Myfanwy McDonald

Systematic review of preventive interventions for children's mental health : what would work in Australian contexts?

In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0–8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australias population, and programme compatibility with Australias service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted childrens behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost–benefits for childrens mental health without delaying dissemination.

Acting early, changing lives: how prevention and early action saves money and improves wellbeing

The Benevolent Society has released a report to mark its 200th Anniversary that sounds a serious warning about the wellbeing of Australia’s children, and unsustainable future costs to fix social problems which can be prevented by more investment in support for families during children’s early years. “In dealing with increasing problems such as crime, obesity, anti-social behaviour, child abuse and mental illness, our governments are stuck in a cycle of reacting too late when it’s more costly and less effective,” said The Benevolent Society CEO Anne Hollonds. The report, Acting Early, Changing Lives: How prevention and early action saves money and improves wellbeing was commissioned by The Benevolent Society, Australia’s first and longest running not-for-profit organisation, and prepared by the Murdoch Children’s Research Institute. “In our 200th year we see the need for stronger commitment and better coordination of support for families with young children by all State and Federal governments,” said Anne Hollonds. “All the evidence shows us that investment in the early years of life is much more effective and brings greater economic returns to the community. This is when the foundations of mental and physical health and development are laid. “Failing to invest in prevention and early action is like signing a blank cheque now for much higher future costs,” she said. The report lists worrying trends affecting many children in Australia today: • One in seven Australian children is affected by a behavioural or emotional problem; • Less than half of our kids who need professional help for a mental health issue receive the help they need; • One in six children live below the poverty line and Australia has the fourth highest rate of children living in jobless families in the OECD [15%]; • One in five Australian children are vulnerable in one or more developmental domains when they start school. Children who experience these disadvantages are likely to suffer lifelong negative consequences. The report shows how children who in their first five years have a home environment where they experience poverty, abuse, neglect, poor health and nutrition, mental health or behaviour problems, are at greater risk in later life of unemployment, low income, depression, anxiety, drug abuse and anti-social and criminal behaviour, leaving school early, emotional problems and ongoing health problems. This report shows that the solution is acting early, especially by providing parenting support and early learning for children under five. It highlights solid benefits of the world’s most effective early intervention programs: • children did better in school and employment; • they grew up to have better mental and overall health; • their parents had better parenting skills which created a more supportive nurturing home life, and • there were serious reductions in rates of risky behaviour, criminality and notifications of child abuse and neglect. Written for The Benevolent Society by The Centre for Community Child Health at the Murdoch Children’s Research Institute and the Royal Childrens Hospital, Melbourne

Early childhood development and the social determinants of health inequities

Childrens health and development outcomes follow a social gradient: the further up the socioeconomic spectrum, the better the outcomes. Based upon a review of multiple forms of evidence, and with a specific focus upon Australia, this article investigates the causes of these socially produced inequities, their impact upon health and development during the early years and what works to reduce these inequities. Using VicHealths Fair Foundations framework, we report upon child health inequity at three different levels: the socioeconomic, political and cultural level; daily living conditions; the individual health-related behaviours. Although intensive interventions may improve the absolute conditions of significantly disadvantaged children and families, interventions that have been shown to effectively reduce the gap between the best and worst off families are rare. Numerous interventions have been shown to improve some aspect of prenatal, postnatal, family, physical and social environments for young children; however, sustainable or direct effects are difficult to achieve. Inequitable access to services has the potential to maintain or increase inequities during the early years, because those families most in need of services are typically least able to access them. Reducing inequities during early childhood requires a multi-level, multi-faceted response that incorporates: approaches to governance and decision-making; policies that improve access to quality services and facilitate secure, stable, flexible workplaces for parents; service systems that reflect the characteristics of proportionate universalism, function collaboratively, and deliver evidence-based programs in inclusive environments; strong, supportive communities; and information and timely assistance for parents so they feel supported and confident.

Sustained home visiting for vulnerable families and children: a literature review of effective programs

Parenting young children has become a more complex and stressful business, especially for those families in our community with the least resources (Grose, 2006; Hayes et al, 2010; Poole, 2004; Richardson & Prior, 2005; Trask, 2010). A widening gap exists between families that function well and those that are vulnerable. The paradox of service delivery for children and families is that vulnerable families – that is, those families with the greatest needs – are also the least likely to be able to access those services (Ghate & Hazel, 2002; Fram, 2003). A range of barriers exist for vulnerable and at risk families in making use of services (Carbone et al, 2004). One of the key barriers to vulnerable families accessing services is that many find it difficult to relate to the formal service system and are easily alienated by practices others find acceptable. Research regarding parents’ experiences of support services suggests that parents want services where they are simultaneously cared for and enabled in their role as parents, and to receive services characterised by empathy, competence, functionality, respect, flexibility and honesty (Attide-Stirling et al, 2001; Winkworth et al, 2009). Vulnerable parents fear a loss of autonomy in their interactions with support services and want services that are non-judgemental and that provide continuity of care (Ghate & Hazel, 2002; von Bultzingslowen, 2006). In addition to the barriers faced by vulnerable and marginalised families in accessing services, the system does not work in an integrated or coherent fashion to ensure that all children and families needing support receive it. Furthermore, the vast majority of services for children and families in Australia do not have an outreach function, that is, a means of engaging these vulnerable and at risk families who are in need of support but use services inconsistently or not at all. In short, the service system was not designed to meet the needs of vulnerable families within the context of a rapidly changing social and economic climate. Therefore, many families requiring support are not receiving it. A research collaboration between the Australian Research Alliance for Children and Youth (ARACY), the Centre for Health Equity Research and Evaluation (CHETRE) and the Centre for Community Child Health (CCCH)

The future of early childhood education and care services in Australia

This policy brief explores four key issues pertaining to the future of early childhood education and care in Australia: the importance of early childhood, quality early childhood education and care, service integration, and the inclusion of children with disability and developmental delays. Overview The past decade has seen an unprecedented policy focus in Australia upon services for children during the early years. This has occurred in response to a growing body of research highlighting the importance of the early years. Progress in regards to early childhood education and care (ECEC) services in the policy arena is often overshadowed by simplistic views and debates in the broader public arena regarding young children. For example, the misconception that child care is ‘bad’ for young children disrupts attempts to move public debate towards how we can build a high quality ECEC service system. In this Policy Brief, we explore four key issues pertaining to the future of early childhood education and care in Australia: the importance of early childhood, quality early childhood education and care, service integration, and the inclusion of children with disability and developmental delays. Although significant improvements have been made recently in Australia in regards to ECEC, it is important that as a nation we carefully consider decisions regarding the ECEC service system and do not lose sight of the profound role that the service system plays in building the foundation for Australia’s future prosperity.