Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study.

BACKGROUND: Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. OBJECTIVE: This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL. METHODS: Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. RESULTS: The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health. CONCLUSIONS: After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51096.

A mixed-methods project on the impact of the mental health first aid training on French university students' knowledge, attitudes and practices.

AIM: University students are increasingly affected by mental health problems and need prompt support. The aim of this project was to assess the impact of the mental health first aid (MHFA) training on students' knowledge, attitudes and practices (KAP) concerning mental health in the short, mid and long-term. METHODS: Three studies were conducted in Bordeaux, France, from May 2021 to March 2022. The first study collected data from 55 students 1 to 6 months after they had followed the training to examine its efficacy in the mid-long term. The second study collected data immediately before and after the training to evaluate the KAP of 52 students in the short-term (1 to 10 days). The third study consisted of 14 semi-structured interviews with students trained since 2020 to identify the training's long-term impact (3 to 18 months). Descriptive statistics were used for studies one and two, and framework analyses for study three. RESULTS: Most participants reported that their KAP about mental health had improved after the training. In the first study, 94.2% of students reported being ready to intervene during a psychotic crisis in their peers. In the second study, 75.0% of students reported improved mental health-related knowledge and decreased stigma. All students in the third study reported that they had assisted at least one person after the training. CONCLUSIONS: These were the first data on the impact of the French MHFA on KAP. While not exhaustive, findings suggest that deploying the training would be beneficial to French students.

Australian Youth Resilience and Help-Seeking during COVID-19: A Cross-Sectional Study.

The COVID-19 pandemic has seriously impacted youth mental health. Their resilience, defined as the ability to respond to adversity, has also been impaired. Help-seeking refers to the activity of addressing oneself to others when facing trouble. The objective of this study was to understand the levels of youth resilience and help-seeking during COVID-19 in 2021. Data were collected online from 181 Australian adolescents aged 12-17 years. The General Help-Seeking Questionnaire, the Actual Help-Seeking Questionnaire, and the Resilience Scale were used. Mean and frequency analysis and independent samples t-tests were performed. The Pearson correlation coefficient was calculated. Resilience was in the low range (mean = 66.56, SD 15.74) and associated with no help-seeking. For a personal problem and suicidal ideation, participants were most likely to contact a mental health professional, with means of 4.97 (SD 1.75) and 4.88 (SD 1.97), respectively. The majority did not seek help (n = 47) for challenges with anxiety or depression. This study corroborates previous findings on limited help-seeking in youth because of self-reliance and low confidence in others. Resilience decreased during COVID-19 in parallel with help-seeking. Strategies aiming to increase resilience and help-seeking, such as school-based programs, are needed given their decrease in Australian youths due to the COVID-19 pandemic.

Australian School Staff and Allied Health Professional Perspectives of Mental Health Literacy in Schools: a Mixed Methods Study.

Schools are an ideal setting to base mental health literacy programs as the learning environment is already established. Mental health literacy represents how to obtain and maintain good mental health and should be incorporated into the school curriculum. Collaboration with key stakeholders in youth mental health, such as school staff and allied health professionals, is critical in ensuring needs are addressed, and programs are sustainable. This study aimed to understand the perspectives of school staff and allied health professionals towards mental health literacy within Australian schools. An exploratory qualitative and quantitative survey was completed by 88 participants across Australia. Results indicated that school staff feel less competent to deliver mental health literacy content and perceive their training did not address mental health education compared to allied health professionals. Most mental health programs reported to be implemented within schools were social and emotional learning programs. School staff viewed mental health programs to strengthen academic performance less than allied health professionals. Thematic analysis of qualitative data identified that participants viewed mental health knowledge, where and how to seek help, and coping skills as vital content to cover in a school-based mental health literacy program. This study reveals that school staff need sufficient training and resources to address youth mental health literacy. Though mental health literacy is lacking in the Australian school system, the perspectives of school staff and allied health professionals in this study provide key ideas and considerations for the future development of school-based mental health literacy programs for youth. Supplementary Information: The online version contains supplementary material available at 10.1007/s10648-023-09725-5.

Developing and Initially Validating the Youth Mental Health Literacy Scale for Ages 11-14.

Despite rising rates of youth mental health disorders and suicides, most youth lack access to accurate, non-stigmatized mental health information. Instead, many describe people with mental illness as violent and incompetent. Mental health literacy aligns with resilience theory. It assumes that youth that have accurate mental health information will have less stigmatized views of mental illness and will be more likely to seek help earlier should mental health symptoms arise. Accurate, non-stigmatized mental health information is especially needed for Children of a Parent or other Family Member that has a mental illness (COPFMI) since they are more likely to acquire a mental illness than children who do not have a family member with a mental illness. COPFMI youth are in need of the same mental health information as general population youth but they can also benefit from knowing how to deal with a family member's mental health disorder. Based on many foundation studies and key stakeholder input from parents, educators, mental health providers, child welfare providers, and especially youth, an emerging Youth Mental Health Literacy (YMHL) scale was developed and validated for measuring the mental health literacy levels of youth ages 11-14. The scale provides a full scale score of youth mental health literacy. It has subscales of knowledge of mental illness and recovery; stigma, help seeking for self/others; coping with stress; and dealing with family mental health challenges. The validation study indicated support for a unidimensional structure for each of the refined subscales. The subscales showed suitable reliability as evaluated by several measures of internal consistency. While the scale needs further study with larger samples of youth, it is hoped that the scale can yield mental health literacy outcome data that can help mental health literacy programs to build evidence-based programs that may, in turn, help prevent, delay, or ameliorate mental health disorders among youth.

"In any crisis there is an opportunity for us to learn something new": Australian teacher experiences during COVID-19.

The aim of this study was to investigate the factors that supported Australian teachers to meet the needs of all learners during COVID-19 lockdowns. A qualitative design was used, and interviews were conducted with teachers who were purposely identified. The participants (n = 5) worked across different educational contexts ranging from primary to secondary school settings. The interview data were analysed using thematic analysis. Five themes were identified related to teachers' intrinsic strengths: passion and commitment, a proactive and organised approach, enhanced flexibility, building relationships and access to online technology. A further three extrinsic supporting factors were identified: supportive school teams, supportive school leadership (empowerment, autonomy and time) and supportive school systems and structures. The implications of these findings are discussed and the need for sharing and applying learnings across the profession are emphasised as an opportunity to further improve the access of every learner to a high quality and inclusive education.

Editorial Perspective: Prato Research Collaborative for change in parent and child mental health - principles and recommendations for working with children and parents living with parental mental illness.

Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent's illness on children. Notwithstanding the availability of several evidence-based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change.

Therapy Dogs in Educational Settings: Guidelines and Recommendations for Implementation.

Therapy dogs in educational settings have gained increase traction in recent years. Despite its potential benefits and popularity, there remain concerns of perceived risks such as sanitation, allergies, and safety issues, as well as a lack of guidelines, regulations and support resources available to school staff. Research is further lacking into the implementation process of therapy dog programs in educational settings. To construct a set of recommendations for school staff to achieve successful implementation of a therapy dog program, the present study investigated the perceived facilitative and impeding factors when implementing a therapy dog program. A total of 13 school staff and 2 coordinators from therapy dog organisations took part in an open-ended online survey and/or a semi-structured interview over the phone, with the aim of gathering their perspectives of implementing a therapy dog program in schools. The thematic analysis of the data indicated facilitative factors such as program flexibility, whole-school support, the need for communication and training for all staff, as well as dog welfare. Successful implementation of therapy dogs in an education setting appear to revolve around (1) flexibility of the dog therapy program to target school's needs, (2) qualities of program instigator, (3) whole-school support, (4) communication, training and education, (5) considerations for dog's welfare. Key barriers identified included a high workload, lack of guidelines on processes, lack of support from the school community, as well as the need for better understanding of the role of a therapy dog. The results highlighted the importance of a whole-school effort when implementing a therapy dog program, as well as the need for guidelines for assessing school readiness, key factors for consideration, and strategies to overcome challenges associated with program implementation.

Co-developing a Mental Health and Wellbeing Chatbot With and for Young People.

There are many young people who experience mental health and wellbeing challenges. A potential negative mental health trigger for some youth is a struggle to cope with stress at school, feelings of depression and anxiety and availability of adequate help for these stressors. In response to youth needs a mental health and wellbeing Chatbot has been co-developed with youth, technology partners and expert stakeholders. An element of the Chatbot is powered by artificial intelligence and rules based AI using natural language processing. It is created to communicate evidence based resources, wellbeing support, educational mental health information and adaptive coping strategies. This paper will discuss how the Chatbot has been developed, highlighting its participatory, co-design process with youth who are the key stakeholders to benefit from this digital tool. Research from interviews and surveys informed the creation of the Chabots personality and its character design. Examples of the conversation design and content development are provided. The paper finishes with how, if at all, digital tools such as Chatbot applications could support the mental health of young people in secondary schools or health care settings in conjunction with the wellbeing or health care team, concluding with lessons learned and cautions.

Using Social Networking Sites in Research: An Emerging Approach to Engaging With Young People Who Have a Parent With a Mental Illness and/or Substance Abuse Disorder.

The challenges involved in engaging young people who have a parent with a mental illness in research and in programs are well documented. Social networking sites provide a potentially useful medium to include at-risk youths and their families by removing some accessibility barriers that may prevent engagement and connection with individuals whose parents or family members have a mental illness. This paper examines how social networking sites can be used to recruit youths and/or their families and engage them in research. Applying a case study analysis, the implications of using social media as a tool for recruitment and data collection and the ethical considerations and limitations will be discussed. Results tentatively indicate that social networking sites may be an effective method to engage young people of parents with a mental illness. The study argues for more informed use of social platforms for the translation and dissemination of research and intervention prevention. Overall, this paper will contribute to public mental health practice through guidelines and policy about social media research with at-risk young people and their families.

Mental Health Literacy of Youth That Have a Family Member With a Mental Illness: Outcomes From a New Program and Scale.

A program evaluation examined mental health literacy levels and coping outcomes for youth (ages 10-16), before and at the end of their participation in a manualized, school-based mental health literacy program called Youth Education and Support (YES). Most of the youth reportedly had a parent or other family member with a mental health disorder such as depression, anxiety, and/or substance abuse. The mental health literacy levels of program participants from pre to post were evaluated with the developing Knowledge of Mental Illness and Recovery (K-MIR) scale. This scale was validated using item-response theory, demonstrating good psychometric properties. Youth answered two coping questions about their use of positive coping during the program and coping skills compared from pre to post intervention. Findings revealed that youth levels of mental health literacy increased significantly from pre to post program participation. Over 90% of the youth reported an improved use of positive coping strategies from pre to post intervention. The program appeared to deliver enhanced levels of literacy and coping for this sample of youth. The scale appeared to be appropriate to measure youth mental health literacy. Recommendations for practice, policy, and research are offered.

A Scoping Review of Different Ways of Thinking in Children.

Despite the growing interest in differences in thinking, much less is known about differences in how children think and how they come to think. The aim of this scoping review is to map out the key concepts underpinning the conceptual boundaries of children's (5⁻12 years of age) individual differences in thinking. The scoping review identified eight papers for analysis; all of which were set in an educational context. The findings presented inconclusive results regarding learning and thinking differences related to students' academic achievement. This review has identified two main drawbacks with this research area. Firstly, there is little consensus between the models employed to understand the different ways children think. To further place these findings into context we look at conceptualisations of individual differences, where individuality is considered a process of stable characteristics interacting with more dynamic structures. This analysis highlights the second drawback, previous research has solely focused on exploring thinking characteristics that are not stable and are therefore subject to change depending on the context. The review found that there is little to no research which explores thinking preferences in children that are consistent across contexts and time. Moreover, there was no research identified that explored the impact of differences in thinking outside the educational domain, such as children's wellbeing. Further research is required to identify the more stable characteristics that reflect and capture children's different ways of thinking.

Mental Health Literacy Content for Children of Parents with a Mental Illness: Thematic Analysis of a Literature Review.

Millions of children have a parent with a mental illness (COPMI). These children are at higher risk of acquiring behavioural, developmental and emotional difficulties. Most children, including COPMI, have low levels of mental health literacy (MHL), meaning they do not have accurate, non-stigmatized information. There is limited knowledge about what kind of MHL content should be delivered to children. The aim of this exploratory study is to identify the knowledge content needed for general population children and COPMI to increase their MHL. A second aim is to explore content for emerging children's MHL scales. Researchers created and analyzed a literature review database. Thematic analysis yielded five main mental health knowledge themes for children: (1) attaining an overview of mental illness and recovery; (2) reducing mental health stigma; (3) building developmental resiliencies; (4) increasing help-seeking capacities; and (5) identifying risk factors for mental illness. COPMI appeared to need the same kind of MHL knowledge content, but with extra family-contextual content such as dealing with stigma experiences, managing stress, and communicating about parental mental illness. There is a need for MHL programs, validated scales, and research on what works for prevention and early intervention with COPMI children.

Improving the aqueous solubility of triclosan by solubilization, complexation, and in situ salt formation.

Triclosan, an antimicrobial, although widely incorporated into many skin care products, toothpastes, and liquid soaps, presents formulation difficulties because it is practically insoluble in water. The objective of this study was to improve the aqueous solubility of triclosan through solubilization, complexation, and salt formation. The solubility of triclosan in distilled water and in phosphate buffers (pH 7.4) was determined at 30 degrees C. The order of solubilizing performance of the solubilizers was: N-methylglucamine> or =L-arginine>sodium lauryl sulfate>beta-cyclodextrin> or =hydroxypropyl-beta-cyclodextrin>ethanolamine>sodium benzoate>sodium methyl 4-hydroxybenzoate>triethanolamine> or =diethanolamine. These solubilizers increased the solubility of triclosan from 80- to 6000-fold. Micellar solubilization and the formation of either salts or complexes are postulated as possible mechanisms for the increase in the solubility of triclosan by the surfactant sodium lauryl sulphate, the cyclic sugar derivatives beta-cyclodextrin and 2-hydropropyl-beta-cyclodextrin, the amino acid L-arginine, and the amino sugar alcohol N-methylglucamine. Furthermore, although the bacteriostatic efficacy of triclosan was significantly increased when solubilized with N-methylglucamine, L-arginine, and ethanolamine, increased solubilization did not increase the effectiveness of triclosan for all solubilizers tested.