Background Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7019
Shared decision making (SDM) is recognized as a person-centered approach to improving health care quality and outcomes. Few digital interventions to improve SDM have been tested in child and adolescent mental health (CAMH) settings. One such intervention is Power Up, a mobile phone app for young people (YP), which has shown some evidence of promise that YP who received Power Up reported greater levels of SDM. However, even though parents play a critical role in CAMH care and treatment, they often feel excluded from services.This protocol is for a pilot trial to determine the feasibility of a large-scale randomized trial to develop and evaluate a Web app called Power Up for Parents (PUfP) to support parents and promote involvement in CAMH decisions.A 2-stage process, consisting of the development stage and pilot-testing stage of the initial PUfP prototype, will be conducted. At the development stage, a qualitative study with parents and clinicians will be conducted. The interviews will aim to capture the experience of making CAMH decisions, preferences for involvement in SDM, and determine situations within which PUfP can be useful. At the pilot-testing stage, up to 90 parents and their clinicians will be invited to participate in the testing of the prototype. Parents will be randomly allocated to receive the intervention or be part of the control group. This study design will allow us to assess the acceptability and usefulness of PUfP in addition to examining the feasibility of a prospective randomized trial. Clinicians' perceptions of the prototype and how it has influenced parents' involvement in SDM will also be examined.Recruitment began in January 2019 and is scheduled to last for 10 months. Interviews and baseline data collection are currently in progress. To date, 11 CAMH sites have been recruited to take part in the study. It is anticipated that data collection will be completed by October 2019.The lack of parents' involvement in CAMH care and treatment can lead to higher rates of dropout from care and lower adherence to therapeutic interventions. There are significant benefits to be gained globally if digital SDM interventions are adopted by parents and shown to be successful in CAMH settings.ISRCTN Registry ISRCTN39238984; http://www.isrctn.com/ISRCTN39238984.DERR1-10.2196/14571.
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Abstract Any child and adolescent mental health service within the NHS seeking to evaluate outcomes on a routine basis must address the following questions: What is the aim of routine outcome evaluation? Whose views of outcome should be taken into account? What needs to be evaluated? How should it be evaluated? How should the results be used? How should this be resourced? In this chapter, we explore possible answers to these questions and suggest practical ways forward, drawing on our experiences of establishing routine outcome evaluation in Bedfordshire and Luton CAMHS and Southampton CAMHS, respectively.
Whom family members blame for their difficulties, and to what extent they blame them, is widely thought to affect their response to those difficulties. In addition, the extent to which parents experience themselves as being blamed by therapists is thought to influence their ability to make use of therapeutic intervention. Yet, despite frequent references in the clinical literature to the need to be sensitive to issues of blame, little attempt has been made to systematically investigate how blame arises naturally in therapeutic encounters. This article develops operational definitions of blame and of exoneration and uses them to undertake an exploratory study into how a sample of 10 families and their systemic therapists attribute blame and exoneration in relation to the presenting problem. Multidimensional scalogram analysis is used to explore how patterns of blame might possibly relate to service uptake. It is argued that as clinicians we may want to hone our sensitivity to the different ways that blame may be invoked in conversation in order to increase our therapeutic efficacy.
BACKGROUND Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. OBJECTIVE The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. METHODS The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. RESULTS There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. CONCLUSIONS It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.7019
Much of the extensive body VLf research into attention deficit hyperactivity disorder (ADHD) has concentrated on understanding the aetiology of the disorder. This research has generated a number of very different conceptualizations of ADHD, ranging from purely medical descriptions to theories that incorporate a range of social and psychological factors. Although a large amount of research has been undertaken in this area, little is known about the individual experiences of those directly affected by the disorder and, in particular, how parents make sense of the variety of different aetiological models. The aim of this study was to investigate this issue. The mothers of nine boys, aged between 8 and 11 years, agreed to participate in the study. One father also participated. In-depth interviews, following a semi-structured format, were held with each participant. Interviews were transcribed verbatim and analysed using a grounded theory approach. Data analysis revealed that the key issue for parents was the discrepancy in the way in which parents understood the causes of ADHD, as compared with the ways in which others viewed the disorder. Parents reported that they believed ADHD to be a biologically based disorder, but that they felt others considered the disorder to be related to psychological and social factors. The implications of these differing perspectives were as follows: (i) parents battled with professionals and family members to encourage them to share their views of the condition; (ii) parents felt blamed by professionals and family members for their sons' difficulties; and (iii) parents reported experiencing significant emotional distress as a result of the differing views.
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