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BackgroundEarly identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective. ObjectiveThe aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years. MethodsThis paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design. ResultsIn study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented. ConclusionsThe ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children.

BackgroundThe advent of eHealth interventions to address psychological concerns and health behaviors has created new opportunities, including the ability to optimize the effectiveness of intervention activities and then deliver these activities consistently to a large number of individuals in need. Given that eHealth interventions grounded in a well-delineated theoretical model for change are more likely to be effective and that eHealth interventions can be costly to develop, assuring the match of final intervention content and activities to the underlying model is a key step. We propose to apply the concept of “content validity” as a crucial checkpoint to evaluate the extent to which proposed intervention activities in an eHealth intervention program are valid (eg, relevant and likely to be effective) for the specific mechanism of change that each is intended to target and the intended target population for the intervention. ObjectiveThe aims of this paper are to define content validity as it applies to model-based eHealth intervention development, to present a feasible method for assessing content validity in this context, and to describe the implementation of this new method during the development of a Web-based intervention for children. MethodsWe designed a practical 5-step method for assessing content validity in eHealth interventions that includes defining key intervention targets, delineating intervention activity-target pairings, identifying experts and using a survey tool to gather expert ratings of the relevance of each activity to its intended target, its likely effectiveness in achieving the intended target, and its appropriateness with a specific intended audience, and then using quantitative and qualitative results to identify intervention activities that may need modification. We applied this method during our development of the Coping Coach Web-based intervention for school-age children. ResultsIn the evaluation of Coping Coach content validity, 15 experts from five countries rated each of 15 intervention activity-target pairings. Based on quantitative indices, content validity was excellent for relevance and good for likely effectiveness and age-appropriateness. Two intervention activities had item-level indicators that suggested the need for further review and potential revision by the development team. ConclusionsThis project demonstrated that assessment of content validity can be straightforward and feasible to implement and that results of this assessment provide useful information for ongoing development and iterations of new eHealth interventions, complementing other sources of information (eg, user feedback, effectiveness evaluations). This approach can be utilized at one or more points during the development process to guide ongoing optimization of eHealth interventions.

The aim of this study was to explore the role of Mothers of young adults on the autism spectrum in Australia, during the transition to adulthood. Data collected through interviews were analysed using Interpretative Phenomenological Analysis resulting in two themes relevant to autism and inclusive practices: Inclusion Support and Mothers' Support. The findings showed that organisational pressure in meeting key educational performance outcomes influenced inclusive practices specifically for young adults on the autism spectrum who were deemed to require high levels of support. The inclusion support theme highlighted that schools, universities, and employers viewed Autism Spectrum Disorder through a deficit lens, with young adults on the autism spectrum positioned as low achievers. Whilst there are policies supporting inclusive education in Australia, individuals on the autism spectrum continue to experience inequity and exclusion, which were challenged by Mothers' persistence and reflected in the second theme on Mothers Support. The findings highlight the need for educational and socially inclusive interventions to support the heterogeneity in individual, social, communication, and behavioural challenges in young adults on the autism spectrum.

BackgroundSubstantial evidence exists that positive therapy outcomes are related to the therapist–client working alliance. ObjectivesTo report two studies that examined (1) the quality of the working alliance in online cognitive behavior therapy (CBT), with minimal therapist contact, for anxiety disorders in youth, and (2) the role of working alliance and compliance in predicting treatment outcome. MethodsStudy 1 participants were 73 adolescents aged 12 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Participants were randomly assigned to clinic or online delivery of CBT, with working alliance being assessed for youth and parents after session 3. Study 2 participants were 132 children and adolescents aged 7 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Youths and parents participated in a minimally therapist-assisted online CBT program supported by brief, weekly emails and a single, short phone call. ResultsStudy 1 revealed a strong working alliance for both online and clinic CBT, with no significant difference in working alliance between conditions for adolescents (F1,73 = 0.44, P = .51, ηp2 = 0.006, Cohen d = 0.15). Parents also reported high working alliance in both conditions, although a slight but significantly higher working alliance in clinic-based therapy (F1,70 = 6.76, P = .01, ηp2 = 0.09, Cohen d = 0.64). Study 2 showed a significant and substantial decrease in anxiety symptoms following online therapy (P < .001 for all outcome measures). Adolescents improved significantly more in overall functioning when working alliance (beta = .22, t79 = 2.21, P = .03) and therapy compliance (beta = .22, t84 = 2.22, P = .03) were higher, with working alliance also predicting compliance (beta = .38, F1,80 = 13.10, P = .01). No such relationships were evident among younger children. ConclusionsWorking alliance is important in determining clinical outcome for online treatment for anxiety among adolescents, with minimal therapist assistance, although this was not the case for younger children. Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000900910; http://www.anzctr.org.au/trial_view.aspx?ID=343375 (Archived by WebCite at http://www.webcitation.org/674C4N3JJ)

: Objective: Rural cancer caregivers report poor wellbeing and high unmet needs for support. This study investigates sources of support sought by cancer caregivers living in rural Australia, and factors associated with support‐seeking. Methods: Informal caregivers of people with cancer completed a questionnaire assessing sociodemographic characteristics, caregiver factors and support‐seeking. Descriptive statistics, bivariate analyses and logistic regression were used to identify common sources of support and factors associated with support‐seeking. Alluvial and radar plots were used to identify and describe support‐seeking profiles. Findings: Of 244 rural caregivers, 64% reported seeking support for themselves, 72% for the cancer patient, and 22% did not seek any support. The most common sources of support were general practitioners and online. Higher caregiver burden, higher income, caring for someone with anxiety/depression or caring for someone who has difficulty completing their usual activities were associated with seeking support from a greater number of sources. The ‘No support‐seekers’ profile had the highest proportions of caregivers who were male, caring for someone Conclusions: Many rural caregivers seek support for themselves and the cancer patient, commonly from medical and online sources. Implications for public health: Further work may be needed to reduce caregiver burden and support caregivers who are male, caring for someone recently diagnosed, and those with lower incomes., Following a cancer diagnosis, family members and friends often become informal caregivers, helping with activities of daily living, medical care and follow‐up, and providing emotional and social support.[sup.1,2] While some [...]

BackgroundGiven the substantive health inequalities in peri-urban communities and the potential for physical activity to promote health in these communities, identifying modifiable physical activity determinants in this population is important. This study explored effects of the peri-urban environment and psychological constructs on physical activity intentions and behavioural automaticity guided by an integrated theoretical framework.MethodsPeri-urban Australians (N = 271) completed self-report measures of environmental (i.e. physical/social environment, and neighbourhood selection), motivational (i.e. autonomous motivation), and social cognition (i.e. attitudes, norms, and perceived behavioural control [PBC]) constructs, past behaviour, intentions, and automaticity.ResultsA well-fitting path analytic model revealed that: autonomous motivation predicted all social cognition constructs; subjective norms and PBC, but not attitudes; autonomous motivation predicted intentions and automaticity; and subjective norms and PBC mediated effects of autonomous motivation on intentions. Of the environmental constructs, only neighbourhood selection was related to intentions, mediated by PBC.ConclusionsAutonomous motivation is an important correlate of physical activity intentions and automaticity, and subjective norms and PBC also related to intentions. Individuals perceiving a supportive environment were more likely to report positive PBC and intentions. Targeting change in autonomous motivation, and normative and control beliefs may help enhance physical activity intentions and automaticity in peri-urban communities.

The aim of this study was to explore the barriers and facilitators during the transition to adulthood for young adults on the autism spectrum, from the perspectives of service providers. Fourteen disability service providers participated in two focus groups. Focus group data were analysed using thematic analysis resulting in two themes relative to transition support: Autism Spectrum Disorder Specific Challenges and Organisational Influences. The findings showed that government and organisational pressure in meeting key performance indicators influenced the quality of service provider support. The autism specific challenges theme highlighted school; community and employer focus on Autism Spectrum Disorder as a deficit with these individuals affecting the cost-benefits ratio. Implications of the findings highlight the need for Autism Spectrum Disorder skilled service providers to facilitate a targeted service delivery to support the heterogeneity in individual, social, communication, and behavioural challenges in young adults on the autism spectrum.

Online youth-focused health programs often include parent modules—that equip parents with skills to assist their child in improving their health—alongside youth-specific content. BRAVE Self-Help, an evidence-based program designed for children and teenagers with early signs of anxiety, is a popular Australian program that includes six parent modules. Despite its popularity and proven efficacy, BRAVE Self-Help shares the same challenge as many online self-help programs—that of low participant engagement. Using parents registered in BRAVE Self-Help as 'information rich' participants, we explored (a) factors that influenced parent engagement in online health programs, and (b) their recommendations for enhancing parent engagement. We conducted semi-structured interviews with 14 parents registered in BRAVE Self-Help. Data were analysed through reflexive thematic analysis. Social-, family- and program-related factors drove parents' program engagement and recommendations. Social sub-themes related to the benefits of professional and community support in promoting more engagement. Family sub-themes included difficulties with program engagement due to competing priorities, perceptions that condition severity influenced engagement, and feelings that previously-acquired health knowledge reduced motivation to engage. Program sub-themes included perceived usefulness and ease-of-use. Program designers could target support systems, include flexible delivery options, and use iterative design processes to enhance parent engagement. [ABSTRACT FROM AUTHOR]

There is growing evidence that children are vulnerable to poor psychological outcomes following exposure to a range of potentially traumatic events. Teachers are in a unique and well-placed position to provide vital support to children following potentially traumatic events and to also provide a vital role in helping to identify children who may be experiencing ongoing psychosocial difficulties. We present a review of mental health trauma resources available for use in educational settings within Australia and New Zealand, with a primary focus on post-disaster resources. We describe the design, development, and dissemination of our resources and training package, Childhood Trauma Reactions: A Guide for Educators from Preschool to Year 12, and present data on how these resources were received. Trauma-informed practices within the school and classroom will enable better outcomes in the immediate post-trauma environment and beyond for all children. Our model focuses on: (1) increasing awareness and understanding of children's post-trauma reactions, (2) exploring effective strategies for teachers within the classroom, and (3) developing policy and procedures for the identification and referral of children who may be at risk. More funding is required to help distribute training and resources and to make mental health following trauma a higher priority.

Background: Anxiety‐related functional impairment, as reflected by life interference, is a lesser explored but highly relevant treatment outcome, and it is crucial that it be included and examined in the evaluation of treatment outcomes of internet‐delivered Cognitive Behavioural Therapy (iCBT). Methods: This single group, pre‐post study examined changes in life interference and anxiety symptoms in a sample of children (n = 1198; mean age 9.66 years) and adolescents (n = 721; mean age 13.66 years) participating in the BRAVE Self‐Help program in Australia. Results: Results demonstrated that both children and adolescents showed improvements in anxiety symptoms, with effect sizes ranging from ηp2 =.194–.318. Reductions in life interference were evident for children (ηp2 =.008–.044), particularly later in the programme, but adolescents did not show such effects. Adolescents in the low completer group (completing 3–5 sessions) showed increases in at‐home interference (ηp2 =.038). Conclusions: Adolescents in particular may require more sessions before entrenched life interference, such as that resulting from avoidance behaviours, can be overcome. [ABSTRACT FROM AUTHOR]