ABSTRACT
Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.
ABSTRACT
Background: Children and families from disadvantaged backgrounds are experiencing significant psychosocial and mental health (MH) issues due to the COVID-19 pandemic with inequity in service access particularly for culturally and linguistically diverse (CALD) and regional/rural families. The Watch Me Grow-Electronic (WMG-E) platform is an innovative technology that reaches vulnerable families at their homes and communities. Objectives: To evaluate WMG-E as a digital support and navigation tool to identify and address parental MH, psychosocial well-being and child developmental needs. Methods: A two-group (intervention and control) by three time-points (baseline, 6 months, 12 months) randomised controlled trial for families with 6-month-old to 3-year-old children from multicultural Fairfield Local Government Area and regional/rural Murrumbidgee Local Health District. Both groups are to complete the WMG-E containing screening measures while the intervention group has access to a service navigator offering 'warm hand-over' and continuity of care. Findings: As of October 2021, a full sample of 300 families have been recruited. Preliminary data suggest that about 33% have no risk;27%, low;38%, moderate;and 3%, high risk. In addition to developmental concerns for their children, the top social needs included unemployment, smoking and food insecurity and one-third reported parental MH concerns. Families reported satisfaction following referral/linkage to relevant services. Conclusion: WMG-E was found to be feasible and acceptable as a digital engagement, monitoring and navigation tool. Families in the intervention group who receive wrap-around health and social care commensurate with needs are expected to show significantly improved engagement and health outcomes at 6-month and 12-month follow-up.
ABSTRACT
Background: Increasing demand for Child and Adolescent Mental Health services over the last decade, in Australia and across the Western world, has been compounded by the COVID-19 pandemic. Reports and inquiries within Australia show the need for long-term creative solutions. Objectives: To explore strategic solutions for the CAMHS response to the pandemic during the recovery phase and into the future. Methods: First, the changing patterns of mental health presentations in children and adolescents will be presented, including analysis of NSW-wide data. In NSW new child and adolescent mental health response teams have been developed;the collaborative approaches to designing the new service, and the challenges associated, will be presented. The response presents serious challenges for workforce development, given long-standing specialist mental health worker shortages. Training and workforce strategy will be discussed, followed by a presentation on the continuum of care for children and young people that demonstrates the need for better integration across health and psychosocial services. Audience discussion is encouraged during the symposium, to explore potential creative solutions. Findings: Trends that emerged during the pandemic demonstrate the need for reform of the mental health care system for children, adolescents and young people. The problem is complex and requires collaboration and sharing of ideas that can be applied bi-nationally. Conclusion: The pandemic created opportunities to improve CAMHS services. An understanding of trends in presentations informs the multi-faceted strategic response to the mental health recovery. Planning is key to improving collaborative and integrated approaches for the future design of CAMHS.
ABSTRACT
Background: Demand for specialist mental health services for children and adolescents has increased disproportionately to other age groups over the last decade. Challenges including drought, bushfires, floods and COVID-19 have further increased numbers of children and adolescents presenting with high levels of acuity and complexity. In 2021, the NSW Government committed to funding 25 new mental health response teams, to be rolled out over 4 years. Objectives: To describe the collaborative model used to develop the service principles, model of care and supporting processes for the new teams. Methods: Service Guiding Principles were developed following broad consultation with key stakeholders by the NSW Branch Faculty of Child and Adolescent Psychiatry, RANZCP and NSW Health, and a literature review. Programme development benefitted from extensive stakeholder engagement including consumers/ carers, and four working groups developed strategies for evaluation, workforce development, rural-specific approaches, and the model of care. Essential elements of the programme include comprehensive multidisciplinary team assessment and management with bio-psychosocio- cultural formulation, with activities including Crisis intervention (responding to child/young person/family needs;safety planning), Comprehensive care planning (inter- and intra-agency integration, collaborative discharge planning) and Care co-ordination (support system navigation, warm hand over). Findings: Collaboration and incorporating the voices of people with lived experience are essential in developing an integrated and evidence based state-wide service model that is acceptable to staff and consumers. Conclusion: Successful roll out is expected with strong evaluation informing flexible approaches to respond to unforeseen circumstances. Unity of purpose leads to better, safer care for vulnerable children and adolescents.
ABSTRACT
BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The 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.
Subject(s)
COVID-19 , Child Development , Child , Electronics , Humans , Mental Health , Parents , Randomized Controlled Trials as Topic , SARS-CoV-2ABSTRACT
The novel coronavirus disease (COVID-19) was identified as the cause of an outbreak of respiratory disease in China at the end of 2019. It then spread with enormous rapidity and by mid-March 2020 was declared a world pandemic. Gilles de la Tourette Syndrome (GTS) is a childhood-onset neurodevelopmental disorder with a worldwide prevalence of about 1% of the population. The clinical symptoms include multiple motor and one or more phonic (vocal) tics. Germane to this communication is that 85% of patients with GTS have associated psychiatric co-morbidities, many of which are being exacerbated in the current global health crisis. In addition, several symptoms of GTS may mimic COVID-19, such as a dry cough and sniffing (phonic tics), while other symptoms such as spitting, inappropriate touching of others and "non-obscene socially inappropriate symptoms" can potentially get patients with GTS into trouble with the law. We suggest that a clear explanation of the COVID-19 illness and GTS is important to enable colleagues of various specialities who tend to patients with GTS. It is important to acknowledge at the outset that the information available on the COVID-19 pandemic changes daily, including cases infected, deaths reported, and how various national health systems are planning and or coping or not. It is fair to say that having read the current medical and lay press we conclude that it is not easy to reassure our patients with absolute certainty. However, notwithstanding that, we hope our documentation is of some assistance.