Valsamma Eapen’s research while affiliated with University of South Wales and other places

Background and Objective Migrant and refugee women, families, and their children can experience significant language, cultural, and psychosocial barriers to engage with child and family services. Integrated child and family health Hubs are increasingly promoted as a potential solution to address access barriers; however, there is scant literature on how to best implement them with migrant and refugee populations. Our aim was to explore with service providers and consumers the barriers, enablers, and experiences with Hubs and the resulting building blocks required for acceptable Hub implementation for migrant and refugee families. Design, Setting and Participants This project was undertaken in Sydney, New South Wales, in communities characterised by cultural diversity. In this qualitative study, we used semi‐structured interviews guided by the consolidated framework for implementation research, with service providers from health and social services (32 participants) and migrant and refugee parents (14 parents) of children who had accessed Hubs. Research and Discussion Our initial qualitative data themes were developed into step‐by‐step building blocks, representing a way to address contextual determinants to establish and sustain a Hub that can support migrant and refugee families. These include the setting‐up phase activities of buy‐in and partnership development, which outlines mechanisms to foster collective action and collaboration between health and social services. Following this, our orientation model articulates the need to establish Hub coordination and navigation, activities that enhance a Hub's relevance for migrant and refugee families and ongoing integration mechanisms, such as engagement of same‐language general practitioners. This is the first study to explore the building blocks required for acceptable Hub implementation to meet the needs of migrant and refugee families in the first 2000 days of a child's life—a critical time to optimise child development and health. Patient or Public Contribution The research questions were developed based on qualitative research undertaken with Hub participants, community members, and service providers. The original investigator team had a consumer representative who has since relocated and consultation was undertaken with local Hub partner services. The researchers also consulted multicultural health services, including cultural support workers, to ensure research materials were culturally nuanced. Patients or participants have not directly been involved in the current study design. Clinical Trial Registration This trial was registered with the Australian New Zealand Clinical Trials (ACTRN12621001088831).

Objective This study aimed to investigate the help-seeking behaviours among children and young people (CYP) from culturally and linguistically diverse (CALD) backgrounds for mental health (MH) needs in a multicultural Australian population. Methods We analysed the electronic medical records (eMR) of 8135 MH-related emergency department (ED) encounters of CYP aged up to 18 years across six public hospitals in the South Western Sydney Local Health District, Australia, from January 2016 to April 2022. Urgency of MH care was grouped into high priority (triage categories 1 and 2, needing to have treatment within 10 minutes) and low-to-moderate (triage categories 3–5, needing to have treatment within 30–120 minutes) presentations. Multilevel logistic regression models adjusted for key covariates and patient level clustering examined the relationship between CALD status and urgency of MH care. We also assessed the combined effects of gender and CALD status, as well as CALD status and residential area socioeconomic status, on urgent ED care. Results About 8.3% of all MH-related ED presentations during the 6-year period were classified as high priority. The odds of high-priority MH ED care were 2.03-fold higher for CALD CYPs compared to non-CALD CYPs (adjusted odds ratio (AOR): 2.03, 95% confidence interval [CI] = [1.46–2.82]). Furthermore, an added increase in the odds of seeking urgent MH care for CYPs who belong to multiple risk groups was observed among CALD male CYPs (AOR: 2.96, 95% CI = [1.81–4.85]) and those living in disadvantaged areas (AOR: 2.36, 95% CI = [1.59–3.49]). Conclusion The findings of this study highlight the need for culturally appropriate services aimed at prevention and early intervention targeted at CYP from CALD backgrounds to avoid crisis presentations.

Positive Childhood Experiences (PCEs) may mitigate the negative outcomes resulting from Adverse Childhood Experiences (ACEs). To date, most PCE research has used cross-sectional or retrospective designs. PubMed, EMBASE, Cochrane, PsychINFO, CINAHL, and Scopus were searched in May 2024 for longitudinal studies that examined the impact of cumulative PCEs. Eight publications from five longitudinal studies with a total of 16,451 participants were included. Three studies focused only on adolescent outcomes. PCEs were associated with reduced rates of depression, substance use, delinquent behavior, risky sexual behavior, persistent insomnia, and lower inflammatory markers. Cumulative PCEs in childhood may moderate the impact of ACEs, potentially playing an important role in reducing the risk for mental disorders and other adverse outcomes later in life. PROSPERO (ID: CRD42022384775).

Background Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds. Aims To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia. Method We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering. Results Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% ( n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% ( n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66–0.99). Conclusions Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

Background Parent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors. Methods This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3). Results At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups. Conclusions Delivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257.

The State-wide Outreach Perinatal Services – Mental Health (SwOPS) is a telehealth consultation liaison service aimed at bridging the gap in perinatal mental health service provision in rural and remote areas across New South Wales (NSW), Australia. The service enables health professionals working within the NSW health service to refer perinatal women with moderate-to-severe or complex mental health conditions for assessment and treatment advice by a perinatal psychiatrist and senior clinical nurse consultant. There is, however, limited research evaluating the impact of the service. The current study represents the first qualitative investigation into the experiences of health professionals accessing the SwOPS service. Qualitative interviews were conducted with 12 health professionals from rural, remote and metropolitan areas who had experience with the SwOPS service. Data was analysed using a thematic analysis approach, four themes and 14 sub-themes were identified: accessing the SwOPS service (limited resources in rural and remote areas, expert advice, and education and clinical supervision), unique and valuable service (easy access and reduction in wait-times, reduces admission and re-presentation, and service providers and capacity building), benefits to health professionals (education, peer networking and community of practice, comprehensive reports), and room for improvement (need for increased resources, cultural sensitivity, expand service, access to electronic medical record, and improve marketing). Results highlight the limited resources available to rural and remote perinatal mental health services providers. Further, findings highlight the need for services such as SwOPS to help bridge the gap in the provision of mental health services and rural and remote areas.

Community-based integrated youth mental health care is the gold standard model of service delivery for young people. However, current research indicates significant challenges exist in the implementation of integrated care due to low levels of service integration. Using the Youth Integration Project (YIP) framework (Hodgins et al., 2024), this study examined the barriers and facilitators of youth mental health service integration from the perspectives of health practitioners. Three priority areas were identified for improving service integration: Service access, workforce development, and forming and sustaining partnerships. These were linked to barriers of long waitlists, limited funding, and inconsistent information systems. Key enablers of service integration were co-located services, interdisciplinary collaboration, and roles for care coordination. The results suggest improving service integration entails a multicomponent health system transformation. These results are used to explain how the multicomponent YIP framework can be used as a framework for implementing strategies for improving youth mental health service integration.