Barriers for implementing an intervention for substance using adolescents when adding a parent component

Research has shown that an intervention process with adolescents involving the parents may achieve better results since the interaction with the parents is a protective factor itself. The brief intervention program for adolescents starting substance use is an intervention used in Mexican clinical centers with adolescents who have experienced problems with their substance use but do not present dependency symptoms. The family context is key to the genesis and progression of behavior problems, including substance use, among children and adolescents. An intervention process that involves parents may achieve better results in preventing substance use problems in adolescents

MindMate2U: Development and feasibility study of a co-designed school-based mHealth intervention for symptomatic adolescents (Preprint)

BACKGROUND Early intervention can reduce the risk of mental health disorder in young people. Given the burden on services, schools often provide frontline support, but with few resources. School-hosted mHealth is a novel option which could meet young people’s needs for privacy in mental health intervention and schools’ need for evidence-based resources. OBJECTIVE We aimed to co-design and feasibility test a self-help, school hosted, digital intervention for symptomatic adolescents in UK high schools. METHODS Extensive co-design processes integrated user and stakeholder design and implementation preferences with evidence, theory and treatment guidelines with. We conducted co-design workshops (n=14) and iterative content development reviews (n=40) with youth, parents/carers, teachers, mental health professionals and software engineers. Co-design determined the intervention aim, content, user features, implementation and evaluation protocol, and led to the production of a web-app 'MindMate2U' as well as to a low-intensity parent component ‘Partner2U’ (email psychoeducation and support). Feasibility was tested in school-selected year groups in four UK high schools where young people opted in to use MindMate2U. We specified rules for progression to an effectiveness randomised controlled trial, tested two candidate primary outcome measures (SDQ and WEMWBS) and conducted an exploratory cost-effectiveness analysis RESULTS MindMate2U is an evidence-based, six-week, self-help program targeting risk and protective factors for mental health with content released weekly to a young person’s smartphone. It met high standards of clinical safety, privacy needs and user testing before trial. Four large UK urban secondary schools opted into the study and committed to low intensity teacher training on MindMate2U, creating individual web-app accounts for participating young people, a teacher being ‘on standby’ for users and assessing any post-intervention needs. Thirty-one adolescents (15-17y) opted to use MindMate2U. Most scored in sub-clinical or clinical ranges. User ratings (n=19) and post-intervention interviews (n=6) showed acceptability of the resource. We met our recruitment, retention and pre-post measure completion targets and identified the SDQ as the most sensitive outcome measure. Young people designed release of the parent component to be under their control. Only one young person opted for this. Improvements and design parameters for an effectiveness trial were identified. CONCLUSIONS This study established the feasibility of a co-designed mental health app as a low-burden, school-hosted resource for symptomatic young people and opens up new possibilities for the integration of mHealth in schools. There is scope to consider how MindMate2U could operate within schools as an adjunct to school counselling. Support via schools to parents of symptomatic young people may need to be universal rather than targeted to protect young people’s needs for autonomy and privacy. Following some development of MM2U, a subsequent phase 2 randomized controlled trial is warranted to test its effectiveness in reducing clinical risk among symptomatic young people.

Atypical Development

This chapter considers deviations from the normal developmental path of two sorts. The first section of the chapter addresses childhood clinical syndromes that impact both children’s development and parents’ beliefs. Three syndromes are discussed: intellectual disabilities, attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The second section of the chapter addresses deviations in the parent component of the parent–child dyad, considering both clinical conditions (in particular, depression and schizophrenia) and maladaptive parental practices (in particular, abuse or neglect). It also discusses the concept of resilience; that is, the ability of some children to overcome adverse early experiences.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents

Background. Adolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes; the level of theory application and the extent of stakeholder involvement in program design. Method. A total of seven databases were searched to identify relevant studies published between January 2000 and November 2018. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. Results. In total 15 studies qualified for assessment, detailing 11 individual parent programs. Of these, nine programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with one program informed by theory, two programs applying theory and four testing theory. Conclusion. Future studies are recommended to further enhance the effectiveness of parental programs. Given stakeholder involvement can increase levels of engagement, increasing levels of stakeholder involvement in the design of parental programs is recommended to extend parental participation in programs developed. Inclusion of theory in program design and evaluation will further extend understanding of the mechanisms leading to change.

An Insight Into the Involvement of Mothers of Low Socioeconomic Status in Scottish Primary School Health Education Activities

School-based health activities that involve parents are more likely to be effective for child health and well-being than activities without a parent component. However, such school-based interventions tend to recruit the most motivated parents, and limited evidence exists surrounding the involvement of hard-to-reach parents with low socioeconomic status (SES). Mothers remain responsible for the majority of family care; therefore, this study investigated mothers with low SES to establish the reasons and barriers to their involvement in school-based health activities and to propose strategies to increase their involvement in those activities. Interviews were conducted with mothers with low SES, who were typically not involved in school-based health activities ( n = 16). An inductive–deductive approach to hierarchical analysis revealed that there are several barriers resulting in mothers being less involved, particularly due to issues surrounding the schools’ Parent Councils and the exclusivity of school-based events. Efforts made by the school to promote health activities and involve parents in such activities were revealed, alongside recommendations to improve on these practices. The findings offer multiple ways in which future school-based health interventions can recruit and involve mothers with low SES.

Children with Anxiety Problems

Anxiety is one of the most common psychological complaints reported by children and is associated with significant psychosocial and physical health problems, a poor prognosis, and significant economic burden. Anxiety is transmitted within families, with parenting variables implicated in the etiology of childhood anxiety. However, meta-analyses have concluded that the addition of a parent component to child-focused cognitive-behavioral therapy does not enhance children’s outcomes. A much smaller body of work has examined the question from the opposite angle, asking, Is it sufficient to work only with parents of anxious children? This research is reviewed and a new parent-only group cognitive-behavioral therapy intervention (Fear-less Triple P) is introduced.