Child and Adolescent Mental Health最新文献

{"title":"Debate: Where to next for universal school-based mental health interventions?","authors":"Louise Birrell,&nbsp;Lucinda Grummitt,&nbsp;Scarlett Smout,&nbsp;Pallab Maulik,&nbsp;Maree Teesson,&nbsp;Nicola Newton","doi":"10.1111/camh.12749","DOIUrl":"10.1111/camh.12749","url":null,"abstract":"<p>In this article, we evaluate the current state of universal school-based mental health prevention. We argue that the field is at another pivotal turning point, with many unanswered questions. As youth mental health issues rise in prominence and prevalence, schools increasingly adopt mental health and well-being programmes. However, recent large-scale trials have reported varied effects, raising questions about their effectiveness. We critically analyse these findings and place them in a global context. We contend results in high-income countries should not be seen as a failure of universal prevention overall and unpack key learnings from trials that have not found significant preventive effects. A comprehensive perspective of the data reveals both negative and positive aspects, as well as some signposts for the way forward. We advocate for programme adaptation based on feedback, embracing proportionate universalism and exploring alternative prevention strategies without discarding universal prevention. We urge continued research with stakeholder involvement, emphasising a nuanced approach to universal school-based mental health prevention, is urgently needed to move the field forward.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"92-95"},"PeriodicalIF":6.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review: Systematic review and meta-analysis – financial incentives increase engagement with parenting programs for disruptive behavior problems","authors":"Nathan Hodson,&nbsp;Madiha Majid,&nbsp;Richard James,&nbsp;Eileen K. Graham,&nbsp;Daniel K. Mroczek,&nbsp;Rinad S. Beidas","doi":"10.1111/camh.12746","DOIUrl":"10.1111/camh.12746","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To evaluate the effect of financial incentives on engagement in parenting programs for disruptive behavior disorders, as well as effect on child behavior. As a secondary aim, demographic differences were investigated as effect modifiers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, CINAHL, Sociological Abstracts, Cochrane Trials, and PsycINFO for randomized controlled trials and quasi experimental studies offering parents a financial incentive for engagement with parenting programs targeting disruptive behavior in children aged under 18, vs no incentive. Engagement in each group was evaluated at four stages: connection, attendance, participation, and enaction. Per protocol (CRD42022336210) random effects meta-analysis was conducted using Stata-16. Meta-analyses of binary data used a log odds ratio and continuous data was standardized using Hedges' <i>g</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 2438 papers and screened 35 at full length. We included eight independent cohorts from seven papers. Parents invited to incentive arms were more likely to complete a threshold of sessions than parents invited to control arms (odds ratio 2.51 95% CI 1.42–4.48). Parents were more likely to agree to participate when they knew they were joining the incentive program (odds ratio 1.40, 95% CI 1.20–1.65) and parents in the incentive group were more likely than parents in the control group to reach a completion threshold of sessions (odds ratio 1.76 95% CI 1.17–2.66).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Incentives increase parenting programs engagement among parents who are invited and among parents who have begun attending programs. Incentives are an effective potential tool for increasing engagement but further research is needed to establish acceptability and optimal design.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"53-65"},"PeriodicalIF":6.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative Matters: Is obedience good? the classics may surprise us","authors":"Mervyn Nicholson","doi":"10.1111/camh.12756","DOIUrl":"10.1111/camh.12756","url":null,"abstract":"<p>We are conditioned not to see some of the most potent facts; one of these repressed facts is the common assumption that goodness is the same as obedience – you are good if you ‘do what you're told’ – and bad if you are disobedient. To illustrate how this invisibility of social conditioning works, some very famous stories are helpful, both for how this conditioning works and for how it is resisted, because, simply put, obedience is <i>not</i> the same as being good.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"89-91"},"PeriodicalIF":6.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: The usual suspects and beyond – decontextualization as explanation for the suboptimal uptake of parenting interventions","authors":"Tycho J. Dekkers,&nbsp;Anil Chacko,&nbsp;Matthew S. Lebowitz","doi":"10.1111/camh.12748","DOIUrl":"10.1111/camh.12748","url":null,"abstract":"<p>Although parenting interventions are recommended by major clinical guidelines for managing children's behavioral challenges, including ADHD, their uptake in clinical practice remains limited. Building on the contributions of Hodson et al. and Nijboer et al. in the current issue of this journal, we here explore solutions to enhance this uptake. We first summarize the usual suspects: solutions that could be implemented in our current mental healthcare systems. Digital and brief interventions could remove obstacles that are often experienced with traditional parenting interventions, and nudges inspired by behavioral economic theories can help remove dynamic, time-varying barriers experienced by parents that may arise during the course of the intervention. We then zoom out and present a paradigmatic challenge. The current narrative surrounding behavioral problems like ADHD is predominantly biomedical, which tends to elevate expectations for treatments such as medication while simultaneously diminishing confidence in parenting interventions. From this perspective, it is unsurprising that engagement issues arise when a context-focused intervention such as parent training is proposed as a solution to a decontextualized problem like ADHD. Adopting a truly balanced biopsychosocial-societal perspective on behavioral problems like ADHD would better reflect their complex and heterogeneous etiology, and would broaden the scope for interventions, such as parenting programs, that focus on optimizing children's contextual environments.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"1-3"},"PeriodicalIF":6.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coping with peer suicidality, help-seeking intentions, and suicidal attitudes among Asian adolescents: a mixed-methods study in Hong Kong","authors":"Sikky Shiqi Chen,&nbsp;Tai Pong Lam,&nbsp;Kwok Fai Lam,&nbsp;Tak Lam Lo,&nbsp;David Vai Kiong Chao,&nbsp;Ki Yan Mak,&nbsp;Edmund Wing Wo Lam,&nbsp;Wai Sin Tang,&nbsp;Hoi Yan Chan,&nbsp;Paul Siu Fai Yip","doi":"10.1111/camh.12757","DOIUrl":"10.1111/camh.12757","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adaptive responses to peer suicidality and the involvement of professional help are crucial for adolescent suicide prevention and may be influenced by suicidal attitudes. This study aimed to explore Hong Kong adolescents' responses to and help-seeking intentions for suicidal peers and to examine the influence of suicidal attitudes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study used an exploratory sequential mixed-methods approach targeting Hong Kong adolescents aged 15–19 between September 2018 and October 2019. Adolescents' reactions to peer suicidality, suicidal attitudes, and willingness to help were examined through six focus groups and 12 individual interviews (<i>N</i> = 40). A cross-sectional survey (<i>N</i> = 1676) was subsequently conducted to investigate the prevalence of different responses to peer suicidality, help-seeking intentions, differences by background characteristics, and the impacts of suicidal attitudes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Qualitative findings revealed three major themes: attitudes toward suicide, reactions to peer distress and suicidality, and willingness to help suicidal individuals. Most survey respondents reported actively responding and seeking informal help, but not professional support. Differences were observed based on sex, academic performance, and self-suicidality. Notably, a stigmatizing attitude was positively associated with both response types and informal help-seeking intentions. The belief that suicide is unpreventable was positively associated with passive responses but negatively associated with active responses and informal help-seeking intentions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings highlight variability in adolescents' responses to peer suicidality and help-seeking intentions, underscoring the need for attitude-tailored courses and more systematic, action-based gatekeeper training. Recommendations are provided to enhance the effectiveness of mental health first aid programs through public education, school interventions, and media campaigns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"21-33"},"PeriodicalIF":6.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review: Efficacy of preventative interventions for children and adolescents at clinical high risk of psychosis – a systematic review and meta-analysis of intervention studies","authors":"Grace Frearson,&nbsp;Javier de Otazu Olivares,&nbsp;Ana Catalan,&nbsp;Claudia Aymerich,&nbsp;Gonzalo Salazar de Pablo","doi":"10.1111/camh.12755","DOIUrl":"10.1111/camh.12755","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite evidence suggesting that age moderates the response to preventative treatment for those at clinical high risk of psychosis (CHR-P), no meta-analysis has assessed the effectiveness of preventative interventions for CHR-P children and adolescents. Our aim was to synthesise evidence assessing preventative interventions on a wide range of mental health outcomes for CHR-P children and adolescents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A systematic search was conducted on Ovid MEDLINE, Pubmed, APA PsycInfo and Web of Science until June 2024 (PROSPERO: CRD42023406696). Intervention studies that had a mean participant age of under 18 years old that reported on mental health outcomes for CHR-P participants were selected. A meta-analysis was conducted for independent studies reporting the effectiveness of interventions on different outcomes (transition to psychosis, attenuated positive, negative and total prodromal psychotic symptoms, depressive symptoms and global functioning) compared to control conditions of no intervention or placebo. Evidence from other studies was also reported narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four studies and 1319 CHR-P children and adolescents were included. Compared to no intervention or placebo, preventative interventions were effective for positive symptoms (SMD = 0.379, <i>p</i> = .022, 95% CI 0.055, 0.703), negative symptoms (SMD = 0.583, <i>p</i> = .004, 95% CI 0.187, 0.980), total symptoms (SMD = 0.677, <i>p</i> = .002, 95% CI 0.249, 1.105) and functioning (SMD = 0.944, <i>p</i> = .038, 95% CI 0.052, 1.836) but not reducing transition to psychosis or depressive symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are disparities in the effectiveness of preventative interventions for different outcomes, with transition to psychosis not being the only relevant outcome. Differences in the efficacy of preventative interventions emerged between CHR-P children and adolescents versus adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"66-82"},"PeriodicalIF":6.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism Spectrum Social Stories in Schools Trial 2 (ASSSIST-2): a pragmatic randomised controlled trial of the Social Stories™ intervention to address the social and emotional health of autistic children in UK primary schools","authors":"Barry Wright,&nbsp;Jane E. Blackwell,&nbsp;Kerry J. Bell,&nbsp;Catarina Teige,&nbsp;Laura Mandefield,&nbsp;Han-I Wang,&nbsp;Charlie Welch,&nbsp;Arabella Scantlebury,&nbsp;Judith Watson,&nbsp;Dean McMillan,&nbsp;Emma Standley,&nbsp;Leah Attwell,&nbsp;Hayley Carrick,&nbsp;Amelia Taylor,&nbsp;Olivia Taylor,&nbsp;Rachel Hodkinson,&nbsp;Hannah Edwards,&nbsp;Hannah Pearson,&nbsp;Steve Parrott,&nbsp;David Marshall,&nbsp;Danielle Varley,&nbsp;Rebecca Hargate,&nbsp;Anne Mclaren,&nbsp;Catherine Hewitt","doi":"10.1111/camh.12740","DOIUrl":"10.1111/camh.12740","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autistic children can experience mental health, social and emotional difficulties. Carol Gray's Social Stories™ are a highly personalised intervention that provide social information in a short individually tailored story.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multi-site pragmatic cluster randomised controlled trial to evaluate the clinical and cost-effectiveness of Social Stories™ alongside care as usual in autistic children aged 4–11 years. The primary outcome was the Social Responsiveness Scale-2 completed by teachers 6 months post-randomisation, analysed on an intention-to-treat basis. Trial Registration: ISRCTN11634810.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven schools, including 249 children, were randomised (intervention 44 schools with 129 children, and usual care 43 schools with 120 children). After 6 months, a reduction of 1.61 points was found on the Social Responsiveness Scale-2 in the intervention group (95% CI −4.18 to 0.96, <i>p</i> = .220) and for those who attended at least six sessions a reduction of 3.37 points (CACE 95% CI −6.65 to −0.10, <i>p</i> = .043). Children in the intervention group met their individual socio-emotional goal more frequently than children receiving usual care alone and this was statistically significant. No statistically significant differences were found in other secondary outcomes including anxiety, depression, general health or parental stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Social Stories™ represent a low-cost, low-burden intervention. Benefits are seen in individual socio-emotional goals but without clinically evident impact on social responsiveness, anxiety, depression, parental stress or general health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"4-12"},"PeriodicalIF":6.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debate: Where to next for universal school-based mental health interventions? Universal versus targeted school-based mental health interventions: a health economic perspective","authors":"Paul McCrone","doi":"10.1111/camh.12751","DOIUrl":"10.1111/camh.12751","url":null,"abstract":"<p>Mental health problems in schools are a concern and various initiatives have been developed to address these. Interventions can be universal (covering a whole school) or targeted (addressing those with specific needs). Any new intervention should be evaluated, and this should include an assessment of cost-effectiveness. Evidence to date suggests that while gains from universal schemes may be modest, they can still be cost-effective given the extent of their reach. However, targeted interventions can address key health inequalities which should also be an objective of an economic evaluation. Studies that have examined the longer term impact of both universal and targeted approaches have demonstrated that both can represent good values for money, and it is likely that a blended or tiered approach is appropriate.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"99-101"},"PeriodicalIF":6.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations in Practice: Brief behavioral parent training for children with impairing ADHD characteristics – a pilot study","authors":"Marijn Nijboer,&nbsp;Roos van Doornik,&nbsp;Annabeth P. Groenman,&nbsp;Saskia van der Oord,&nbsp;Rianne Hornstra,&nbsp;Barbara van den Hoofdakker,&nbsp;Tycho J. Dekkers","doi":"10.1111/camh.12743","DOIUrl":"10.1111/camh.12743","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Behavioral parent training (BPT) is a well-established intervention for children with attention-deficit/hyperactivity disorder (ADHD), but most programs are long, which may limit their accessibility. This could be improved by making programs shorter. Here, we studied (1) the feasibility of a new brief BPT program and its procedures, and (2) pre–post changes in daily rated problem behaviors (primary outcome), children's disruptive behaviors, ADHD/ODD characteristics, impairment, and parents' sense of parenting competence (secondary outcomes).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nonrandomized pilot study including parents of 28 children (4–12 years) with impaired ADHD characteristics. We examined treatment dropout, parent and therapist satisfaction, recruitment rates, study drop-out, measurement response and completion rates, acceptability of measurements according to parents, and treatment fidelity. Pre–post changes in the treatment group were compared to those in a historical control group using mixed model analysis, except for those outcomes that were not assessed in the control group. Within-group differences were analyzed for all outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Feasibility of the program and study procedures were good. Treatment dropout was 14.2%, parents and therapists were satisfied with the new program. We recruited 1.5 participants per month, study dropout was 10.7%, response/completion rates ranged from 82% to 100%, measurements were acceptable for parents, and treatment fidelity was 96%. We found substantial within-group changes (<i>d</i>'s = .68–.77) and medium-sized between-group changes (<i>d</i>'s = .46–.48) on daily rated problem behaviors. We observed no changes on most of the secondary outcomes, except for disruptive behaviors and impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our newly developed brief BPT program was feasible and we observed improvements in children's daily-rated problem behaviors. These results suggest that brief BPT might be beneficial for clinical practice if the findings are confirmed in large-scale randomized controlled trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"83-88"},"PeriodicalIF":6.8,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debate: Where to next for universal school-based mental health interventions? Time to move towards more effective alternatives","authors":"Jack L. Andrews,&nbsp;Lucy Foulkes","doi":"10.1111/camh.12753","DOIUrl":"10.1111/camh.12753","url":null,"abstract":"<p>There is an urgent need to improve mental health outcomes among young people. One approach taken to address this problem has been the design and delivery of universal school-based prevention, based on therapeutic models such as CBT and mindfulness. Such interventions are delivered to groups of young people, irrespective of risk or need. However, in this commentary, we argue that the initial appeal of universal interventions has not been supported by the evidence: universal school-based prevention is less effective than targeted approaches, often leads to null or unsustained positive effects, has the potential to elicit negative effects and is not well liked by young people themselves. In addition, many young people in each classroom already meet the criteria for a mental disorder, meaning that prevention approaches may not be appropriate or effective for this group. In this commentary, we respond to Birrell et al.'s (2025) paper by arguing that the field should move away from universal prevention and instead invest our limited resources in the refinement and dissemination of interventions with a stronger evidence base, such as one-to-one, targeted and indirect approaches.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"30 1","pages":"102-104"},"PeriodicalIF":6.8,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}