The Cool Little Kids randomised controlled trial: Population-level early prevention for anxiety disorders

Abstract

BackgroundThe World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful 'efficacy' trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry.Methods/DesignThis randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child's bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (cost-consequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms.DiscussionThis trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally.Trial RegistrationISRCTN: ISRCTN30996662RCH Human Research Ethics Approval30105A

Gender Expression and Risk of HIV Infection Among Black South African Men Who Have Sex with Men

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“…Studies have shown that older MSM are more likely to be infected than younger MSM (8, 10, 11, 15, 17, 18, 21, 22), although incidence seems higher among younger MSM (7). HIV infection also seems to be associated with indicators of social vulnerability, including lower levels of education (9, 10), being unemployed (5), and low income (11). Behavioral risk factors for HIV infection in sub-Saharan MSM include having engaged in receptive anal intercourse (6, 8, 9, 11), number of sexual partners (15, 16), having been paid for sex (12, 16, 18, 21) (while having paid for sex seems to be a protective factor (9)), and having experienced violence (5, 17, 22).…”

HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

“…The proportion of HIV positive MSM in South Africa who do not know their status has been found to be between 88% and 94% (15, 19). In a study that included Black and White South African MSM, ever having tested for HIV was associated with being Black, living in a township, and lacking social support (20).…”

Increasing Wellbeing through a Parenting Program: Role of Gender and Partnered Attendance

“…A popular medium for improving parent wellbeing is social emotional parenting programs (e.g., 'Tuning into Kids'; Havighurst, Wilson, Harley, & Prior, 2009;and 'Cool Little Kids';Bayer et al, 2011). These programs are often delivered within a positive parenting framework, where an emphasis on parental warmth, acceptance, effective communication and behavioural management strategies aims to develop confident, caring and balanced parenting (The Positive Parenting Network of Australia, 2013; Sanders, 2008).…”