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Background: Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary., Objective: This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia., Methods: A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit., Results: In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it., Conclusions: The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice., Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883., International Registered Report Identifier (irrid): RR2-10.1186/s13063-020-04686-4., (©Christiaan Vis, Josien Schuurmans, Bruno Aouizerate, Mette Atipei Craggs, Philip Batterham, Leah Bührmann, Alison Calear, Arlinda Cerga Pashoja, Helen Christensen, Els Dozeman, Claus Duedal Pedersen, David Daniel Ebert, Anne Etzelmueller, Naim Fanaj, Tracy L Finch, Denise Hanssen, Ulrich Hegerl, Adriaan Hoogendoorn, Kim Mathiasen, Carl May, Andia Meksi, Sevim Mustafa, Bridianne O'Dea, Caroline Oehler, Jordi Piera-Jiménez, Sebastian Potthoff, Gentiana Qirjako, Tim Rapley, Judith Rosmalen, Ylenia Sacco, Ludovic Samalin, Mette Maria Skjoth, Kristine Tarp, Ingrid Titzler, Erik Van der Eycken, Claire Rosalie van Genugten, Alexis Whitton, Enrico Zanalda, Jan H Smit, Heleen Riper. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.02.2023.)

Background: The Australian Government's Fifth National Mental Health and Suicide Prevention Plan recommends a stepped care model of mental healthcare that focuses on matching the intensity of care to the severity of illness. General practitioners (GPs) need to learn more about low-intensity online interventions to better meet the needs of patients of lower severity., Objective: This article provides GPs with information about low-intensity, evidence-based online resources developed in Australia and available for integration into the care of patients with mild-to-moderate mental health conditions. This article has an emphasis on new developments since 2015., Discussion: The internet provides an opportunity to deliver effective mental health treatment to people who would otherwise not seek, or be able to reach, skilled help for their mental health conditions. High-quality, evidence-based cognitive behavioural therapy treatment programs are available to all Australians, at no or low cost. These options can be integrated into a stepped care model of mental healthcare, and provide GPs with an opportunity to help patients access treatment that suits their needs.

Purpose of Review: Depression and anxiety are prevalent among adolescents; however, many young people do not seek help from professional services. This is due, in part, to the inadequacies of existing healthcare systems. This article aims to review the current evidence for e-health interventions for depression and anxiety in youth, as a potential solution to the gaps in mental health service provision., Recent Findings: Five randomized controlled trials reporting on e-health interventions for youth depression or anxiety were identified. Of these, two trials focused exclusively on anxiety symptoms, and three trials examined both anxiety and depression. The majority of trials assessed online cognitive behavioral therapy and focused on prevention rather than treatment. In all but one trial, results demonstrated positive effects for the e-health interventions, relative to the control., Summary: There is growing evidence for the effectiveness of online cognitive behaviour therapy interventions for reducing the level of anxiety and depressive symptoms in adolescents aged between 12 and 18 years, when delivered in school and clinical settings, with some level of supervision. However, there are a number of gaps in the literature. More research is needed to strengthen the evidence base for prevention and treatment programs that are delivered via the internet, particularly for depression.

Objective: Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth., Design: Cross-sectional data from a longitudinal cohort study., Setting: Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate., Participants: Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney., Measures: Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning were assessed using clinical interview and self-report., Results: A total of 19% (n=130/696) were NEET. NEETs were more likely to be male, older, have a history of criminal charges, risky cannabis use, higher level of depression, poorer social functioning, greater disability and economic hardship, and a more advanced stage of mental illness than those engaged in education, training or work. Demographics such as postsecondary education, immigrant background and indigenous background, were not significantly associated with NEET status in this sample., Conclusions: One in five young people seeking help for mental health problems were not in any form of education, employment and training. The commonly observed risk factors did not appear to influence this association, instead, behavioural factors such as criminal offending and cannabis use appeared to require targeted intervention., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Australia is a world leader in the development of internet-delivered programs for the prevention and management of mood and anxiety disorders. Despite a strong evidence base of time- and cost-effectiveness, as well as clinical efficacy, the uptake of these programs in general practice remains low., Objective: To familiarise general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems., Discussion: E-mental health programs provide an efficacious and accessible form of mental healthcare and have the potential to fill the gap for those for whom such care is inaccessible, unaffordable or unacceptable. Clinicians can also use it in a stepped-care manner to augment existing healthcare services. There are a number of online resources currently available to Australians who have mood or anxiety disorders. These resources have strong evidence to support their effectiveness. Online portals facilitate access to these programs. Recently the Australian Federal Government has funded an education program (eMHPrac) for GPs and mental health professionals, to outline what is available, indicate situations where recommending such resources is appropriate, and suggest ways in which they can be incorporated into general practice.

Background: The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. Aim: The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. Methods: A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. Conclusion: This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. Study Registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606. [ABSTRACT FROM AUTHOR]

This study examined school counsellors' and parents' experiences of a school-based digital mental health service (Smooth Sailing) that screened students' mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child's participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools. Trial registration: This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12617000977370). [ABSTRACT FROM AUTHOR]

Objective: Parents are important facilitators of mental healthcare for their adolescent children. An online, school-based, mental health service may assist parents in gaining access to care. This study explored parental attitudes towards this new type of service provision. Method: The study was undertaken in July and August 2016. Semi-structured interviews were used to understand parents' attitudes towards a proposed online, school-based service called Smooth Sailing. Themes were identified through thematic analysis. Fourteen parents were interviewed. Results: Seven key themes emerged. Parents' own experiences seeking help and awareness of mental health services, their perceived prevalence of mental health issues in youth and the appropriateness of online and school-delivered care, the desire to be involved in their child's care, alongside concerns about stigma, service trust and credibility, and the availability of face-to-face support, were all found to influence parents' attitudes to the proposed service. Discussion: This study confirmed that parents have both positive and negative attitudes towards online, school-based mental health service provision. By understanding these attitudes, service providers are better equipped to develop strategies to mitigate concerns and promote engagement. In doing so, parents are likely to be more supportive of their child seeking help for mental health in the school setting. [ABSTRACT FROM AUTHOR]

Background : Schools play an important role in supporting young people's mental health, but face challenges identifying and responding to students in need of care. To assist secondary schools, the Black Dog Institute has developed an online, school-based, mental health service (Smooth Sailing). Delivered in the classroom, Smooth Sailing uses a website to screen, assess, allocate, and deliver care for depression and anxiety. The service is based on the principles of stepped care, offering treatments with varied intensity and follow-up by a school counselor when necessary. The current study aimed to evaluate the feasibility, acceptability, and safety of this new type of service among secondary school students. Methods : Between February and June 2017, a single-arm, pre-post, pilot study was conducted among students from four NSW secondary schools. Schools were given access to the service for 6 weeks. Feasibility measures (consent rates and step allocations), acceptability measures (service use and satisfaction) and safety measures (deterioration in help-seeking intention scores and mental health symptoms) were assessed at baseline and completion of the 6-week trial period. Results : A total of 59 students took part in the service pilot (mean age, 14.57 years; SD, 0.89 years; range, 13-16 years). At baseline, 18.64% of students were found to require follow-up from the school counselor, and 80% of these were new cases. Although completion of the online modules was low, service satisfaction was high. At 6 weeks, the mean scores for help-seeking, depression, and anxiety remained relatively stable or improved. Conclusions : The current study presents important findings for the development and implementation of an online mental health service that screens students' mental health and allocates care accordingly, all within the school setting. Although the findings provide some support for the feasibility, acceptability, and safety, service improvements are needed. The modifications outlined are likely to improve the quality of the service and its effectiveness. Trial Registration : Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000977370 [ABSTRACT FROM AUTHOR]

Background: Mental health problems are common among youth in high school, and school counselors play a key role in the provision of school-based mental health care. However, school counselors occupy a multispecialist position that makes it difficult for them to provide care to all of those who are in need in a timely manner. A Web-based mental health service that offers screening, psychological therapy, and monitoring may help counselors manage time and provide additional oversight to students. However, for such a model to be implemented successfully, school counselors' attitudes toward Web-based resources and services need to be measured. Objective: This study aimed to examine the acceptability of a proposed Web-based mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators to implementation as perceived by school counselors in New South Wales (NSW), Australia. Methods: This study utilized an online cross-sectional survey to measure school counselors' perspectives. Results: A total of 145 school counselors completed the survey. Overall, 82.1% (119/145) thought that the proposed service would be helpful to students. One-third reported that they would recommend the proposed model, with the remaining reporting potential concerns. Years of experience was the only background factor associated with a higher level of comfort with the proposed service (P=.048). Personal beliefs, knowledge and awareness, Internet accessibility, privacy, and confidentiality were found to influence, both positively and negatively, the likelihood of school counselors implementing a Web-based school mental health service. Conclusions: The findings of this study confirmed that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counselors. Although the school counselors in this study were open to the proposed service model, successful implementation will require that the issues outlined are carefully addressed. [ABSTRACT FROM AUTHOR]