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Background: Mental disorders affect the well-being of adolescents. This study aims to describe adolescents' concerns and hopes from their own perspective when referred to adolescent psychiatric outpatient treatment. Method: The qualitative data consisted of adolescents' (n = 70) short essays gathered using the Depis.Net Internet program and analyzed with inductive thematic analysis. Results: The adolescents described their concerns and hopes regarding their relationships, daily actions, identity, and well-being. Conclusions: Adolescents share their concerns and find solutions if they find a safe channel to do so. Professionals should find new ways to help adolescents share their life experiences and information technology may be a promising tool. Key Practitioner Message• Adolescents with mental disorders have a lot of suffering in their lives, but also hopes of getting better.• They have difficulties finding channels to share their concerns, even though they want to share them.• New ways are needed for adolescents to share their problems, and information technology could be a promising tool.

Background Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care. Objective The study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland. Methods The study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions. Results Demographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase ( χ 1 2 =3.2; P =.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively ( t 279.5 =0.26; P =.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group ( t 318.8 =1.38; P =.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P <.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches. Conclusions The implementa...

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Background There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. Objective The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. Methods The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. Results The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (–0.2, 95% CI –1.3 to 1.6; P=.83), total score (–0.7, 95% CI –3.0 to 4.5; P=.70), internalizing score (–0.3, 95% CI –1.0 to 1.6; P=.64), and ICU total score (–0.4, 95% Cl –1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl –0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. Conclusions The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996 International Registered Report Identifier (IRRID) RR2-10.1186/1471-2458-13-985

Background Depression in adolescence is common. Less than half of the adolescents with depression receive mental health care; furthermore, treatment tends to be suspended, and its success rates are low. There is a need for these adolescents to have a safe place to share their thoughts. Studies have shown that writing may be a useful treatment method for people with mental health problems. Objective This study aims to describe the use of an electronic diary (e-diary) among adolescents with depressive symptoms. Methods This paper describes a substudy of a randomized controlled trial. We used a mixed-methods approach to understand the way in which e-diaries were used by participants in the intervention under the randomized controlled trial. Data were collected during 2008-2010 at 2 university hospitals in Finland. Study participants (N=89) were 15-17-year-old adolescents who had been referred to an adolescent outpatient psychiatric clinic due to depressive symptoms. Participants were instructed to use the e-diary at least once a week to describe their thoughts, feelings, and moods. The content of the e-diary data was analyzed using descriptive statistics and inductive content analysis. Results Overall, 53% (47/89) of the adolescents used the e-diary. Most of them (39/47, 83%) logged into the program during the first week, and about one-third (19/47, 40%) logged into the e-diary weekly as suggested. The number of words used in the e-diary per each log ranged between 8 and 1442 words. The 3 topics most often written about in the e-diary were related to mental health problems (mental disorder), social interaction (relationship), and one’s own development (identity). Conclusions An e-diary may be a usable tool to reflect experiences and thoughts, especially among adolescents who have signs of depression. The results of this study can be used to develop user-centered electronic health applications that allow users to express their own thoughts and experiences in ways other than systematic mood monitoring.

BackgroundDepression is the most common mental health problem among adolescents. Despite policy guidance and governmental support to develop usable mental health services, there is still a lack of easily accessible and modern interventions available for adolescents in Finland’s majority official language.ObjectiveOur objective was to develop a user-friendly and feasible Internet-based support system for adolescents with depression.MethodsThe Internet-based support system for adolescents with depression was developed. To create this new intervention, some examples of existing interventions were studied, the theoretical basis for the intervention was described, and the health needs of adolescents identified. As an outcome of the process, the results were combined and the content and delivery of a new intervention will be described here.ResultsSix individual weekly Internet-based support sessions were delivered by a tutor over a 6-week period of time and developed to form an intervention called Depis.Net. This was an Internet-based support system for adolescents with depression tailored to improve self-management skills and increase awareness of their own well-being and mental health. The intervention was accessible via an electronic platform, which was secured and password protected for users. The intervention on the Depis.Net website consisted of elements identifying adolescents’ needs, and offering self-monitoring, access to health information and self-reflective written exercises. An educated nurse tutor gave written feedback to each adolescent via the electronic platform.ConclusionsAn Internet-based support system for adolescents with depression was developed using a systematic approach with four steps. This was done to ensure that the intervention had a sound theoretical background and at the same time caters flexibly for the problems that adolescents commonly face in their daily lives. Its potential for adolescents visiting outpatient clinics will be evaluated in the next phase by means of a randomized controlled trial.

Scand J Caring Sci; 2020; 34: 420-427 Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet-based parent training programme Background: In Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems. Aim: To describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four-year-old children and an Internet-based parent training programme with telephone coaching. Methods: This is a descriptive, cross-sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open-ended question were analysed using inductive content analysis. Results: The experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet-based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies. Conclusion: Within primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.