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Objective: There is a wealth of qualitative research indicating that parents experience distress while caring for a child with anorexia nervosa. Applying the Common Sense Model of Self-Regulation (CSM) may help to understand the antecedents of parental distress, which could inform how to support parents in treatment. The aim of this systematic review was to deductively synthesise outcomes from qualitative research in relation to parents’ experiences of caring for a child with anorexia nervosa using the CSM. Method: Systematic search of three electronic databases (psychINFO, MEDLINE, and EMBASE) alongside a two-way screening process was used to identify eligible studies. Qualitative themes were synthesised using a “best fit” framework analysis and reported according to CSM dimensions of cognitive and emotional illness representations. Results: 26 studies published between 1970 to 2022 were eligible for inclusion for this review. Parents perceived their child’s anorexia nervosa as a major health threat observable by illness representations that anorexia nervosa was uncontrollable, incomprehensible, chronic, and associated with negative consequences. Parents generally took responsibility for causing anorexia nervosa. These illness representations were linked with emotional representations of fear, anxiety, shame, guilt, loneliness, and depression. Conclusions: The findings provide evidence of the utility of using the CSM to understand the antecedents of parents’ distress and negative impacts of caring for a child with anorexia nervosa. Recommendations for future research and clinical practice are discussed emphasising the need to understand parents perceptions of their child’s illness to putatively maximise treatment benefits for families.

Objectives: Integrating cognitive behavioural interventions into primary care support for patients with long-terms conditions (LTCs) is a priority for the National Health Service (NHS) in the United Kingdom (UK). To inform delivery of cognitive behavioural interventions for this clinical population, the aim of this study was to evaluate the taxonomy of treatment goal-themes of patients with LTCs. Design: Single group mixed-methods design analysing treatment goals and their association with patient characteristics. Method: A total of N = 222 (males = 86; females = 132) patients who participated in a service development evaluation of the Accessible Depression and Anxiety Psychological Therapies for Individuals with Long-Term Conditions in Scotland (UK) were selected for inclusion if they reported at least one treatment goal at assessment. Data was drawn from a routine outcome measures that recorded information in relation to client demographics, physical conditions, mental health, functioning and treatment goals. Participants freely reported up to three goals as part of assessment. Results: Thematic analysis identified four major goal-themes ranked in the following order of frequency: functioning, emotional health, condition management, and self-appraisal. Wanting to improve functioning was positively associated with age and depression and negatively associated with anxiety. No other patient characteristics were associated with any of the major themes. Conclusions: Patients with LTCs can have wide ranging goals that may only partially correspond with their condition. Practitioners and service providers need to flexibly deliver therapy to enhance the individual relevance of psychological intervention which is goal-oriented and tailored to patient’s needs.

BACKGROUND: History of childhood emotional abuse (CEA) is prevalent among adults with affective disorders; therefore, a comprehensive measure of it is vital. The Rating of Emotional Abuse in Childhood Questionnaire (REACH) was developed to assess history of CEA in relation to threat, ignoring, humiliation/denigration, scapegoating, antipathy, and overcontrol/conditionality in a single measure. This paper investigated the psychometric properties of REACH in a community sample and proposes values for identifying individuals with clinically significant history of CEA. METHOD: A convenient sample of N = 483 adults (Female, 78.3 %) was recruited to complete questionnaires that included the REACH alongside measures of mental health, insecure attachment, emotion regulation, and childhood abuse. A subset of participants (n = 198) completed the REACH 7 days later. RESULTS: Factor analysis indicated a 2-factor model provided a good fit, with factors consistent with direct threat and covert categorisation of CEA. A total scale score of CEA was also recommended. The direct threat, covert, and total scales demonstrated strong psychometric properties with high internal consistency, test-retest reliability, and convergent validity, while our cutoff value for identifying significant history of CEA demonstrated good discriminant validity. LIMITATIONS: Convenient community sampling was used whereby most participants were female, thus the results may not generalise to other populations. CONCLUSIONS: The results support REACH as a valid measure and suggest history of CEA should be measured in relation to direct threat and covert CEA as they represent unique dimensions of CEA even though they often co-occur.

Purpose Associations between prenatal earthquake exposure and children’s mental health remain unclear. Moreover, there is a paucity of research using quasi-experimental statistical techniques to diminish potential selection bias. Thus, this study aimed to explore the impact of prenatal exposure to the Chilean earthquake of 2010 on children’s behavioural and emotional problems between 1½ and 3 years old using propensity score matching. Methods Participants included 1549 families from the Encuesta Longitudinal de la Primera Infancia cohort in Chile. Maternal reports using the Child Behaviour Checklist (CBCL) were used to assess behavioural and emotional problems between 1½ and 3 years old. Information on prenatal earthquake exposure was collected via maternal report. The Kernel matching estimator was used to compare the average treatment effects of children who were exposed to the earthquake compared to those who were not. Results Five of the seven CBCL outcomes were statistically significant after matching and adjustment for multiple testing, suggesting greater difficulties for exposed children which included emotional reactivity, anxious/depressed, sleep problems, attention problems, and aggression (mean difference of 0.69, 0.87, 0.73, 0.85, 3.51, respectively). The magnitude of the effect was small to medium. Conclusion Findings contribute to the potential causal inferences between prenatal earthquake exposure and increased behavioural and emotional problems in early childhood. Results suggest that in utero experiences may have long-term consequences for infants’ well-being, supporting the need for specific interventions in pregnancy after natural disasters.

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners’ skills in engaging fathers in family-based interventions.

BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to an individual’s risk of illness progression. The application of staging has been traditionally limited to trained clinicians, yet if digital technologies could be leveraged to apply clinical staging, then this could increase the scalability and utility of this model in services. OBJECTIVE The aim of this study is to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS The cohort comprised 131 young people, aged between 16 to 25 years, who presented to youth mental health services in Australia for the first time between November 2018 to March 2021. Clinical stages (either stage 1a or stage 1b+) were allocated independently by expert psychiatrists and compared to the digital algorithm based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean (SD) age was 20.3 (2.4) years and 94 (71.8%) were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the expert ratings with a substantial interrater agreement (κ=0.67, P CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in early stages of common anxiety and depressive disorders. Between 11% and 27% of young people presenting for care may be suitable for low intensity online or brief interventions, creating additional clinical capacity to be directed towards those who are in stage 1b+ for further assessment and intervention.

BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to an individual’s risk of illness progression. The application of staging has been traditionally limited to trained clinicians, yet if digital technologies could be leveraged to apply clinical staging, then this could increase the scalability and utility of this model in services. OBJECTIVE The aim of this proof-of-concept study is to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS The cohort comprised 131 young people, aged between 16 to 25 years, who presented to youth mental health services in Australia for the first time between November 2018 to March 2021. Clinical stages (either stage 1a or stage 1b+) were allocated independently by expert psychiatrists and compared to the digital algorithm based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean (SD) age was 20.3 (2.4) years and 94 (71.8%) were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the expert ratings with a substantial interrater agreement (κ=0.67, P CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in early stages of common anxiety and depressive disorders. Between 11% and 27% of young people presenting for care may be suitable for low intensity online or brief interventions, creating additional clinical capacity to be directed towards those who are stage 1b+ for further assessment and intervention.

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

Objective: Although parental help-seeking processes are thought to play a role in explaining the treatment gap in child mental health care, no empirical research has reported mothers’ and fathers’ help-seeking behaviors for child mental health separately. This study examined mothers’ and fathers’ informal and professional help-seeking to further understand their preferences. Method: A total of N = 394 mothers and fathers reported on a target child between the ages of 3 and 7. Parents completed questionnaires assessing the types of help sought for child mental health concerns, as well as measures representing illness profile, predisposing characteristics, and barriers/facilitators proposed to influence parental help-seeking. Results: Parents most often sought informal help from family/friends and teachers rather than professional help for child mental health concerns. Regression modelling of parental help-seeking for externalizing concerns indicated potential differences between mothers and fathers. Mothers’ help-seeking was significantly associated with illness profile (marital quality, child mental health, parental education), predisposing factors (parental attributions, child age), and family income, while fathers’ help-seeking was significantly associated with child demographics (age, gender). Conclusions: The findings support expanding treatments into nonclinical settings. Improving child mental health literacy in the community is also supported as a way of influencing parents’ assessment and attributions of child problems that facilitates appropriate help-seeking for child mental health concerns.

This study conducted a systematic review of existing research to inform whether SES influences psychotherapy outcomes for children and young people with emotional difficulties such as anxiety and depression. Three electronic databases (PsychInfo, Web of Science and SCOPUS) were searched to identify studies that tested whether SES predicted and/or moderated psychotherapy outcomes for anxiety and depression. Fifteen studies met inclusion criteria. Nine of the fifteen studies reported that SES influenced treatment outcomes. Five studies reported lower SES predicted poorer treatment outcomes for anxiety, one study reported lower SES predicted better treatment outcomes for anxiety, and one study reported lower SES predicted poorer treatment outcomes for depression. Two studies reported SES moderated treatment outcomes for depression whereby individuals with a lower SES benefitted less from psychotherapy alone compared to individuals with a higher SES. Overall, the findings call for further attention to the potential socioeconomic inequality experienced by some young people in treatment.

Purpose: Service-level factors that influence father engagement within child and family services are not well understood due to diversity in research studies and evidence from different contexts. Accordingly, the aim of this systematic review was to identify and synthesise available qualitative evidence across contexts to identify the common service-level barriers and facilitators of father engagement in child and family services.Methods: The following six databases were systematically searched: AMED, EMBASE, Medline, CAB Abstracts, PsycINFO, and Global Health). A screening process conducted by two independent reviewers identified twenty-three eligible qualitative studies. Results from the included studies were synthesised thematically.Results: Thematic synthesis identified seven main themes encompassing service-level barriers and facilitators to father engagement: practitioner factors; environment; marketing; resource factors; staff education; policy and practice guidelines; and evaluation.Conclusions: The findings show that father engagement is dependent on a mixture of top-down policies and procedures, as well as individual practitioner competencies. Addressing the barriers and prioritizing facilitators requires an overall service commitment to father-inclusive practice, that takes into account the organizational structure, policies, and procedures, and the skills and knowledge of the workforce.

Youth self-harm is associated with poor health outcomes and attempted and completed suicide. Associations exist between self-harm and expressed emotion (EE), attachment insecurity, and reflective functioning (RF), but these associations are poorly understood. This study evaluates a mediation model in which perceived caregiver EE (pEE) exerts an indirect effect on youth self-harm through attachment insecurity and RF uncertainty. 461 participants aged 16-24 years completed an online survey. Statistical analyses revealed significant direct effects of pEE on attachment insecurity, and of RF uncertainty on self-harm; however, some direct effects were specific to pEE from female caregivers, and attachment insecurity in youth relationships with female caregivers. A significant direct effect of pEE on self-harm was found for pEE from male caregivers only. Significant indirect effects of pEE on self-harm through attachment anxiety and RF uncertainty were found only in relation to female caregivers. The findings encourage family-, attachment-, and mentalization-based approaches to preventing and treating youth self-harm, with a recommendation that caregivers are given adequate support, education, and skills-based training following youth disclosures of self-harm.The online version contains supplementary material available at 10.1007/s12144-022-03614-w.

Background and objectives: The current study examined cognitive emotion regulation strategies (CERS) as a factor underlying recurrent depression using a novel stratified depression paradigm. Methods: Differences in negative (self-blame, blaming others, rumination, catastrophising) and positive (positive reappraisal, positive refocusing, putting into perspective, refocus on planning, acceptance) CERS between formerly depressed and never depressed individuals were examined, whereby each group was stratified by symptoms and risk. A sample of N = 155 young adults (aged 18-25) completed questionnaires assessing CERS, history and severity of depression, and functioning. Participants were stratified into one of four groups - never depressed controls (NDC), subthreshold depression (SubD), formerly depressed in remission (FDR), and formerly depressed with elevated symptoms (FDE). Results: Catastrophizing and rumination were higher in the FDR compared to the NDC group, but no other differences were found. Conclusion: Despite remission, the depression course maybe associated with persistent impairments in catastrophizing and rumination at levels comparable to subthreshold depression.

Behaviour parent training (BPT) is known to effectively reduce child externalising problems. However, evidence for BPT to have secondary benefits for reducing internalising symptoms remains unclear. To address this, electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, and SCOPUS) were systematically searched for studies examining internalising outcomes from BPT among children aged 2–12 years with clinically elevated externalizing problems. Outcomes for internalising problems following BPT were analysed by meta-analysis. Of 9105 studies identified, 24 studies met the eligibility criteria. Results from meta-analysis demonstrated a significant small treatment effect size (g = − 0.41) for reducing internalising symptoms immediately after treatment. Studies showed moderate heterogeneity (I2 = 44%). Moderation analyses indicated that the overall treatment effect was robust against variations in treatment and study design characteristics. However, a review of individual study methods indicate that these results are limited by significant heterogeneity and limitations in clinical assessment. Overall, the results suggest that BPT programmes for reducing externalising problems have the potential to improve internalising outcomes, but that there is limited information to determine the reliability of these effects, highlighting the need for further investigation.

An ongoing need exists for innovation in service delivery to ensure that mental health services deliver high-quality treatment and prevention in the population. This Special Article proposes the adoption of “staged care” as a population health–oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders. Staged care integrates measures of clinical need alongside clinical stage and personal choice to select hierarchically arranged service packages for individuals. Packages then vary according to the intensity, duration, and mix of treatment options. This Special Article describes five levels of care in staged care: self- or family-directed monitoring and management, low-intensity services, moderate-intensity services, high-intensity services, and acute and specialist community mental health services. The care environment, treatment team, and length of treatment are also described, and provisional criteria are specified for assigning individuals to different care levels on the basis of current clinical need and clinical stage. Staged care is presented as a model that guides treatment selection and health service delivery to ensure that the high-quality care aims of “right care first time” and prevention are achieved and optimal use of available resources is considered.

BackgroundDepression commonly co-exists with human immunodeficiency virus (HIV), but in low- and middle-income countries (LMICs), where the HIV burden is greatest, mental health resources are limited. These settings may benefit from psychosocial interventions delivered to people living with HIV/AIDS (PLWH) by non-mental health specialists. We aimed to systematically review randomised controlled trials (RCTs) that investigated the effectiveness of psychosocial interventions delivered by non-mental health specialists to prevent depression in PLWH in LMICs.MethodsWe used a comprehensive electronic search strategy to identify RCTs of any stage, including pilot studies, which reported on the effectiveness of a psychosocial intervention on depression among adults living with HIV/AIDS in a LMIC setting. Screening, study selection and data extraction was completed independently by two authors. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and performed a narrative synthesis.ResultsWe identified 3431 studies, from which we included 15 studies corresponding to 14 RCTs and a total of 3997 PLWH. Eleven studies were parallel RCTs, one was a stepped-wedged RCT, one was a full factorial RCT, one was a three-arm RCT and four were pilot studies. Studies were generally small, with eight including depression as a primary outcome. All but four trials included men and women and most studies followed participants for less than one year. Twelve trials had at least one domain in which there was a high risk of bias, with the remaining two trials having at least one domain of concern, due to lack of reporting of items. In 12 studies people in the intervention arm had statistically significantly (pConclusionsPsychosocial interventions delivered by non-specialist mental health workers may be effective in preventing or reducing depression in PLWH in LMICs. However, existing studies are small with a relatively short follow-up period and have methodological limitations. Future trials should address these shortcomings, establish whether intervention effects are clinically meaningful and investigate cost-effectiveness.

Marginalised individuals face significant and consistent adversities and injustices that their dominant culture counterparts rarely or never face, such as discrimination, low resource access, and violence. These challenges have been linked to poor wellbeing, both empirically and in individuals’ lived experiences. An original approach to improving this situation is introduced here via a novel transtheoretical construct: socially transformative resilience. Socially transformative resilience is conceived as a type of resilience in which individuals not only improve their psychosocial wellbeing in the face of challenge, but also resist, transcend, and/or seek to change the status quo, increasing their liberation as well. The key components and mechanisms of this new construct are described in detail, drawing on theoretical and empirical evidence. Key propositions of the model include the dual importance of moral and emotional initial responses to stressors, the centrality of a multidimensional reflection process, and the utility of acceptability-control appraisals in choosing which actions and resources to activate in service of wellbeing and liberation. An agenda for future research is presented, including examining and refining the model, developing a measure, creating interventions, and investigating relationships with psychopathology.

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.

Objectives: Digital mental health interventions (DMHIs) have potential to provide support at scale for young people, yet uptake is low. The present study investigated whether attitudes towards technology solutions in relation to perceived usefulness, perceived ease of use, and trust of DMHIs influenced young people’s intentions to use DMHIs. Methods: Young people aged 17–25 (N = 248) were recruited online via advertising (e.g., Facebook, Twitter) to a survey assessing attitudes of technology acceptance and intentions to use DMHIs, previous use of DMHIs, demographics, and mental health need. Results: Participants reported relatively neutral attitudes towards DMHIs. Outcomes from linear regression indicated that greater perceived usefulness (β = .24) and trust of DMHIs (β = .28) have significant small to moderate positive associations with higher intentions to use DMHIs. Perceived ease of use (β = .07) was not associated with intentions to use DMHIs. Gender, age, previous use of DMHIs, and mental health need did not moderate unique associations between intentions to use DMHIs and perceived usefulness, perceived ease of use, and trust of DMHIs. Conclusions: Moderate levels of technology acceptance for mental health, particularly in domains of perceived usefulness and trust of DMHIs, may represent a barrier to DMHI adoption among young people. Developers and service providers are recommended to provide information about the usefulness, effectiveness, and trustworthiness of DMHIs to improve uptake among young people.

Parents' attributions about their child's personality and behaviour are known to predict the quality of parent-child interactions and outcomes for the child, including those from parenting interventions. Nothing is known, however, about the quantity and quality of attributions parents use during free speech about their children referred for treatment of behavioural and emotional problems. We tested hypotheses about the types of attributions and associations among parental attributions, parental psychopathology and child conduct problems, using 504 five-minute speech samples (FMSS) coded using the Parent Attribution Speech Sample (PASS) coding system. Both mothers and fathers talked about their thoughts and feelings regarding their children with disruptive behaviour problems (N = 295; 74% male; 3-8 years old). The assessment of spontaneous parental attributions via the PASS coding system was shown to be valid and reliable. Mothers made more negative, dispositional attributions than fathers, however, parents of either gender made, on average, more positive than negative attributions about their children. Parents' natural attributions about these children with emotional and behavioural problems were rather independent from parents' own mental health, but were consistently related to child factors. Specifically, across parent gender and across all attribution dimensions, levels of callous-unemotional traits were associated with spontaneous parental attributions above and beyond other child and parent factors. Overall, the results show that parents' spontaneous speech about referred children contains important information about their causal attributions, and that these are associated with child temperament rather than specific referral symptoms.

Problematic parental attributions refer to negative causal explanations for child problem behaviour and are known to predict parenting intervention outcomes. This study examines alternative accounts of how mothers’ problematic parental attributions, operationalised as negative pre-treatment and change resistant parental attributions during treatment, may affect child behaviour outcomes from a parenting intervention program. Putative mediators included parental feelings about the child and use of harsh discipline. Participants were 163 families with children aged from 3 to 16 referred to specialist clinics for the treatment of conduct problems. Measures were collected as part of pre-treatment, post-treatment, and 3-month follow-up assessments. Mothers’ pre-treatment and change resistant parental attributions were associated with smaller improvements in parental feelings at the end of treatment which in turn were associated with greater use of harsh discipline. Greater use of harsh discipline was associated with greater conduct problems overall. Smaller improvements in parental feelings mediated the effects of pre-treatment and change resistant parental attributions on outcomes in mothers’ use of harsh discipline and mediated the effects of change resistant parental attributions on outcomes in child conduct problems. Smaller improvements in parental feelings about the child may act as a mechanism that explains the impact of problematic parental attributions on treatment outcomes. Electronic supplementary material The online version of this article (10.1007/s10578-019-00942-0) contains supplementary material, which is available to authorized users.

There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers’ attributions about their child’s problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers’ anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β = – .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β = – .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.

Background Parent attributions about the causes of their children's behaviour problems are a known predictor of problematic parenting and ongoing child problems. However, their importance in parenting interventions remains unknown as research has not addressed whether parental attributions predict outcomes associated with parenting training. The current study examined whether problematic pre-treatment and change resistant parental attributions during treatment uniquely predict child behaviour outcomes. Method Participants were 250 families with children aged from 3 to 16 referred to specialist clinics for the treatment of conduct problems. Measures of family demographic information, parental attributions, and severity of child conduct problems were collected as part of pre-treatment, post-treatment, and 3-month follow-up assessments. Results Linear regression showed that mothers' pre-treatment parental attributions uniquely predicted severity of conduct problems at the post-treatment and 3-month follow-up assessments. Fathers' pre-treatment parental attributions uniquely predicted severity of conduct problems at the 3-month follow-up assessment. Reductions in problematic pre-treatment parental attributions were recorded at post-treatment for both parents. However, smaller reductions or increases in mothers’ problematic attributions uniquely predicted worse child behaviour outcomes, a result not replicated for fathers. Conclusions Findings that pre-treatment and change resistant parental attributions predict poorer child behaviour outcomes after controlling for other predictors and treatment effects recommend that parental attributions should be assessed prior to and after treatment and possibly included in treatment to maximise treatment gains for children with conduct problems.

We present and evaluate a new self-report measure of parental attributions developed for assessing child causal and dispositional attributions in parenting interventions. The Parent Attribution Measure (PAM) ascribes attributions along first-order dimensions of intentionality, permanence, likeability, and disposition, and a higher-order Total Scale. The psychometric analyses involved participants drawn from populations of clinical (n = 318) and community-based families (n = 214) who completed questionnaires assessing parental attributions, parenting behaviours, parental depression, parental feelings about the child, and child behavioural problems. Confirmatory factor analysis indicated that a 3-factor hierarchical structure provided a close fitting model. The model with intentionality, permanence, and disposition (consolidating likeability and disposition) dimensions as first-order factors grouped under a higher-order general factor was validated in independent samples and demonstrated sound psychometric properties. The PAM presents as a brief measure of parental attributions assessing parents' intentionality, permanence, and dispositional attributions of their child with conduct problems.

Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.

Evidence-based parenting interventions are effective in reducing conduct problems, yet these interventions have limited reach, and few involve the participation of fathers. This paper describes the outcomes of an open trial of ParentWorks, a universal, online, father-inclusive parenting intervention aiming to decrease childhood behavioural problems and promote positive parenting in mothers and fathers. A total of 388 families (456 individual parents; 36.6% fathers) were included in the study. Mixed model analyses showed significant decreases in child emotional/behavioural problems, dysfunctional parenting, interparental conflict, and parental mental health problems. The baseline severity of child behavioural problems significantly moderated the effects on child outcomes so that children with higher levels of problems benefitted more from the program. Participation of both caregivers in two-parent families, as well as parent sex, did not significantly affect the program outcomes. Results provide initial empirical support for the universal, self-directed, online parenting intervention, in addressing both child behavioural problems and parenting outcomes. Trial registration: ACTRN12616001223426, registered 05/09/2016. Electronic supplementary material The online version of this article (10.1007/s10578-019-00934-0) contains supplementary material, which is available to authorized users.

The role of parental attributions in parenting interventions has been the subject of intense interest from clinicians and researchers attempting to optimise outcomes in treatments for children with conduct problems. Despite research articulating the many ways parental attributions can influence behavioural parent training (BPT) outcomes, and recognition that addressing parental attributions in treatment is one of the great challenges faced by BPT practitioners, parenting interventions generally do not provide components that explicitly target or focus on changing problematic parental attributions. In this paper, we ask ‘Should parental attributions be included into best practice interventions? If so, how can this be done in a way that improves outcomes without cluttering and complicating the parent training model?’ We review the theoretical and empirical status of our understanding of the role of parental attributions in BPT with reference to three questions: ‘do pre-treatment parental attributions uniquely predict treatment outcomes’; ‘do changes in parental attributions uniquely predict treatment outcomes’; and ‘does targeting parental attributions in BPT affect treatment outcomes’. Our review indicates that existing research supports the importance of focussing on parental attributions for some families in order to maximise treatment outcomes. However, clinical processes for doing this are yet to be identified and specified in a way that would allow for manualised replication and scrutiny in research designs. We finish with a discussion of how these clinical and research challenges could be approached.