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BackgroundThere is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. ObjectiveThis review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. MethodsA literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively. ResultsThis study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs. ConclusionsThe development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.

Bullying is a social phenomenon that involves the repetition of aggressive, intentional and harmful behaviors directed at a specific person. Currently, one in three children is a victim of bullying. The present study aimed to analyze the relationship between the quality of the relationship with teachers, memories of childhood care and bullying in adolescents. The sample consisted of 416 adolescents aged between 12 and 17 years old. Data were collected using a sociodemographic questionnaire, the Cuestionario de Evaluación de la Violencia entre Iguales en la Escuela y en el Ocio, the Inventory of Parent and Peer Attachment and the Early Memories of Warmth and Safeness Scale. The results demonstrated that bullying behaviors are more often perpetrated by males and with higher levels of aggression in private schools. They also revealed that students who perceive higher levels of support, understanding, trust and openness from teachers tend to be less likely to be targets of bullying. The results also demonstrated a relationship between positive memories of childhood care and students' perceptions of greater support, understanding, trust and openness from their teachers. An analysis of the results was discussed considering attachment theory due to the implications of memories of primary care and the quality of teacher–student relationships regarding bullying. [ABSTRACT FROM AUTHOR]

Establishing goals for young people in residential care (RC) is a gap in the literature, especially in terms of the relationship between family support and resilience. The literature suggests that RC is associated with the breakdown of family relationships, so the possibility of the family playing a positive role in establishing life goals for young people is reduced. However, family support in the context of organization and stability can be assumed to be a protective factor for the formulation of life goals and contribute to the resilient development of young people. This study aimed to analyze the role of family support in the process of setting goals for young people in RC, as well as to analyze the potential mediating role of resilience in the previous association. The sample included 124 young people aged between 12 and 23 years living in RC. The results point to a positive association between family support (autonomy) and the planning of life goals and verify the total mediating effect of resilience in this association. The results are discussed considering attachment theory and the role of the family in the adaptive development of young people. This study's findings provide important indications for developing future interventions. [ABSTRACT FROM AUTHOR]

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According to the attachment theory, early experiences with primary caregivers are the foundation of the expectations and beliefs about the self, others, and the world. It becomes particularly relevant in youth living in Residential Care (RC) settings, due to their past adversities. In this context, care workers can provide emotional healing experiences by acting as secure base figures and fostering conditions for youth's revision of their internal working models. The main aim of the present study was to explore the relationship between youth attachment dimensions and satisfaction with the residential caregiving environment, as well as, to analyze the potential mediator effect of the relationship quality with care workers in RC settings in the prior association. The sample was composed of youth, aged 12 to 18 (M = 15.54; SD = 1.66) living in RC settings in Porto district, Portugal (N = 248), that responded to three self-report measures. Results showed that attachment dimensions were associated with youth satisfaction with their caregiving environment, being this association mediated by the relationship quality with care workers. This study highlights the importance of investing in good relational experiences for youth satisfaction with the RC caregiving environment. [ABSTRACT FROM AUTHOR]

Background: Attachment theory states the importance of secure relationships with significant figures for the development of resilience and well-being. The institutional care context represents a particular environment where relationships beyond the family should be attended for. Objective: The purpose of this study was to analyse the relationship between significant figures (teachers, school and institution staff), resilience and well-being in a sample of 246 Portuguese adolescents, aged 12-18, from both genders and under institutional care. Method: The mediational role of resilience in the association between relationship to significant figures and well-being was tested through structural equations modelling. Results: Results showed that resilience plays a mediational role in the association between quality of relationship to significant figures and well-being. Results were discussed according to attachment theory that stresses the importance of safe haven and secure base provided by significant figures for the individual's adaptation and development. Results pointed also to the importance of preparing caregivers and other significant adults to face demands and challenges of adolescents in institutional care. Conclusion: An investment on caregivers' developing competences and attitudes is required, in order to overcome contingencies and vicissitudes of working with this population.

This study analyzes the contribution of peer attachment in predicting active coping and self-esteem in a sample of 109 institutionalized adolescents. It also explores the mediating role of social skills in the association between peer attachment, coping, and self-esteem. Structural equation modeling identified a model able to predict a positive and direct contribution of peer relationships on self-esteem. Results confirmed the mediating role of social skills but only between quality of peer attachment and the development of active coping. From an ecological perspective, quality of relationships with significant peer figures can contribute to the development of a secure base, especially in adolescents without family support. Consequently, institutionalized adolescents who perceive quality in their peer relationships seem to be more able to express their feelings and ideas. As a result, they can become able to establish positive and empathic relationships with others, which can lead to the development of active coping skills. The quality of peer relationships can also increase the self-esteem of these adolescents because they feel they have a source of personal support and can share their difficulties.