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.

Health of the Nation Outcome Scales for Infants field trial: concurrent validity.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0-47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes. AIMS: To examine the concurrent validity of the HoNOSI. METHOD: Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress. RESULTS: The HoNOSI was statistically significantly correlated with the PIR-;GAS, rs = -0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency. CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. AIMS: We aimed to investigate the interrater reliability of the HoNOSI. METHOD: Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. RESULTS: Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Child and Adolescent Psychiatry International Relations (CAPIR): building bridges for psychiatry workforce capacity with Pacific Island nations.

OBJECTIVE: To describe the span of work of child and adolescent psychiatrists in Australia and New Zealand in recent years aimed at collaborative efforts to build mental health capacity in the Pacific Island nations of Fiji, Samoa, Cook Islands, Tonga, Kiribati, Vanuatu, Solomon Islands and Papua New Guinea. METHOD: Steps taken to coordinate resourcing, networking, delivery of appropriate initiatives, establishing and maintaining key relationships with partners are described. RESULTS: Engagement with Pacific nations mental health professionals, ministries of health, NGOs, universities, multilateral agencies and professional and international organisations has expanded and strengthened since 2013. CONCLUSIONS: Planned and staged implementation of initiatives can harness RANZCP (and its faculties and interest groups) goodwill to effectively contribute to psychiatry and mental health capacity building in partnerships with Pacific Island nations to address mental health needs over the life-span.

Addressing the specialist workforce CAMH skill-gap: providing and evaluating iCAMH training in Fiji and Papua New Guinea.

OBJECTIVE: Child and adolescent mental health problems are common and result in significant morbidity. Whereas in high-income countries there is an established workforce, in lower income countries, such as the Pacific nations, the workforce has little capacity despite a potentially higher population risk of mental disorder. We report on a workforce development effort, a child and adolescent mental health training package. METHOD: We describe the implementation and evaluation of the International Child and Adolescent Mental Health certificate training in two Pacific nations. RESULTS: Clinicians rated the training positively. Some participants reported concern with teaching materials. Attitudes to child and adolescent mental health were more favourable following the course. A change in knowledge or skill could not be determined. CONCLUSIONS: The training seems of value to Pacific clinicians and the framework provides for case-based learning across settings. The training would benefit from the addition of a valid assessment of participant skill and knowledge. The sociocultural and contextual factors are considerations for the content and delivery. Contextually appropriate resources and teaching strategies are important.

Pasifika Study Group: a child and adolescent mental health capacity building and leadership workshop with Pacific nations doctors and psychiatrists.

OBJECTIVE: To describe the Pasifika Study Group (PSG), a biennial workshop for Pacific nations psychiatrists and doctors working in psychiatry under the auspices of the Royal Australian and New Zealand College of Psychiatry Faculty of Child and Adolescent Psychiatry. METHOD: Since 2013 the PSG has brought together doctors and other health professionals from eight Pacific nations for a two-day study group. RESULTS: On evaluation the PSG is considered informative and relevant and participants were generally confident of adapting the material to their own context. CONCLUSION: The PSG demonstrates a successful approach to regional engagement in mental health in the Pacific region.

Building capacity for child and adolescent mental health and psychiatry in Papua New Guinea.

OBJECTIVE: To describe the recent work of child psychiatrists in Australia, New Zealand (ANZ) and Papua New Guinea (PNG) adding to mental health capacity building across the life-span, starting with children and adolescents. METHOD: Concerns about treatment access and clinical training needs, combined with academic leadership and National Department of Health commitment, supported the collaborative involvement of the Royal Australian and New Zealand College of Psychiatry (RANZCP) in workforce development. This has been initially established under the auspices of the Faculty of Child and Adolescent Psychiatry (FCAP). RESULTS: Workforce development in child and adolescent mental health is underway, with sustainability, consolidation and scaling up of initiatives required to meet need. CONCLUSIONS: Expanding mental health workforce capacity in partnership with the National Department of Health and the University of Papua New Guinea (UPNG) seems feasible. Ongoing cooperation is required to realize the potential of such collaborative initiatives.

Mental health professionals' family-focused practice with families with dependent children: a survey study.

BACKGROUND: Many people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients' parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals' family-focused knowledge and practices when working with parents with mental illness and their children and families. METHODS: This cross -sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ). RESULTS: The majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families. CONCLUSIONS: The findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.

Awareness, Access and Use of Internet Self-Help Websites for Depression by University Students.

BACKGROUND: University students have a higher prevalence rate of depression than the average 18 to 24 year old. Internet self-help has been demonstrated to be effective in decreasing self-rated measures of depression in this population, so it is important to explore the awareness, access and use of such self-help resources in this population. OBJECTIVE: The objective of this study is to explore university students' awareness, access and use of Internet self-help websites for depression and related problems. METHODS: A total of 2691 university students were surveyed at 3 time points. RESULTS: When asked about browsing behavior, 69.6% (1494/2146) of students reported using the Internet for entertainment. Most students were not familiar with self-help websites for emotional health, although this awareness increased as they completed further assessments. Most students considered user-friendliness, content and interactivity as very important in the design of a self-help website. After being exposed to a self-help website, more students reported visiting websites for emotional health than those who had not been exposed. CONCLUSIONS: More students reported visiting self-help websites after becoming aware of such resources. Increased awareness of depression and related treatment resources may increase use of such resources. It is important to increase public awareness with the aim of increasing access to targeted strategies for young people.

Supporting depressed mothers at home: their views on an innovative relationship-based intervention.

This study explored the responses of a group of 111 mothers who experienced distress and/or depression in the early months after childbirth and who received an innovative home visiting service until their child's first birthday. The current study reports a thematic content analysis of the qualitative questionnaire responses returned by the mothers after completing the intervention. The mothers valued the home visiting program for its capacity to increase their parenting confidence and to enhance their bond to their infants. They attributed this to the reassurance provided by the program and the skills and qualities of the home visitors. Their responses complement the benefits identified in quantitative analysis of the program and demonstrate its impact from participants' viewpoint.

Adolescents' reactions to universal and indicated prevention programs for depression: perceived stigma and consumer satisfaction.

There is a common view that one of the major considerations in selecting between universal and indicated interventions is the marked stigma produced by the latter. However, to date there has been no empirical examination of this assumption. The current study examined reported stigma and program satisfaction following two school-based interventions aimed at preventing depression in 532 middle adolescents. The interventions were conducted either across entire classes by classroom teachers (universal delivery) or in small high risk groups by mental health professionals (indicated delivery). The indicated delivery was associated with significantly greater levels of perceived stigma, but effect sizes were small and neither program was associated with marked stigma in absolute terms. Perceived stigma was more strongly associated with aspects of the individual including being male and showing greater externalizing symptomatology. In contrast, the indicated program was evaluated more positively by both participants and program leaders and effect sizes for these measures of satisfaction were moderate to large. The results point to the need for further empirical evaluation of both perceived stigma and program satisfaction in providing balanced considerations of the value of indicated and universal programs.

Acceptability of routine screening for perinatal depression.

BACKGROUND: To assess the acceptability of routine screening for perinatal depression. METHOD: Postnatal women (n=860) and health professionals (n=916) were surveyed after 3 years of routine perinatal (antenatal and postnatal) use of the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Over 90% of women had the screening explained to them and found the EPDS easy to complete; 85% had no difficulties completing it. Discomfort with screening was significantly related to having a higher EPDS score. A majority of health professionals using the EPDS was comfortable and found it useful. LIMITATIONS: The sample involved only maternity services supporting depression screening. In addition, the response rate from GPs was low. CONCLUSIONS: Routine screening with the EPDS is acceptable to most women and health professionals. Sensitive explanation, along with staff training and support, is essential in implementing depression screening.

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents.

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

Parenting is a mental health issue.

OBJECTIVE: Increasing numbers of adults with a psychiatric disorder are also parents of dependent children. The present article aims to outline ways in which Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) can assist in enhancing psychiatric care when a person with a mental illness also has parenting responsibilities. METHODS: The national Children of Parents With A Mental Illness (COPMI) initiative undertook consultations with consumers, carers, young people and a range of professionals to assist in development of documents and resource materials to enhance policy and practice. Communication and interaction with key psychiatrists' professional bodies to seek their advice and participation has been maintained throughout the project. RESULTS: The RANZCP Fellows have assisted the COPMI project in the development and dissemination of draft principles and recommended actions for services and people working with children of parents with a mental illness and their families, and in the development of associated resource materials. They are now considering a College position statement on this issue. CONCLUSIONS: If children of parents with a mental illness are to benefit from proposed enhancements to practice relating to services provided to their families, it is essential that psychiatrists themselves are involved in the development, implementation and review of good practice in this area.