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Background Children and adolescents’ mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life). Method The study examined longitudinal association between a young person’s self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral. Results Pupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0–1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9–0.98). Conclusion Children and young people’s perception of their quality of life should be considered at the stages of a clinical needs assessment.

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS).Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service.Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

IntroductionYoung people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People's Secure Estate: a ‘whole systems’ approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme.Methods and analysisA mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences.Ethics and disseminationEthical approval was granted by the Health Research Authority, Her Majesty’s Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.

Background Research investigating the role of emotion regulation (ER) in the development and treatment of psychopathology has increased in recent years. Evidence suggests that an increased focus on ER in treatment can improve existing interventions. Most ER research has neglected young people, therefore the present meta-analysis summarizes the evidence for existing psychosocial intervention and their effectiveness to improve ER in youth. A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Twenty-one randomized-control-trials (RCTs) assessed changes in ER following a psychological intervention in youth exhibiting various psychopathological symptoms. We found moderate effect sizes for current interventions to decrease emotion dysregulation in youth (g = − 0.46) and small effect sizes to improve emotion regulation (g = 0.36). Significant differences between studies including intervention components, ER measures and populations studied resulted in large heterogeneity. This is the first meta-analysis that summarizes the effectiveness for existing interventions to improve ER in youth. The results suggest that interventions can enhance ER in youth, and that these improvements correlate with improvements in psychopathology. More RCTs including larger sample sizes, different age groups and psychopathologies are needed to increase our understanding of what works for who and when.

Purpose:\ud Promoting positive mental health, particularly through enhancing competencies (such as prosocial behaviors and learning skills), may help prevent the development of health risk behaviors in adolescence and thus support future well-being. Few studies have examined how mental health competencies in childhood are associated with adolescent health risk behaviors, which could inform preventative approaches.\ud \ud Methods:\ud Using UK Millennium Cohort Study data (n = 10,142), we examined how mental health competence (MHC) measured at the end of elementary school (11 years) is associated with self-reported use of cigarettes, e-cigarettes, alcohol, illegal drugs, antisocial behavior, and sexual contact with another young person at age 14 years. A latent measure of MHC was used, capturing aspects of prosocial behavior and learning skills, categorized as high MHC, high–moderate MHC, moderate MHC, and low MHC. Logistic and multinomial regression estimated odds ratios and relative risk ratios for binary and categorical outcomes, respectively, before and after adjusting for confounders. Weights accounted for sample design and attrition and multiple imputation for item missingness.\ud \ud Results:\ud Those with low, moderate, or high-moderate MHC at age 11 years were more likely to have taken part in health risk behaviors at age 14 years compared with those with high MHC. The largest associations were seen for low MHC with binge drinking (relative risk ratio: 1.6 [95% confidence interval: 1.1–2.4]), having tried cigarettes (odds ratio: 2.2 [95% confidence interval: 1.6-3.1]) and tried illegal drugs (odds ratio: 2.0 [95% confidence interval: 1.3-3.1) after adjusting for confounders (which attenuated results but largely maintained significant findings).\ud \ud Conclusions:\ud MHC in late childhood is associated with health risk behaviors in midadolescence. Interventions that increase children's MHC may support healthy development during adolescence, with the potential to improve health and well-being through to adulthood.

BackgroundPsychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances.MethodsWe analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding.ResultsPrior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems.ConclusionsPrior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children.

Background There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based, universal prevention programmes are thought to be one way of helping tackle such difficulties. This protocol describes a four-arm cluster randomised controlled trial, investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. The primary outcome for Mindfulness and Relaxation interventions is a measure of internalising difficulties, while Strategies for Safety and Wellbeing will be examined in relation to intended help-seeking. In addition to the effectiveness analysis, a process and implementation evaluation and a cost-effectiveness evaluation will be undertaken. Methods and analysis Overall, 160 primary schools and 64 secondary schools will be recruited across England. This corresponds to 17,600 participants. Measures will be collected online at baseline, 3–6 months later, and 9–12 months after the commencement of the intervention. An economic evaluation will assess the cost-effectiveness of the interventions. Moreover, a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, appropriateness and feasibility), and their moderating effects on the outcomes of interest, and perceived impact. Discussion This trial aims to address important questions about whether schools’ practices around the promotion of mental wellbeing and the prevention of mental health problems can: (1) be formalised into feasible and effective models of school-based support and (2) whether these practices and their effects can be sustained over time. Given the focus of these interventions on mirroring popular practice in schools and on prioritising approaches that present low-burden, high-acceptability to schools, if proved effective, and cost-effective, the findings will indicate models that are not only empirically tested but also offer high potential for widespread use and, therefore, potentially widespread benefits beyond the life of the trial. Trial registration ISRCTN16386254. Registered on 30 August 2018.

Background/objectives Maternal psychological distress is associated with a range of adverse child outcomes. We sought to determine whether children’s exposure to medium or severe distress at 5 years was associated with increased risks of overweight and obesity when they were aged 11 years. We also investigated whether any association was attenuated after accounting for potential confounding and mediating factors. Subjects/methods We analysed data from the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood, imputing missing covariates (analytic sample: n = 9206). Multinomial regression was used to examine whether maternal psychological distress (Kessler-6 scale, using medium and severe score thresholds) at 5 years of age predicted children’s objectively measured overweight and obesity at 11 years, adjusting for sex and ethnicity. We then carried out a series of models incorporating potential confounders (early life and socio-demographic, recorded at 9 months) and mediators (physical activity and dietary factors, at 7 years) in turn, and then simultaneously. Results A third of mothers reported distress when their child was aged 5 years (29% medium; 4% severe distress), and over a quarter of children were overweight at 11 years (22% overweight; 6% obese). Risks of obesity at 11 years increased with severity of maternal distress at 5 years (medium distress: relative risk ratio (RRR) = 1.43, 95% confidence interval [CI] 1.17–1.75; severe RRR = 2.27, CI 1.42–3.63). Adjusting for each set of explanatory factors in turn (particularly early years and socio-demographic confounding factors) reduced but did not eliminate these elevated risks. However, risks were attenuated in the fully adjusted model (medium: RRR = 1.14, CI 0.92–1.41; severe: RRR = 1.26, CI 0.75–2.11). Conclusions We demonstrated that maternal psychological distress, particularly if severe, at 5 years was associated with risk of obesity (but not overweight) at 11 years. Accounting for potential explanatory factors attenuated this association to non-significance, suggesting a range of mechanisms may be implicated. Future research should seek to disentangle the potentially complex pathways linking explanatory factors, maternal distress and child obesity.

Quality of life is typically reduced in children with mental health problems. Understanding the relationship between quality of life and mental health problems and the factors that moderate this association is a pressing priority. This was a cross-sectional study involving 45,398 children aged 8-13 years from 880 schools in England. Self-reported quality of life was assessed using nine items from the KIDSCREEN-10 and mental health was assessed using the Me and My School Questionnaire. Demographic information (gender, age, ethnicity, socio-economic status) was also recorded. Quality of life was highest in children with no problems and lowest in children with both internalising and externalising problems. There was indication that quality of life may be reduced in children with internalising problems compared with externalising problems. Approximately 12 % children with mental health problems reported high quality of life. The link between mental health and quality of life was moderated by gender and age but not by socio-economic status or ethnicity. This study supports previous work showing mental health and quality of life are related but not synonymous. The findings have implications for measuring quality of life in child mental health settings and the need for approaches to support children with mental health problems that are at particular risk of poor quality of life.

Purpose To examine the changes in mental health difficulties in early adolescence between 2009 and 2014 in England. Methods Analysis reports on data from two cross-sectional samples of adolescents (aged 11–13 years) collected 5 years apart in 2009 and 2014 in secondary schools across England. Samples were matched using propensity scoring, resulting in a total pooled sample of 3,366 adolescents. Mental health difficulties were reported by participants using the Strengths and Difficulties Questionnaire. Results Overall, there were similar levels of mental health difficulties experienced by adolescents in 2009 and 2014. Notable exceptions were a significant increase in emotional problems in girls and a decrease in total difficulties in boys in 2014 compared to 2009. Conclusions The increased prevalence of emotional problems in girls mirrors a trend found in other similar studies, and the results are discussed in the context of recent economic and societal changes. The small decrease in total difficulties in boys, although promising, clearly warrants further research.

The present research addressed gaps in our current understanding of validity and quality of measurement provided by Patient Reported Experience Measures (PREM). We established the psychometric properties of a freely available Experience of Service Questionnaire (ESQ), based on responses from 7,067 families of patients across 41 UK providers of Child and Adolescent Mental Health Services (CAMHS), using the two-level latent trait modeling. Responses to the ESQ were subject to strong ‘halo’ effects, which were thought to represent the overall positive or negative affect towards one’s treatment. Two strongly related constructs measured by the ESQ were interpreted as specific aspects of global satisfaction, namely Satisfaction with Care, and with Environment. The Care construct was sensitive to differences between less satisfied patients, facilitating individual and service-level problem evaluation. The effects of nesting within service providers were strong, with parental reports being the most reliable source of data for the between-provider comparisons. We provide a scoring protocol for converting the hand-scored ESQ to the model-based population-referenced scores with supplied standard errors, which can be used for benchmarking services as well as individual evaluations.

The Targeted Mental Health in Schools (TaMHS) programme was a nationwide initiative that funded mental health provision in schools for pupils at risk of or already experiencing mental health problems. The implementation, impact and experience of this programme was evaluated using quantitative and qualitative methodology involving three main studies: (1) a 1-year RCT involving 8658 8-10 year olds and 6583 11-13 year olds, (2) a 3-year longitudinal study involving 3346 8-10 year olds and 2647 11-13 year olds and (3) qualitative interviews with 26 TaMHS workers, 31 school staff, 15 parents and 60 pupils. The RCT demonstrated that TaMHS led to reductions in behaviour problems but not emotional problems for 8-10 year olds. No impact was found for 11-13 year olds. The effects on behaviour problems in primary school were enhanced by the provision of evidence based self-help materials, but not by other area level support. The longitudinal study found information giving and good inter-agency working correlated with more positive outcomes for behavioural problems in secondary schools. The qualitative findings indicated that TaMHS was well received by all groups, though challenges to its implementation were noted. Overall, findings indicate the utility of targeted mental health provision in schools, particularly in primary settings. The implications for implementation are discussed. © 2013 Copyright SEBDA.