Search

Explore the feasibility of an integrated Child and Family Hub within Victorian Community Health Services (CHS) to identify and respond to family adversities as preventable determinants of child mental health problems.Thirteen Victorian CHS staff and government policy makers (PMs), recruited via snowball sampling, participated in semi-structured interviews exploring: 1) barriers and facilitators for implementing a hub; 2) feasibility of a proposed integrated hub; and 3) resources needed to scale and sustain a hub. Transcripts were analysed employing framework analysis.1) Barriers included inadequate and activity-based funding, inability to fund community paediatricians and inadequate workforce competencies. Facilitators included CHS engagement with vulnerable communities and readiness to act. 2) The proposed hub model was identified as feasible to implement. Local co-design, co-location, and virtual delivery would support hub implementation. 3) To sustainably scale a hub, clear policy leadership and workforce and funding model reviews are needed.A hub was perceived as feasible when based in CHS; however, local and system-wide issues need consideration to support its sustainable scaling.Findings will inform the scaling of hub models of care across Victoria and other states to potentially optimise broader child and family health outcomes.

Background Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes. Methods This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8–15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding. Results Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms. Limitations The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment. Conclusions While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice.

Objective Few studies have examined the sleep behaviors associated with a caregiver-reported sleep problem beyond early childhood and across different age groups. This study examined sleep behaviors associated with a caregiver-reported sleep problem from birth to middle childhood. Methods Participants were 5107 children from the Longitudinal Study of Australian Children—Birth Cohort. Caregiver-reported child sleep problems and sleep behaviors were assessed biennially from ages 0–1 to 10–11 years. Logistic regressions were used to examine associations between three child sleep behaviors (waking overnight, difficulty falling asleep, and difficulty sleeping alone) and the odds of having a caregiver-reported sleep problem at each age. Results Caregiver-reported child sleep problems were most prevalent in infancy (17.1%) and decreased through middle childhood (7.7%). All three sleep behaviors were associated with a sleep problem at each age. Whereas waking overnight was the most common sleep behavior and was associated with the highest odds of having a sleep problem from infancy to age 6–7 years (ORs = 5.78–8.29), difficulty falling asleep was the most common sleep behavior and was associated with the highest odds of having a sleep problem at ages 8–9 and 10–11 years (ORs = 10.65 and 17.78, respectively). Conclusion Caregivers’ endorsement of a child sleep problem was associated with developmentally-relevant sleep behaviors, with night awakenings most relevant during infancy and difficulty falling asleep most relevant in middle childhood. Study findings have implications for targeted and developmentally-focused sleep problem screening questions in child healthcare settings. Future research examining additional indicators of caregiver-defined sleep problems is required.

Problem Identifying pregnant women whose children are at risk of poorer development in a rapid, acceptable and feasible way. Background A range of antenatal psychosocial and socioeconomic risk factors adversely impact children’s health, behaviour and cognition. Aim Investigate whether a brief, waiting room survey of risk factors identifies women experiencing increased antenatal psychosocial and socioeconomic risk when asked in a private, in-home interview. Methods Brief 10-item survey (including age, social support, health, smoking, stress/anxious mood, education, household income, employment) collected from pregnant women attending 10 Australian public birthing hospitals, used to determine eligibility (at least 2 adverse items) for the “right@home” trial. 735 eligible women completed a private, in-home interview (including mental health, wellbeing, substance use, domestic violence, housing problems). Regression models tested for dose-response trends between the survey risk factor count and interview measures. Findings 38%, 31%, 15% and 16% of women reported a survey count of 2, 3, 4 and 5 or more adverse risk factors, respectively. Dose-response relationships were evident between the survey count and interview measures, e.g. of women with a survey count of 2, 8% reported ever having a drug problem, 4% experienced domestic violence in the last year and 10% experienced housing problems, contrasting with 31%, 31% and 26%, respectively, for women reporting a survey count of 5 or more. Discussion/Conclusions A brief, waiting room survey of psychosocial and socioeconomic risk factors concurs with a private antenatal risk factor interview, and could help health professionals quickly identify which women would benefit from more support.

Rising anxiety rates and equity of care are ongoing concerns. Through 2 pediatric practice audits conducted 5 years apart, we aimed to determine the change in 1) anxiety diagnoses; 2) associated comorbid diagnoses; 3) variance in management by location; and 4) child, family, and pediatrician predictors of management.Members of the Australian Paediatric Research Network (APRN) were invited to participate in patient-level prospective national pediatric practice audits in 2008 and 2013. Pediatricians were asked to complete standardized forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first. Demographic data, diagnoses, medications, and referrals were collected. Logistic regressions were conducted, clustered at the pediatrician level.Of eligible APRN pediatricians in 2013 and 2008, 48% and 66% participated and contributed 7102 and 8345 consultations, respectively. Anxiety diagnoses increased over the 5-year period (4.4% vs 7.6%; P.001), as did proportions with comorbid autism spectrum disorder (18.4% vs 29.5%; P.001) and sleep problems (5.1% vs 9.5%; P = .02). There was an increase in the prescription of core anxiety medications, with prescription of selective serotonin reuptake inhibitors increasing from 2.0% to 27.7% (P = .01). Children were more likely to be referred to a psychologist if they were seen in metropolitan practices (odds ratio = 2.0; 95% confidence interval, 1.1-3.9; P = .03) or had learning difficulties (odds ratio = 2.1; 95% confidence interval, 1.1-3.9; P = .03).Prevalence of anxiety among children and adolescents attending pediatricians nearly doubled over the 5-year period. Children in regional and remote locations are less likely to be referred to psychological services, prompting concerns about inequity in access to care.

Objectives To determine (1) the relationship between sleep hygiene practices and parent-reported child sleep problems in students in the first year of elementary school, (2) whether the relationship differed by (a) gender and (b) SES and (3) in a multivariate explanatory model. Design Cross-sectional survey of a population-based sample. Setting Forty-five elementary schools in metropolitan Melbourne, Australia. Participants Families of children aged 4–6 years in the first year of elementary school in Melbourne, Australia. Measurements Exposures: Parent-reported child sleep hygiene, gender and data linkage to community-based disadvantage. Outcome: Parent-reported child sleep problems. Analyses: Logistic regression models were used to examine each aim. Results Of 6635 approached parents, 4901 (74.30%) participated. In the final model, using audio devices at bedtime was associated with increased risk of child sleep problems (OR 2.12, 95% CI 1.60, 2.81) as was an inconsistent bedtime routine on school nights (OR 2.52, 95% CI 1.76, 3.60) and non-school nights (OR 1.66, 95% CI 1.09, 2.55). Boys with an inconsistent bedtime routine on non-school nights had a higher risk (OR 2.07, 95% 1.49, 2.88) than girls (OR 1.61, 95% CI 1.15, 2.28). SES was not associated with sleep problems. Conclusion Inconsistent bedtime routines and audio device use were each associated with an increased risk of parent-reported sleep problems. Associations did not differ based on SES but did for boys and girls in terms of inconsistent bedtimes on weekends. Behavioral sleep interventions targeting sleep hygiene could have similar benefits for all children, regardless of socio-economic status.

Aim Using national Australian time-diary data, we aimed to empirically determine sleep duration thresholds beyond which children have poorer health, learning, quality of life, and weight status and parents have poorer mental health. Methods Design/Setting: Cross-sectional data from the first three waves of the Longitudinal Study of Australian Children. Participants: A nationally representative sample of 4983 4–5-year-olds, recruited in 2004 from the Australian Medicare database and followed biennially; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave. Main measures: Exposure: At each wave, a parent completed 24-h time-use diaries for one randomly selected weekday and one weekend day, including a "sleeping/napping" category. Outcomes: Parent-reported child mental health, health-related quality of life, and maternal/paternal mental health; teacher-reported child language, literacy, mathematical thinking, and approach to learning; and assessed child body mass index and girth. Results Linear regression analyses revealed weak, inconsistent relationships between sleep duration and outcomes at every wave. For example, children with versus without psychosocial health-related quality of life problems slept slightly less at 6–7 years (adjusted mean difference 0.12 h; 95% confidence interval 0.01–0.22, p = 0.03), but not at 4–5 (0.00; −0.10 to 0.11, p = 1.0) or 8–9 years (0.09; −0.02 to 0.22, p = 0.1). Empirical exploration using fractional polynomials demonstrated no clear thresholds for sleep duration and any adverse outcome at any wave. Conclusions Present guidelines in terms of children's short sleep duration appear misguided. Other parameters such as sleep timing may be more meaningful for understanding optimal child sleep.

Children living in out-of-home care are known to have more health needs than same-aged peers. Routine health assessment with subsequent management of need is recommended by health experts. In Victoria, Australia, the out-of-home care system relies upon home-based care through kinship (with family) and foster carer placements, placing some of the healthcare access and utilisation burden upon foster and kinship carers. This paper explores the experiences of Victorian foster and kinship carers accessing timely health assessment and ongoing healthcare for a child placed in their care; identifying barriers and enablers. Through interviews with 19 carers, we found that while carers play a significant role in facilitating healthcare, it is often difficult to navigate a complex health system especially while concurrently navigating the child protection system. Although some carers had faced few challenges, barriers were frequently reported at every step in accessing healthcare: receiving necessary paperwork (including child Medicare numbers); obtaining past medical history including immunisations; knowing what appointments were required; gaining appropriate authorisation for healthcare; identifying appropriate healthcare services; accessing timely appointments; attending appointments and paying for services. Carers had often been strong advocates for children in their care and had found support from case managers or carer support workers to be instrumental in enabling healthcare. Carers identified potential solutions to help children in their care receive timely healthcare.

Objectives To evaluate whether there are distinct childhood sleep problem trajectories from birth to 10-11 years and to assess associations with cumulative socio-ecological risks (child, family, context). Study design Participants were 5107 children from the Longitudinal Study of Australian Children—Birth Cohort. At birth, cumulative risk indexes were generated for birth, parenting, family, socioeconomic, and neighborhood risks. Parent-reported child sleep problems were assessed biennially from ages 0-1 to 10-11 years. Sleep problem trajectories were derived using latent class analysis. Multivariable logistic regression was used to examine associations with risk indexes. Results Five distinct trajectories emerged: persistent sleep problems through middle childhood (7.7%), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%), and no sleep problems (51.9%). Cumulative mother- and father-reported family risks (distress; marital/relational hostility) were linked to nearly all of the trajectories, whereas father- and mother-reported parenting risks were associated with fewer trajectories. Birth risks were associated with increased middle childhood sleep problems. Neighborhood risks were not associated with any trajectories. Socioeconomic risks were linked to mild and persistent sleep problem trajectories. Cumulative risk indexes were most associated with increased middle childhood sleep problems. Conclusions This study identified distinct longitudinal sleep problem trajectories, suggesting the need for continuous sleep screening over development. Cumulative risks assessed at birth—primarily maternal and paternal family risks—predicted these trajectories, especially for the sleep problems in middle childhood trajectory. Preventive interventions targeting modifiable factors, particularly caregiver distress and marital/relational hostility, could benefit child sleep.

This study aimed to examine the relationship between sleep problems and working memory in children aged 5-13 years with attention-deficit/hyperactivity disorder (ADHD).Children with ADHD were recruited into a randomized controlled trial from 21 paediatric practices in VIC, Australia. Cross-sectional data for intervention and control children were pooled at 6 months post randomization for the current analyses (n = 189). Children who met the Diagnostic Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for ADHD and had a parent-reported moderate/severe sleep problem that fulfilled diagnostic criteria for a behavioural sleep disorder were recruited into the study. Sleep was assessed by detailed parent (Children's Sleep Habits Questionnaire) and self-reports (Self-Sleep Report). Working memory was measured using the Working Memory Test Battery for Children (low and very low working memory defined as25th and10th percentiles, respectively). Analyses were adjusted for child age and gender, internalizing and externalizing comorbidities, and socio-economic status.Self-reported sleep problem severity was associated with poorer working memory; for each standard deviation increase in self-reported sleep problems, working memory scores decreased by -3.8 points (95% confidence interval (CI): -6.7, -0.8; p = 0.01). There was some evidence that self-reported sleep problems were associated with low (p = 0.06) and very low working memory (p = 0.01). There was minimal evidence that parent-reported sleep problems were associated with poorer working memory with the exception of bedtime resistance problems.Behavioural sleep problems and working memory are associated in children with ADHD, particularly when sleep is assessed by self-report.

Background Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet their persistence or otherwise is unknown. We examined behavioral sleep problem trajectories, types of sleep problems experienced, and associated risk/protective factors. Methods Design: Prospective cohort study. Setting: Twenty-one pediatric practices across Victoria, Australia. Participants: A total of 195 children with ADHD (5–13 years). Outcomes: Sleep problem trajectories classified as never, transient, or persistent on the basis of sleep problem severity measured at baseline, 6, and 12 months. Explanatory variables: Types of sleep problems, internalizing and externalizing comorbidities, ADHD symptom severity and medication use, autism spectrum disorder, caregiver mental health, and sociodemographic factors. Analyses: Multinomial logistic regression models. Results Sleep problems fluctuated over 12 months, but for 10% of children they persisted. In adjusted analyses, co-occurring internalizing and externalizing comorbidities were a risk factor for persistent (odds ratio (OR) 9.2, 95% confidence interval (CI) 1.6, 53.9, p = 0.01) and transient (OR 3.7, 95% CI 1.5, 8.8, p = 0.003) sleep problems, while greater ADHD symptom severity and poorer caregiver mental health were risk factors for persistent and transient sleep problems, respectively. Conclusions Sleep problems in children with ADHD are commonly transient, but in a subgroup they are characterized as persistent. Early preventive/intervention strategies should target children at risk of persistent sleep problems.

Background: Australian paediatricians use a wide variety of practices when managing sleep disturbances in children, including use of melatonin and behavioral strategies. However, practice patterns around the use of strategies, dosing, and how the patient populations managed, are unknown. Results could inform guidelines for the management of child sleep disturbances. Objective: We aimed to document management practices by Australian general paediatricians for paediatric sleep disturbances through an online survey sent to members of the Australian Paediatric Research Network (APRN) who are recruited from the Royal Australasian College of Physicians. Results: 181 (49%) of 373 eligible paediatricians responded, with 101 prescribing melatonin. The most commonly prescribed medications for poor sleep initiation were melatonin (89.1%), clonidine (48%) and antihistamines (29%). Melatonin doses ranged from 0.5 mg to 12 mg and duration of treatment was as long as 200 weeks. Less than half of the paediatricians were aware of any potential melatonin side effects. Most paediatricians (82%) reported using behavioral strategies for sleep disturbances, most commonly anxiety relaxation techniques (75%) for poor sleep initiation and graduated extinction (i.e. ‘‘controlled crying’’, 52%) for disrupted overnight sleep. Conclusions: Australian paediatricians use both pharmacological and non-pharmacological treatments for paediatric sleep disturbances. Melatonin is the most commonly prescribed medication, but wide variation in its prescribing suggests a lack of knowledge of recommended dosages and effectiveness. Given the prevalence and variation in prescribing, there is an urgent need to develop clear guidance for paediatricians managing children with sleep disturbance.

Sleep problems affect up to 40% of children in the first eight years of life. Most problems are behavioural in origin (eg refusing to go to sleep or waking frequently during the night) and as such are often amenable to behavioural interventions. Behavioural interventions such as graduated extinction (controlled crying) and adult fading (camping out) have been shown to be effective and acceptable to parents. Interventions should be tailored to individual families and address family’s goals. Most families will benefit from a discussion about good ‘sleep hygiene’ that is setting and maintaining a constant bedtime, ensuring bedrooms are a media free zone, and avoiding caffeinated drinks and foods after 3pm. Sleep diaries are a useful adjunct to clarify sleep problems and response to management. Medication has a limited role in management of sleep problems as effects are usually short-term and side effects can occur. Currently, there is no evidence that behavioural sleep interventions cause any long-term harm to children.