stress. The findings emphasize the importance of parental support and anticipatory guidance in promoting nurturing care to facilitate child health and development, particularly in disadvantaged communities.

Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives.

BACKGROUND: Peer support is a recovery oriented approach where consumers and carers are introduced to people with lived experience of the disorder who have recovered. Paid roles within health services for such consumer peer workers and carer peer workers (or 'specialists') are increasingly common. To date specific studies on such peer support for consumers with borderline personality disorder (BPD) and their carers has not been conducted. METHODS: This qualitative study used interviews to explore perceptions and models of peer support for BPD from the perspectives of 12 consumers, 12 carers, and 12 mental health professionals. Participant responses were analyzed using reflexive thematic analysis within a phenomenological methodology. RESULTS: All groups described how consumer peer workers may provide hope, connection, and validation to a consumer's lived experience. Offering both traditional mental health treatment plus peer support, and giving consumers choice regarding a consumer peer worker was welcomed. Differences in opinion were found regarding the consumer peer worker's role in relation to the mental health team, including whether consumer peer workers should access medical records. Perspectives differed regarding the consumer peer worker and carer peer worker positions, highlighting potential role confusion. Carers discussed the value of receiving support from carer peer workers and consumer peer workers. Mental health professionals described how consumer peer workers can experience workplace stigma and problems with boundary setting, and acknowledged a need for peer workers to be valued by having a duty of care and confidentiality code to follow and be offered supervision. CONCLUSIONS: Two models of peer support for BPD emerged: an integrated model where consumer peer workers work within the mental health team, and a complementary model where consumer peer workers are separate from the mental health team. Based on these findings we provide recommendations for services to help support such peer work for consumers with BPD and their carers.

Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences.

BACKGROUND: Despite effective treatments for personality disorders being developed, consumers and carers often report negative experiences of mental health services, including challenges accessing these treatments. METHODS: This qualitative study used separate focus groups to compare the unique perspectives of consumer and carers, and to investigate how to improve services for individuals with personality disorders. Reflexive thematic analysis was used to analyze the data. RESULTS: Both consumers and carers (N = 15) discussed the value of providing appropriate information to consumers when they are diagnosed with personality disorder. Consumers and carers described the importance of creating a safe environment for consumers when they present to the emergency department. Both groups discussed experiencing positive and negative treatment from mental health professionals, and suggested that professionals should be trained to understand personality disorder. Limited accessibility and quality of services, and offering peer support to consumers were also described by consumers and carers. Consumers and carers also had perspectives which were unique to their group. Consumers identified the importance of psychological treatment, having a strong therapeutic relationship with a mental health professional, and the benefit of long term psychotherapy with the same professional. Broadening the scope of psychotherapies including creative, animal-assisted, and physical therapies was recommended by consumers. Carers described the importance of assessing for personality disorder and intervening early. Involvement in the assessment, diagnosis, and intervention process was important to carers. The desire to be recognized and supported by mental health professionals was discussed by carers. CONCLUSIONS: This research contributes to the concern that consumers with personality disorder and their carers experience stigma and low quality care within mental health services. In line with these findings, we recommend guidelines for health professionals who work with consumers with personality disorder.