Both parent participation improves parenting program outcomes, yet fathers’ attendance remains low. This qualitative study examined how coparenting decision-making shapes attendance decisions. Twelve heterosexual couples with children aged 2–12 years completed joint, semi structured interviews responding to a vignette about a parenting program. We recorded the evolving “decision cascade” from initial preference to final decision and conducted reflexive thematic analysis. Two overarching themes emerged, Program Factors and Coparenting Factors, with subthemes including scheduling/workplace flexibility, delivery format and credibility, topic fit, and gendered role assumptions. Although all couples initially preferred to attend together, discussion of practical constraints and role expectations reliably shifted final decisions toward only one parent attending, most often the mother. Fathers’ full-time employment and inflexible work norms were commonly cited, and fathers frequently deferred to perceived maternal expertise, consistent with gatekeeping dynamics. Findings suggest that low father attendance reflects entrenched couple level decision patterns interacting with program design and extra family constraints, rather than fathers’ motivation alone. The decision-making processes had their origins in couples transition to parenthood era, which had become fairly entrenched over the course of their coparenting experience. Recruitment and intervention strategies that target coparenting processes, address workplace barriers, and optimize program credibility and fit may better support father participation and improve outcomes for families.

There is a lack of digital gatekeeper resources developed for parents to assist them in recognising and responding to mental health problems in their children and adolescents. We aimed to address this by exploring parents' mental health information needs, and to iteratively develop and design a resource incorporating their feedback. A three-phase iterative user-centred design process was conducted to (1) explore parents' information needs and preferences through a survey; (2) develop and revise resource content through interviews with parents; and (3) obtain feedback from parents regarding the resource prototype to improve it. An online survey of Australian parents (n = 631) confirmed that there was a demand for an online gatekeeper style resource that focused on anxiety, depression, self-harm and suicide in children and adolescents. Thematic analysis of 14 semi-structured interviews with parents applied three deductive themes and one inductively identified theme, which reinforced the resource content and led to the inclusion of additional topics (e.g. self-care) and the lived experience voice (e.g. stories and quotes). A prototype of the resource was developed and reviewed by nine parents and two State/Territory Education Department representatives. Overall, the resource was rated as suitable by the participants, although additional improvements were made to usability and content relevance. Given sampling limitations, it is important that the program is validated with a diverse sample of parents, to ensure it meets the needs of the broader population.

This longitudinal study explored the prevalence and cumulative incidence of pain among rural cancer survivors, assessed the prevalence of persistent pain over time, and identified sociodemographic, clinical, and psychological factors associated with worse outcomes. This study was a secondary analysis of data from the Travelling for Treatment study. Adult cancer survivors living in Queensland, Australia, who had travelled ≥ 50 kms for cancer treatment were included (N = 659). Pain outcomes (intensity, interference, frequency) were assessed at baseline, three months, 12 months, and annually for up to five years using the Adjusted Quality of Life 8-Dimension Tool (AQoL-8D). Sociodemographic, clinical, and psychological factors were assessed at baseline. Prevalence and cumulative incidence of pain, and the proportion of cancer survivors reporting persistent pain was calculated. Cumulative link mixed models and binary logistic regression explored factors associated with pain outcomes and likelihood of experiencing persistent pain. Across follow-up (median 3 years), 84

Digital mental health programs can expand access to psychological support for children and adolescents, especially where stigma, cost, and workforce shortages limit traditional care. Understanding which features young people and parents value most is essential for improving engagement and real-world uptake. We conducted a cross-sectional discrete choice experiment to quantify preferences for online youth mental health program features among adolescents and parents. Data were collected through an online survey of BRAVE Program families with prior experience using the BRAVE self-help anxiety program. Participants completed ten choice tasks comparing two program options varying by content format, effectiveness or professional contact, personalization, cost, and session frequency or additional supports. Preferences were analyzed using mixed multinomial logit models. Among 238 participants (80 parents; 158 adolescents), both groups preferred programs that were engaging, interactive, and personalized, and both were sensitive to program cost. Parents placed strong emphasis on effectiveness, with cost (36

The integration of digital mental health interventions (DMHIs) into mainstream mental health services can reduce access barriers for young people and enhance client outcomes. To support effective implementation of DMHIs into routine care, it is vital to understand the factors supporting their uptake. This study aimed to better understand how Australian mental health professionals currently use DMHIs in their personal and professional practice, and how they select effective, evidence-based interventions. An overview of a proposed DMHI platform for children and adolescents was disseminated to mental health professionals from hospital, community, education and crisis support hotline settings. Participants (n=87) then completed a mixed methods survey, exploring relevant domains of the Consolidated Framework for Implementation Research. Quantitative data (electronic-therapy attitudes and process questionnaire, bespoke items) were summarised descriptively and compared between organisation types. Open-ended questions were examined via qualitative content analysis. Survey results indicate strong support for DMHIs; 78% of participants incorporated DMHIs into clinical practice, and 86% had recommended DMHIs to friends, family and colleagues. Common reasons for recommending DMHIs to clients were utility for monitoring symptoms, providing support, and offering another source of information. When selecting DMHIs, the minority of participants independently sought out research evidence. More often, participants relied on endorsements from their workplace and trusted third parties, the source of the intervention, or self-assessment of intervention quality. Assessing client and family needs, preferences and feedback was the most common strategy for determining if interventions were effective for young people. While DMHIs are commonly used and recommended by mental health professionals, there is variation in how practitioners assess and select appropriate and effective interventions. Findings highlight the importance of strategically communicating evidence of intervention efficacy. Disseminating evidence via commonly accessed platforms may support improved evidence-informed decision making when selecting DMHIs in clinical practice.

ABSTRACT Background and Aim Environmental pollutants, including contaminated air, harmful chemicals, and excessive noise, are increasingly prevalent in modern society. These contaminants can significantly affect mental well‐being, a fundamental determinant of cognitive functioning, emotional regulation, interpersonal relationships, life satisfaction, and overall physical health. Methods This systematic review examines the effects of various types of pollution, such as air pollution, noise pollution, and chemical contaminants, as well as their interactions, on mental health outcomes across diverse populations. Results Our search identified 61 high‐quality studies that met our inclusion criteria. Among quantitative studies, 81% (n = 49) reported a significant association between pollution and mental health outcomes. Air pollution was the most frequently studied factor, with 50% confirming an association. In contrast, chemical pollution showed the lowest positive associations, with only 10% reporting an association. Our analysis reveals critical limitations in current research, particularly regarding data availability and quality, with most mental health data sets being limited in temporal scope and geographical coverage. While we discuss Artificial Intelligence as a prospective methodological framework to improve the precision and efficiency of future studies, we emphasize that its effective implementation fundamentally depends on addressing underlying data limitations. Specifically, spatiotemporal models can address exposure misclassification, attention mechanisms can handle confounding complexity, and deep learning can manage temporal variability, but all require systematic improvements in data collection infrastructure. Conclusion This review highlights the urgent need for standardized mental health monitoring systems, interdisciplinary collaboration, and the development of comprehensive data collection frameworks as essential prerequisites for leveraging advanced analytical methods in understanding pollution–mental health relationships.

Self-directed digital mental health services can increase access to evidence-based interventions for child anxiety. However, there has been little comprehensive investigation of real-world dissemination especially utilizing implementation science approaches. To describe and comprehensively assess implementation of the BRAVE Self-Help program for child and adolescent anxiety in Australia over a 10-year period, including implementation strategies during establishment and sustainability phases and implementation-effectiveness outcomes. This study was a large, open implementation-effectiveness trial with Australian child and adolescent participants of the BRAVE Self-Help Program, collected between January 1, 2015, and December 31, 2024. Implementation strategies were reported descriptively across program establishment and sustainability phases. Implementation and effectiveness outcomes were reported across 10 years, in line with the Implementation Outcomes Framework (IOF) and taxonomy of implementation outcomes for digital interventions. Metrics include Adoption, Penetration, Appropriateness, Fidelity, Feasibility, Acceptability and Effectiveness. Examples of implementation strategies included targeted promotion and education strategies across academic, professional and community settings, a focus on geographical areas with low service accessibility, provision of easy-to-access resources and support for common challenges, targeting education contexts, and continuous data-driven and user-informed improvement. Over the 10-year period, the BRAVE Self-Help program had 53,726 users, including 28,700 children (mean 9.36, SD 1.40 years) and 25,026 adolescents (mean 14.15, SD 1.62 years). Data revealed a wide variety of user characteristics in terms of age, gender, geographical location, baseline severity, and referral sources (community, health and education settings). Improvement in anxiety symptoms from first to last interaction with the program was observed for participants in general, particularly among those with elevated anxiety at program registration (P <.001, Cohen d=0.54). Of all users completing the registration assessment, 38.72% (20,026/51,721) completed 3 or more of the 10 sessions, with consistent moderate to high satisfaction rates across all sessions. This study demonstrated that a self-help digital program for child and adolescent anxiety can be successfully disseminated nationally, and that it is feasible, acceptable and effective for many young people. During a span of 10 years, the BRAVE Self-Help program for child and adolescent anxiety offered evidence-based support to more than 50,000 families. Notably, although progress through sessions was low for some young people, significant improvements can be made in as few as three sessions, and decisions to stop treatment may occur for many reasons, including treatment success.

Digital mental health interventions (DMHIs) offer a promising means of extending care for children and adolescents, yet their integration into routine clinical services remains inconsistent. Understanding implementation from the perspective of mental health professionals (MHPs) is critical to bridging the gap between efficacy and real-world uptake. This study examined the perspectives of MHPs working with children and young people to identify key implementation considerations for the development and adoption of DMHIs. Nineteen focus groups were conducted with 50 mental health clinicians (including psychologists, social workers, and counsellors) from a range of service settings between May 2020 and May 2021. Data were analyzed using a mixed deductive-inductive thematic approach informed by the interview domains. MHPs were cautiously optimistic about DMHIs, viewing them as most valuable when implemented as supplementary rather than replacement tools. Key perceived uses included waitlist support, screening and assessment, between-session engagement, and flexible treatment pathways. However, MHPs consistently emphasized the need to preserve clinical judgement and oversight across all stages of DMHI use. Risk management, duty of care, and privacy and confidentiality were identified as critical prerequisites for implementation. Successful DMHI implementation in child and adolescent mental health services requires flexible, clinician-centered integration approaches, robust risk management protocols, and clear organizational frameworks delineating clinician responsibility. These findings have direct implications for the implementation planning, rollout, and governance of DMHIs in youth mental health settings.

Up to 40% of all cancers diagnosed could be prevented through the uptake of healthy lifestyle behaviours. This paper describes the co-design of a novel community-centric digital programme for cancer prevention and early detection support. Twenty-two community panel members partook in a series (i.e., three group-based sessions followed by one individual session) of iterative online workshops to co-design the programme. Based on established Design Thinking principles, the workshops aimed to i) identify barriers to access and use of existing cancer prevention information and support, ii) explore consumers' needs and preferences for information and support related to cancer risk reduction and early detection, iii) generate ideas for a digital solution to address those, and iv) seek panel members' feedback on a digital prototype developed in line with the insights from previous stages. The key barriers to accessing cancer prevention and screening support identified by the panel included limited availability and knowledge of cancer-specific resources alongside a paradoxical information overload regarding generic options. Panel members expressed concerns about information accuracy and relevance, while time constraints, financial limitations, and motivation deficits further impeded resource engagement. Regarding prototype preferences, participants prioritised accessibility, diversity, communication and connectedness, usability, and personal relevance as essential design elements. Digital solutions for cancer prevention and screening support should offer a customised experience, while catering for varying practical constraints and motivational challenges.

Outside school hours care (OSHC) services for primary school aged children are the fastest growing child care services in Australia and yet these educators are rarely considered in academic literature. These educators can spend more time with children than classroom teachers and therefore, considering growing mental health problems in childhood, it is vital they can recognise and support mental health difficulties when and if they arise. Considering the lack of prior research in this population, a multi method case study methodology was employed to measure three constructs in which a vignette describing an OSHC setting with a child displaying clinical symptoms of a mental health difficulty was followed by open ended and Likert scale questions. The vignette measured educator capability 1) to identify, and 2) support mental health difficulties, as well as their 3) self-efficacy in relation to the above. The results show many educators were unable to identify the specific mental health difficulty or provide targeted support strategies; however, they did recognise signs of distress and offered caring strategies to support the child. Positive findings regarding educator self-efficacy indicate educators are willing to overcome mental health capability gaps to learn new skills to support children in their care with mental health difficulties.

Background Self-guided internet-delivered cognitive behavioral therapy (ICBT) achieves greater reach than ICBT delivered with therapist guidance, but demonstrates poorer engagement and fewer clinical benefits. Alternative models of care are required that promote engagement and are effective, accessible, and scalable. Objective This randomized trial evaluated whether a stepped care approach to ICBT using therapist guidance via videoconferencing for the step-up component (ICBT-SC[VC]) is noninferior to ICBT with full therapist delivery by videoconferencing (ICBT-TG[VC]) for child and adolescent anxiety. Methods Participants included 137 Australian children and adolescents aged 7 to 17 years (male: n=61, 44.5%) with a primary anxiety disorder who were recruited from participants presenting to the BRAVE Online website. This noninferiority randomized trial compared ICBT-SC[VC] to an ICBT-TG[VC] program, with assessments conducted at baseline, 12 weeks, and 9 months after treatment commencement. All ICBT-TG[VC] participants received therapist guidance (videoconferencing) after each session for all 10 sessions. All ICBT-SC[VC] participants completed the first 5 sessions online without therapist guidance. If they demonstrated response to treatment after 5 sessions (defined as reductions in anxiety symptoms to the nonclinical range), they continued sessions without therapist guidance. If they did not respond, participants were stepped up to receive supplemental therapist guidance (videoconferencing) for the remaining sessions. The measures included a clinical diagnostic interview (Anxiety Disorders Interview Schedule) with clinician-rated severity rating as the primary outcome and parent- and child-reported web-based surveys assessing anxiety and anxiety-related interference (secondary outcomes). Results Although there were no substantial differences between the treatment conditions on primary and most secondary outcome measures, the noninferiority of ICBT-SC[VC] compared to ICBT-TG[VC] could not be determined. Significant clinical benefits were evident for participants in both treatments, although this was significantly higher for the ICBT-TG[VC] participants. Of the 89 participants (38 in ICBT-SC[VC] and 51 in ICBT-TG[VC]) who remained in the study, 26 (68%) in ICBT-SC[VC] and 45 (88%) in ICBT-TG[VC] were free of their primary anxiety diagnosis by the 9-month follow-up. For the intention-to-treat sample (N=137), 41% (27/66) ICBT-SC[VC], and 69% (49/71) ICBT-TG[VC] participants were free of their primary anxiety diagnosis. Therapy compliance was lower for the ICBT-SC[VC] participants (mean 7.39, SD 3.44 sessions) than for the ICBT-TG[VC] participants (mean 8.73, SD 3.08 sessions), although treatment satisfaction was moderate to high in both conditions. Conclusions This study provided further support for the benefits of low-intensity ICBT for children and adolescents with a primary anxiety disorder and highlighted the excellent treatment outcomes that can be achieved through therapist-guided ICBT delivered via videoconferencing. Although noninferiority of the stepped care adaptive approach could not be determined, it was acceptable to families, produced good outcomes, and could assist in increasing access to evidence-based care. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001418268; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001418268

Background:Digital mental health (dMH) interventions offer the ability to reach many more adolescents with anxiety than face-to-face therapy. While efficacious dMH interventions are available for adolescents, premature dropout and low engagement are common, especially if delivered on a self-help basis without any form of therapist guidance. This is concerning, given that higher engagement, in terms of the number of sessions completed, has been repeatedly associated with improved clinical outcomes. The reasons for poor adolescent engagement in dMH programs are unclear. A clear understanding of when and why disengagement occurs is important in order to seek to improve engagement rates. Contemporary models consider engagement as multifaceted, comprising both "use" (eg, amount of content completed, frequency of use, duration spent logged into the dMH program, and depth of use, such as word or character count) and "user experience" (eg, interest and satisfaction in the program and affect and attention whilst engaging in the program). Objective:This study investigated the role of demographic and early engagement (EE) factors, specifically program use, in predicting overall program engagement and continued engagement, respectively, in a self-directed, internet-based cognitive behavioral therapy program for adolescent anxiety, namely, BRAVE Self-Help. It examined multiple measures of program use, including task completion, homework completion, and depth of response (character count of responses typed into program tasks). It also examined the moderating role of baseline anxiety severity. Methods:Data collected between July 2014 and May 2020 from 2850 adolescents aged 12 to 18 years who participated in BRAVE Self-Help were analyzed via a series of moderated regressions. Results:Results showed that EE (in terms of program use) was associated with continued engagement, demonstrated by early tasks (tasks completed in the first two sessions; R2=0.035; P<.001) and early depth (characters written in the first two sessions; R2=0.08; P<.001) predicting continued depth of program response (total character count of responses typed into all program tasks from sessions 3 to 10). Demographic factors and anxiety severity did not directly impact adolescents' engagement in BRAVE Self-Help. Conclusions:These findings highlight the need to investigate ways to (1) enhance EE and (2) better understand how to measure and capture all aspects of program engagement.

Objective:Emerging evidence suggests a negative impact of COVID-19 on children's mental health. The aims of this study were to examine trajectories of mental health in children younger than 6 years as well as risk and protective factors during the first year of the pandemic. Method:In a prospective, longitudinal online study, data were collected on N = 837 children aged 1 to 5 years in Australia between May and July 2020 and after 3, 6 and 12 months, with n = 257 participating at all 4 timepoints. Individual trajectories ofanxiety, anger/irritability, depressive symptoms and sleep disturbance were analysed using latent growth mixture modelling. Results:The results showed that 1 in 4 children experienced moderate to severe symptoms in each problem domain. The overall means for depressive symptoms, anger/irritability, and sleep disturbance decreased while anxiety increased over time. For most outcomes, two individual trajectories were identified: moderate/high-decreasing (26-29%) andlow-increasing. Important predictors were negative COVID-19 related impact on daily life, caregiver distress, lower child positive affect and self-regulation. Conclusions:The current results highlight that the pandemic indirectly affected young children's mental health, especially in the presence of risk factors such as caregiver distress and poor child self-regulation skills.

Introduction Universal digital mental health interventions (DMHIs) are emerging as a viable approach to promoting mental health among children and adolescents in general population. However, there is a scarcity of meta-analyses that examined their short- and long-term effects or potential moderators in individuals aged 19 or younger. Methods A systematic search was conducted to identify randomised controlled trials that delivered universal DMHIs for promoting mental health, targeting children and adolescents aged 19 or younger in general population. Meta-analysis was performed to identify studies using Comprehensive Meta-Analysis. Results The meta-analysis of 29 included studies identified significant overall effects ( g = 0.16) as well as significant effects for anxiety ( g = 0.09), depression ( g = 0.06), psychological distress ( g = 0.28), externalising problem ( g = 0.21), psychological well-being ( g = 0.19), interpersonal functioning ( g = 0.21) and social-emotional skills ( g = 0.19) at post-intervention. The analysis of 7 studies that followed up 6 months or longer revealed a significant overall effect ( g = 0.09) as well as significant effects for anxiety ( g = 0.11) and depression ( g = 0.05) at follow-up. Age and intervention duration moderated the overall effects. Gamification moderated the effect on depression. Attrition rate moderated the effect on social-emotional skills. Conclusions Providing universal DMHIs with longer durations to younger children may be critical for effectively improving a range of mental health outcomes among children and adolescents. To promote engagement and effectiveness, future studies may explore how gamification and other features for reducing attrition could be effectively incorporated into DMHIs.

During the most recent global crisis due to COVID-19 pandemic, mental health researchers globally were tasked with carrying out high-quality and responsive research to understand the changes and long-term trajectories in young people’s mental health symptoms. Comparative international longitudinal research has been recommended as a particularly promising avenue to understand pandemic impacts and facilitate global solutions. The Co-SPACE International Consortium comprises researchers from 14 sites who aimed to compare findings on the impact of the pandemic on young people and family mental health. This paper describes the process and challenges associated with the Consortium’s efforts to combine country-level data to produce global insights for research and clinical practice for the past three years. Several key challenges were identified, particularly about the conduct of international comparative research. These challenges concerned funding, ethics review, data sharing, variations in cultural and local contexts, lack of cross-culturally comparable or meaningful measures, research design, and dissemination. After considering these challenges, we provide a range of recommendations that provide a blueprint for the gathering of timely and robust evidence, the identification of global trends, the mobilisation of resources, and effective support to children and families in public health crises.

BACKGROUND:Self-Help Internet Cognitive Behavioural Therapy (iCBT) interventions are highly efficacious and overcome numerous barriers adolescents experience when accessing face-to-face interventions, including stigma, privacy, lengthy wait lists and cost. Despite this, adolescents struggle to engage in Self-Help iCBT, which is problematic given that there is a relationship between higher engagement and better treatment outcomes. The reasons for poor engagement among adolescents are unclear. Using the iCBT program, BRAVE Self-Help as an example, this study explored (1) the barriers to engagement directly from the adolescent's perspective and, (2) their viewpoints on enhancing engagement in iCBT. METHODS:Semi-structured interviews were conducted with 14 adolescents aged 12-17 years (M = 14.36, SD = 2.12) who had participated in BRAVE Self-Help in the previous 12 months. Reflexive thematic analysis was utilised to analyse data. RESULTS:Stigma, program factors (program design, content and length) and environmental factors (competing priorities and distractions), were identified as adolescent barriers to engagement. With respect to strategies to enhance engagement, adolescents identified (1) specific program factors (positive reinforcement and personalisation), and (2) support factors (reminders and optional support). CONCLUSIONS:Codesign methods with adolescents at both the design and implementation stages of iCBT programs is imperative for engagement.

To examine the prevalence and characteristics of cancer patients in Australia who experienced a delay in starting treatment, according to best practice standards in the Optimal Care Pathways (OCPs). A cross-sectional analysis was conducted with 640 adults who accessed Cancer Council Queensland subsidised accommodation while receiving cancer care in a major city. Treatment delay was defined as a diagnosis-to-treatment interval exceeding OCP recommendations. The median time from diagnosis to treatment was 4.4 weeks (interquartile range: 2.1–8.9 weeks). Of the 494 participants whose data were assessable against OCPs, 199 (40

Growing recognition of the high prevalence of childhood adversity and maltreatment in the general population has led to efforts to support students through trauma-informed practice (TIP). This study investigated the use of coaching in effectively implementing trauma-informed programs in schools. A psychologist and a program "champion" (learning engagement coordinator) provided individual teachers coaching on student socio-emotional and behavioral concerns. Semi-structured interviews were conducted with 26 teachers at an Australian primary school implementing the Trauma-informed Behavior Support (TIBS) program. Reflexive thematic analysis was employed to ascertain coaching acceptability, feasibility, and impact themes. Findings suggested that the alignment of coaching with preceding trauma-informed training and teacher values generated positive expectancies and engagement amongst educators. Provision of reflective practice from coaching also met teacher learning needs. Teachers reported feeling validated and understood by the coach, benefiting from collaborative problem-solving and tailored solutions. Additionally, the program champion's facilitative role through advocacy and logistical support was vital to feasible implementation. This study highlights the critical delivery of coaching within a tiered TIP program, aiding the transfer of pedagogy into classrooms. It extends previous literature, affirming coaching as a feasible and acceptable implementation strategy, supporting educators to manage complex student needs.