A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece.

BACKGROUND: Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. METHODS: The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. RESULTS: Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. CONCLUSIONS: Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.

Staff who support refugee children without parents come from different backgrounds, and often have limited mental health knowledge and skills. To address this gap, a national programme was established for 17 organisations hosting accommodation centres across Greece. Selected professionals were upskilled as trainers to cascade knowledge to their staff group. Training was based on the understanding of the impact of trauma and children's cultural needs and was provided to interdisciplinary staff groups. In total, 199 staff attended pilot training. Experiences of the training were shared by a sub-group of 33 trained staff, nine managers and six trainers through focus group discussions. These were analysed through a qualitative thematic approach. Key findings included the relevance of new knowledge to children's needs and staff roles, training as a team, using learning methods based on real issues, and supports that should be put in place to ensure that benefits are maintained. Such a model of cascading knowledge and skills can be useful for large numbers of organisations and staff supporting refugee and other vulnerable children. Training should include staff such as caregivers, who may have had limited educational opportunities, while balancing between different staff roles. Training should be integral to all functions of accommodation centres.

Youth-led co-production of mental health promotion in Pakistan: intergenerational influences.

Youth with mental health needs face barriers in seeking and accessing help, especially in resource-constrained settings in Majority World Countries. Community engagement is thus important for mental health promotion, particularly in addressing stigma. Engagement can be enhanced by involving peer educators and by relating to intergenerational experiences in the sociocultural context of the community. The aim of this study was to explore how intergenerational experiences and perspectives can inform the co-production of youth-led mental health promotion in a Majority World Country, Pakistan. We recruited 11 families (one grandmother, mother and granddaughter in each family) as advisers from two disadvantaged areas of Karachi, and 14 peer educators. Training for peer educators included seminars, experiential activities, three participatory workshops with family advisers and supervision. A sub-sample of family advisers and peer educators attended four focus groups, and peer educators completed reflective diaries following each activity. Data were integrated and subjected to thematic codebook analysis. The three themes related to enabling and hindering factors towards co-production of mental health promotion, incorporation of intergenerational resilience and cascading knowledge to communities. The findings highlighted potential benefits of youth-led mental health promotion that contextualizes intergenerational experiences for those communities. Peer educator roles should be supported by training, and mental health promotion should be integrated within local service systems.

Investigating question-answer sequences in child mental health assessments: Engaging children and families through declarative question design.

OBJECTIVE: In mental health settings, before a child can be diagnosed with a mental health condition, they must initially be assessed. These assessments are characterised by question-answer sequences with the child and family members, and our objective is to explore the function of declarative questions. METHODS: Video recordings of mental health assessments from 28 families were collected, each being approximately 90 min. Referred children were aged 6-17-years. Data were transcribed using the Jefferson approach and conversation analysis was used. RESULTS: Attention to question-answer sequences identified that one common type was the declarative question. We focus on three identifiable forms: clean language short declaratives, declaratives with extreme case formulations, and reformulation declaratives. CONCLUSIONS: The response to these three types of declaratives formed the basis for subsequent question-answer elaboration sequences. The question functioned both to engage the child directly and align with other family members. PRACTICE IMPLICATIONS: Implications for practitioners are that these types of declarative questions offer a resource to engage in fact-checking in a way that is non-face-threatening. Conversation analysis provides a methodological tool for practitioners to engage in reflective practice to enhance their clinical skills in relation to question design.

Child protective services and out-of-home Care for Children during COVID-19: A scoping review and thematic analysis.

BACKGROUND: The COVID-19 pandemic challenged child protection and posed new risks for child maltreatment (CM). Moreover, governmental efforts worldwide prioritized mitigating the spread of the virus over ensuring the welfare and protection of families and children. This neglect caused hardship for many vulnerable children, including those in out-of-home care (OOHC), and challenged the functionality of child protective services (CPS). However, only limited research has investigated the impact of COVID-19 on OOHC and CPS and explored how CPS overcame the challenges of helping children in OOHC. OBJECTIVE: This review aims to address this gap in the research to unveil the 'positive legacy' left by CPS in their work with children in OOHC during COVID-19. METHOD: This review utilized three stages of analysis, including a scoping review followed by two rounds of thematic analysis. The scoping review was carried out in six languages: English, Hebrew, Arabic, French, Portuguese, and Spanish. The first round of thematic analysis found eight relevant articles for this review. The second round of thematic analysis found three themes related to this paper's aim in the context of COVID-19. RESULTS: Three main themes were identified: 1) decision-making and OOHC, 2) difficulties in procedures related to OOHC placement, and 3) handling challenges of OOHC. CONCLUSIONS: The discussion emphasizes the crucial role of preserving children's rights, hearing their voices and needs, and considering their safety and well-being when planning policies and practices to protect them. It also emphasizes society's responsibility to acknowledge contextual factors in child protection.

Perspective on clinical high-risk for psychosis in Africa.

Clinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psychosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising assessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma.

A survey of the workplace experiences of police force employees who are autistic and/or have attention deficit hyperactivity disorder.

BACKGROUND: There has been little focus on autism and attention-deficit hyperactivity disorder (ADHD) in occupational groups, particularly in high-demand roles such as the police. AIMS: To describe the characteristics and experiences of UK-based police force employees who are autistic and/or have ADHD, including the benefits and challenges their conditions bring to their occupation, their need for reasonable adjustments, and their co-occurring mental illnesses. METHOD: An online survey was developed, containing both quantitative and qualitative elements. Survey invitations were disseminated through the National Police Autism Association. The survey was open from 23 April to 23 July 2022. RESULTS: A total of 117 participants participated in the survey, including 66 who were autistic and 51 with ADHD. Participants who were autistic and/or had ADHD widely reported both benefits and challenges related to their condition(s) in policing work. Both the autistic and ADHD groups widely reported having requested workplace adjustments related to their condition(s), although these were frequently not made. Anxiety (n = 57; 49%) and depression (n = 40; 36%) were both highly prevalent among the participants.The qualitative findings identified four themes: (a) motivations for taking on this career, (b) rewards of the role, (c) challenges of the job and (d) challenges regarding career progression. CONCLUSIONS: Police force employees who are autistic and/or have ADHD reported that their conditions provided both benefits and challenges with respect to policing work, and that they had requested related workplace adjustments, although such adjustments frequently do not take place. Healthcare professionals need to recognise the importance of workplace considerations and advocacy for people who are autistic and/or have ADHD.

The global impact of COVID-19 on child protection professionals: A scoping review and thematic analysis.

BACKGROUND: The COVID-19 pandemic triggered new risks for child maltreatment (CM) and exacerbated existing challenges for families and children, elevating the importance of child protection professionals (CPPs) while also adding barriers to their work. During the pandemic, many CPPs experienced increased workloads, a disrupted work environment, and personal pandemic-related hardships. However, the scope of how COVID-19 impacted CPPs globally, as well as their adopted coping strategies, have not been well explored. OBJECTIVE: This study addresses these gaps in the research by conducting an international scoping review to explore and analyze these topics. METHOD: The scoping review was performed in six languages: English, Hebrew, Arabic, French, Spanish, and Portuguese, across 16 databases. Sixteen manuscripts were included in the final thematic analysis of this review. RESULTS: Two main themes were identified: 1) the impact of COVID-19 on CPPs, and 2) the coping and adaptation strategies employed by CPPs during COVID-19. This review revealed and emphasized the importance of CPPs' resilience during COVID-19, underpinned by the theoretical framework of the social ecology of resilience. CONCLUSIONS: This study highlights the responsibility of social ecologies and organizational structures to create readiness for a rapid response in times of crisis as well as valuable evidence to inform how CPPs, children, and families may be better supported in the event of a future crisis.

Qualitative research interviewing: application and use of free association.

BACKGROUND: Free association is a core concept of the free association narrative interview method, an approach that is well-known among researchers in the UK who are interested in using psychoanalytic ideas in qualitative psycho-social research. AIM: To examine the relationship between the framing of the psychoanalytic concept of free association in the contexts of qualitative research interviewing, clinical psychoanalysis and psychoanalytically oriented psychotherapy. DISCUSSION: This article considers the definition of free association in psychology and psychoanalysis. It then explores free association's role in the free association narrative method, in terms of interview technique and the analysis of interview material. CONCLUSION: Researchers should carefully consider differences in the contexts of research, clinical psychoanalysis and psychotherapy to avoid makeshift integrations of clinical concepts. IMPLICATIONS FOR PRACTICE: The free association narrative interview method is an attractive approach for researchers interested in applying psychoanalytic ideas in their studies. However, researchers should carefully reflect on the meanings of the clinical ideas and terminology they use.

Exploring the potentially positive interaction between social media and mental health; the perspectives of adolescents.

Adolescents are spending significant time online. Consequently, concerns are consistently raised about potential negative impacts on their mental health. Potentially, these concerns minimise their autonomy and reify the construction of the vulnerable adolescent. Using template analysis, we explored adolescents' perspectives (N = 54) of the relationship between social media and mental health. We centrally considered the wide array of uses made of different social media by the participants, focusing on their understandings of the potentially positive effects these might have. Focus group discussions showed social media could be used to reduce stress, have value for social connectivity, were an important source of information about mental health, and provided a platform for peer-to-peer support. Our conclusion indicated adolescents are generally socially competent online and are often experimenting with their emergent sense of agency.

Soliciting children's views on other-perspectives in child mental health assessments.

Child mental health assessments are complex and involve the analysis of data from multiple sources to inform treatment decisions. Question sequences are central to mental health assessments; however, little research has examined the functions of questions in child mental health interactions, particularly questions that aim to elicit information from children that might be used to inform diagnosis and treatment. In this study, we utilize a large corpus of video-recorded child mental health assessments to examine the use and function of a particular kind of wh-question-circular questions-that is, questions that seek clients' views on other family members' feelings, actions, and thoughts. Using conversation analysis, we identified three "broad" functions of circular questions in child mental health assessment. Our findings provide clinicians with clinically relevant examples for using circular questions to more fully involve children in the assessment process and acquire valuable information for diagnosis.

Psychoanalytic therapy and narrative research interviewing: some reflections.

BACKGROUND: This article focuses on approaches to qualitative research interviewing that draw direct inspiration from psychoanalytic therapy. The reflective discussion piece provides a critical spotlight on this method to promote reflection and ethical application. AIM: To provide clarity regarding the meaning of psychoanalytically informed, psycho-social research and the interpretive nature of qualitative interviews and of therapy, and to reflect on nurse researchers' partiality for using quasi-dynamic interpretative comments and the sharing of formulations in interviews. DISCUSSION: The authors review relevant literature, and comment on the apprehension and uncertainty researchers may experience with this type of research approach. CONCLUSION: Researchers should consider how they conduct themselves as interviewers and what to share of the analysis of participants' accounts based on the specifics of the research, including their or their team's experience of conducting psychotherapy and their and participants' expectations about what may be therapeutic about interviews. IMPLICATIONS FOR PRACTICE: Psychoanalytically informed research interviewing should be used in a reflective way by nurse researchers with attention paid to the limitations and possibilities of parallels between psychotherapeutic and research interview dialogue.

Disruptions, adjustments and hopes: The impact of the COVID-19 pandemic on child well-being in five Majority World Countries.

Drawing on integrated data from focus groups and diary entries, we explored the impact of the COVID-19 pandemic on child well-being for children from five Majority World Countries. We focus on the disruptions the pandemic caused, the adjustments made in response to these, and children's vision of a post-pandemic world. Underlying children's experiences of loss, boredom and concerns about educational progress, was an awareness of systemic inequalities that disadvantaged them or others in their community. Findings have implications on capturing children's voices through introspective and dialogical approaches that transcend cultures and for the development of preventive and responsive interventions during crises.

Email correspondence, interpretation and the psychoanalytically informed research interview.

BACKGROUND: Approaching qualitative interviews using principles drawn from psychoanalytic therapy can assist nurse researchers in developing nuanced accounts of participants' and their own subjectivity. Yet, doing so means confronting questions about the use of psychoanalytic concepts and techniques outside the traditional clinical context of the consulting room. AIM: To consider the researcher's interpretive involvement when a psychoanalytically informed interview approach is used with specific reference to email correspondence as a form of interpretive intervention. DISCUSSION: The authors describe the experience of completing a study involving a psychoanalytically informed interview approach. The interpretive quality of email correspondence is illustrated via reference to the case of one study participant for whom this correspondence appeared to help in the level of insight afforded overall. CONCLUSION: When using a psychoanalytically informed interview approach, researchers should consider emails delineating topics for discussion in follow-up interviews as a form of interpretive intervention. IMPLICATIONS FOR PRACTICE: Nurse researchers interested in this type of method should reflect on the interpretive function of email correspondence. Pre-participation and pre-interview dialogue with participants may be used to explore participants' views on the potentially therapeutic aspects of participation and what might be related to them of the researcher's understanding.

Operationalizing strategic objectives of suicide prevention policy: Police-led LOSST LIFFE model.

Suicide is a global public health challenge. We explore the benefits and challenges of operationalizing strategic objectives of national suicide prevention policies locally. To implement policy effectively, local resources must be mobilized, and we investigate a real-time surveillance, principles-based model led by the police through a multiple case-study design. We found current data collected on deaths by suicide is limited and more localized responses are necessary. Multi-agency communication, utilization of existing local support systems, and emotional support for frontline practitioners is essential. Police are on the frontline for suicide and are uniquely placed to collect data and support families.

Application of digital child mental health training to improve capacity in majority world countries: Professional perspectives from Turkey and Pakistan.

Digital technology offers opportunities for child mental health capacity building, which is a priority for Majority World Countries (MWC). The aim of this study was to explore the experiences and perspectives of professionals from different disciplines in Turkey (n=12) and Pakistan (n=15), who had completed a two-module digital trauma-informed programme on enhancing practice skills and instigating systemic changes. Interview data were analysed through a coding thematic approach. Participants especially valued the interdisciplinary and holistic approach of the training, and its proposed scaled service model. Digital training, particularly in blended format, can enhance reach and capacity in MWC low-resource settings.

From gateways to multilinear connections: A qualitative longitudinal investigation of the relationships between vaping and smoking among adolescent users.

BACKGROUND: The international growth of e-cigarette use has been accompanied by a corresponding concern that e-cigarettes will act as a 'gateway' to smoking and the use of other drugs. Taking these concerns as our point of departure, we explore the relationships between vaping and smoking among a cohort of young people. METHODS: Qualitative longitudinal methods with a diverse sample of 36 14-18-year olds from the UK city of Leicester. A total of 66 depth interviews conducted across two phases separated by 6-12 months. The interviews were recorded, transcribed verbatim and thematically analysed. FINDINGS: We highlight a complex 'tangle' of connections between substances/risk behaviours recounted to us by our adolescent study participants, including multiple and multilinear relationships between vaping and smoking. These findings problematise some of the core axioms of the notion of gateways as an explanatory model of causality and sequential connection between smoking and vaping. They also throw into question gateway logics more fundamentally. While many of our study participants themselves consciously invoked ideas of 'gateway effects', the accounts they produced repeatedly disrupted the logics of connection (between e-cigarettes and smoking; one set of behaviours and another) presupposed in gateway theory and our own early lines of questioning. Accordingly, we explore how cultural understandings of gateway effects are invoked by users in accounting for their vaping and smoking behaviours, noting the potential influence of these ideas upon the very processes they are understood to apprehend. CONCLUSION: Our findings suggest there is a case to be made to reinforce the distinctiveness of tobacco and e-cigarettes in the life-worlds of young people to avoid naturalising a 'gateway' logic of connection that might ultimately inform the associative logic of young users themselves, and potentially the development of their usage careers.

A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education.

BACKGROUND: Virtual Reality (VR) simulation has been a topic of interest in recent years as an innovative strategy for healthcare education. Although there are a handful of studies evaluating VR simulation on knowledge, motivation, and satisfaction; there is a paucity of evidence to evaluate the effectiveness, acceptability and usability of 'Immersive' VR (IVR) simulation in nursing students. OBJECTIVES: A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses' self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education. METHODS: The IVR simulation intervention was designed in collaboration with serious game specialists. Stage one collated pre and post-intervention self-efficacy scores with 19 pre-registration nurses using the validated instrument, Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale. Stage two used a descriptive qualitative approach to explore student nurses' perceptions of the game. RESULTS: In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four over-arching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game. CONCLUSION: IVR simulation show promise as an adjunct for nurse simulation and it appears to increase self-efficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.