Targeted community-based programmes for children’s mental health: A systematic review and meta-analysis of the Australian literature

Abstract

Objective: No synthesis of the Australian evidence regarding targeted prevention and early intervention for mental health concerns among young children exists. This review aimed to (1) describe the types of targeted community-based mental health programmes evaluated in Australia to support children aged 1–9 years exhibiting internalising and/or externalising symptoms and (2) examine their impact on children’s internalising and externalising symptoms and disorder diagnosis. Method: A systematic review and meta-analysis was conducted (PROSPERO: CRD42021255257). Four databases (PsycINFO, PsycArticles, MEDLINE and CINAHL) were searched for Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children’s mental health. The National Institute of Health Quality Assessment Tools were used to evaluate the study quality. Results: Forty-two studies were included; the majority (67%) were medium quality. The mean sample size was 142 (SD = 170), children’s average age was 5.78 years (SD = 2.44) and 58% were male. Aboriginal and Torres Strait Islander children were underrepresented. Studies evaluated 16 programmes that targeted (1) externalising symptoms ( n = 20 studies, n = 6 programmes), (2) internalising symptoms ( n = 14 studies, n = 7 programmes) or (3) both, termed transdiagnostic programmes ( n = 8 studies, n = 3 programmes). Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = −0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = −0.25) and 57% reduced odds of anxiety disorder diagnosis. Evidence supporting transdiagnostic programmes was inconclusive. Conclusion: Parenting-focused programmes targeting young children’s internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting. Greater implementation and evaluation of community-driven integrated and systemic approaches that identify, engage and support Australia’s most disadvantaged cohorts of young children and their families are needed.

“I literally had no support”: barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

“…Participants identified a dearth of services in Tasmania to appropriately support the psychosocial functioning of young people experiencing mental illness. This was also confirmed in recent service mapping of communitybased mental health services across Tasmania, as existing services do not have the capacity, integration, diversity and accessibility to meet the need [7]. Young people and carers acknowledged that existing services are only addressing the 'tip of the iceberg' , and consistently called for greater holistic support, including schooling, work, activities of daily living, engaging in community/hobbies/ activities, housing, and healthy lifestyle behaviours to address the increasing psychosocial complexity, stressors, and underlying socioeconomic factors of young people in Tasmania requiring support.…”

“…Nonetheless, the most predominant accessibility barrier identified in this study was the difficulty travelling to appointments (i.e., due to distance, no carer to take them). Tasmania has a highly dispersed population, and large proportion of youth living in rural and regional areas that are significantly underserviced and disadvantaged [7]. It is well-established that young people living in rural and regional areas experience poorer health outcomes and greater difficulties accessing supports [8].…”

“…Despite significant need, Tasmania has one of the most underdeveloped and under-resourced youth mental health sectors in Australia [6]. Recent service mapping of community-based youth mental health services in Tasmania identified limited availability, accessibility, and capacity of existing services to appropriately and holistically support youth experiencing mental illness [7]. Nonetheless, local reform is underway to better support young people's psychosocial wellbeing.…”

Interventions for Young Children’s Mental Health: A Review of Reviews

“…A total of four meta-analyses (Buchanan-Pascall et al, 2018 ; Carr et al, 2017 ; Savaglio et al, 2023 ; Sheridan et al, 2019 ), and four systematic reviews (Bayer et al, 2009 ; Everett et al, 2021 ; Shucksmith et al, 2010 ; Zarakoviti et al, 2021 ). evaluated parenting interventions for a range of mental health symptoms in children.…”

“…Dose response: N/A McDonald and Drey ( 2018 ) Low/Moderate Risk of bias: some lack of randomization/blinding, limitations in methodology (sparse methodology in one study); Precision: moderate effect sizes observed; Heterogeneity of study populations and outcome measures was substantial; Publication bias: funnel plot suggested no evidence of publication bias; Magnitude of effect: medium; Dose response: N/A Money et al, ( 2021 ) Low Risk of bias: high risk as only 2/6 of the included studies were RCTs; Precision: half of the interventions did not report ES, small samples and heterogeneity between included studies with no overall ES calculated, Intervention directly related to outcome, Publication bias: not ascertained. Magnitude of effect: unclear; Dose response: N/A Moula, ( 2020 ) Low Risk of bias: high or unclear due to mainly selection bias, lack of randomization/blinding; Precision: moderate effect sizes observed; Consistent across studies; Interventions directly related to outcome; Publication bias: not ascertained; Magnitude of effect: moderate; Dose response: N/A; No information regarding loss to follow-up Moula et al, ( 2020 ) Moderate Risk of bias: some lack of randomization/blinding, small sample sizes reduce power; Precision: moderate effect sizes observed; Consistent across studies; Interventions directly related to outcome; Publication bias: not ascertained; Magnitude of effect: mostly moderate; Dose response: N/A Pester et al, ( 2019 ) Very Low Risk of bias: case series methodology, lacking randomization/blinding, low sample sizes reduces power; Precision: moderate effect sizes observed; Consistent across studies; Interventions directly related to outcome of interest; Publication bias: examination of funnel plot indicated potential underreporting of studies with larger effects for externalizing symptoms and smaller effects for internalizing symptoms; Magnitude of effect: moderate; Dose response: N/A Pilling et al, ( 2020 ) Moderate Risk of bias: all RCTs, but moderate to high risk of bias most studies; Precision: small to moderate effect sizes observed; High levels of heterogeneity; Interventions directly related to outcome; Publication bias: asymmetric funnel plot and significant Egger’s test indicated presence of publication bias; Magnitude of effect: mostly moderate; Dose response: N/A Sanchez et al, ( 2018 ) High Risk of bias: Low risk of bias given all studies were RCTs; Preci...…”