I'm not a diagnosis: Adolescents' perspectives on user participation and shared decision-making in mental healthcare

Examining the Feasibility and Acceptability of Identifying Signs of Social Anxiety, in University Students Aged 18-25, While Watching 360° Immersive Films

Timely, accurate assessment and treatment for social anxiety disorder (SAD) in young people is crucial. There is potential for the adoption of tailored virtual reality interventions for a complementary diagnostic tool using heart rate monitoring as a response indicator. This study examined the feasibility and acceptability of this concept by exposing healthy individuals, aged 18-25, to developed 360° immersive films while collecting heart rate sensor data. Two immersive scenarios were designed with a participatory advisory youth group. A clinical consultant nurse mapped scenario events against validated routine assessment subscales in child and adolescent services. The films were shown to seven participants through a VR headset while monitoring heart rate. They provided qualitative feedback on their quality, acceptability and usability. The study indicated that this approach has the potential to enhance assessments in child and adolescent mental health services. The study has several limitations which are discussed with recommendations for consideration if this concept is taken further. The intervention could act as a potential portable, user-friendly complementary diagnostic tool for clinicians in practice. However, further research is needed to examine its validity.

Building up bit by bit, parent's experiences of equine-assisted intervention among children and adolescents with mental illness: a grounded theory study

BACKGROUND

Mental ill health among children and adolescents has increased worldwide. Mental health difficulties from a young age are associated with school absence and educational underachievement. A holistic perspective of treatments besides medical treatment is essential Thus, there is a need for research regarding equine-assisted intervention (EAI).

PURPOSE

The present study aimed to understand the outcomes of an equine-assisted intervention for children and adolescents with mental ill health from the perspectives of parents and close relatives.

METHODS

This study used a qualitative research design informed by Charmaz's Grounded Theory, with a purposive sample including six in-depth interviews.

RESULTS

The theory "building up bit by bit" was constructed, explaining the recognition that their children/adolescents were built up bit by bit and created a stronger self-identity. The participants referred to changes in the child's or adolescent's way of being and emotional regulation, which constituted building blocks leading to the child's or adolescent's 1. increased Harmony. 2. enhanced Self-identity, and 3. improved Capability.

CONCLUSION

Parents and close relatives experienced that their child or adolescent was built up bit by bit and gained a stronger foundation to stand on. This led to increased harmony in everyday life with stronger self-worth, better performance, and reduced school absenteeism.

Adolescents' involvement in mental health treatment and service design: a systematic review

BACKGROUND

Adolescents' involvement in their mental healthcare is considered a fundamental human right. However, there is a lack of consensus regarding the extent and nature of user involvement and limited research on user involvement in adolescent mental healthcare has previously been identified. Given the evolving focus on this area, this study explores the experiences with, the effectiveness of, and safety issues related to adolescents' user involvement in mental healthcare.

METHOD

We conducted a systematic review, updating our original review with current research evidence relating to adolescents' involvement in mental healthcare at individual and organizational levels. Searches across six databases, screening of reference lists, and suggestions from experts within the field helped to identify 5,527 records, of which 251 full text articles were screened. Established guidelines were used for data extraction, critical appraisal, and reporting of results.

RESULTS

Collectively, the literature searches resulted in 36 eligible studies, of which 28 provided qualitative data and eight provided quantitative data. The quantitative studies identified the importance of personal help and online tools to support adolescents' involvement in their mental healthcare. A few qualitative studies suggested shared decision-making is associated with improved self-reported mental health and treatment satisfaction. No studies focused on safety issues. A thematic synthesis of qualitative studies yielded four themes at the individual level and two themes at the organizational level. The findings highlight the growing recognition of adolescents' right to be involved and their capacity to take part in decision-making, emphasizing shared decision-making, two-way communication, and trust as key components of a collaborative relationship fundamental to user involvement. Further facilitators for user involvement at both individual and organizational levels are described.

CONCLUSION

The significance of user involvement in adolescent mental healthcare is underscored by a sense of increased empowerment and services tailored to meet adolescents' needs. The evidence gathered from qualitative studies suggests involving adolescents in their treatment contributed to greater motivation for treatment, higher attendance rates, and treatment continuation. User involvement should emphasize adolescents' preferences and a collaborative relationship that incorporates shared decision-making. Further implications for future practice and research are discussed.

Could be better: adolescent access to health information and care

Many adolescents must overcome a broad range of barriers to access health information and care and are consequently reluctant to pursue assistance for their health concerns. In this review, we examine from whom and how adolescents seek help (for example, by consulting with friends and family members and by searching for health information using online platforms) and how adolescents treat symptoms without consulting with a clinician by engaging in self-medication. Next, we suggest ways to help adolescents receive accurate health information and access to healthcare through school-based health education programs and health centers. We also discuss how to improve the experience of care for adolescents by collaboratively engaging young patients with their physicians and caregivers using shared decision-making. Finally, we propose developing and posting accurate and engaging multilingual materials on popular online platforms to improve adolescent access to accurate health information and knowledge of how to engage with the healthcare system.

CONCLUSION

The purpose of this review is to examine how adolescents seek, and propose ways to help adolescents access, health information and care despite the many barriers they face.

WHAT IS KNOWN

• Adolescents encounter a broad range of barriers to access health information and care and turn to family members and friends, and search online, for health information. In addition, adolescents benefit from school-based health education programs and health centers that reduce barriers to healthcare access.

WHAT IS NEW

• Adolescents engage in self-medication, including with cannabis use, to treat self-diagnosed illness or symptoms in a potentially harmful manner. • While many adolescents distrust health information shared on social media, recent evidence suggests adolescents are receptive to, and will change some beliefs, in response to health information posted on social media platforms.

Shared decision-making in adolescent healthcare: a literature review of ethical considerations

PURPOSE

Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare.

METHODS

We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012).

RESULTS

We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition.

CONCLUSIONS

Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation.

WHAT IS KNOWN

• Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.

Development of a digital mental health intervention for youth with ADHD: exploring youth perspectives on wants, needs, and barriers

Background

Attention deficit hyperactivity disorder (ADHD) is a mental health disorder affecting five to eight percent of children and youth worldwide. Inattention, impulsivity, and hyperactivity are core symptoms, which often leads to comorbid disorders and impairments. Increased prevalence of ADHD among youth requires development of accessible and scalable interventions. Digital interventions for ADHD show promising results for adults, yet insight into youths perspectives and needs from digital ADHD interventions is lacking. This study is set in a person-based approach and explore what youths want and need from a therapist-guided digital intervention for ADHD.

Methods

Exploratory individual interviews were conducted with youths aged 13-16 years diagnosed with ADHD (N = 16). Participants with an ADHD diagnosis were recruited primarily via social media. The interview guide was based on research, treatment guidelines, and clinical expertise. The study applied reflexive thematic analysis, within a Big Q framework. Codes and themes were generated in Nvivo.

Results

Four main themes and sub-themes were generated: (1) Tailoring the intervention to youths with ADHD (Push the right buttons; Stumbling blocks), (2) Managing ADHD (Planning and Focus; Regulation and Balance; Social interactions), (3) Me and my ADHD (Insight and Understanding; Accept and Normalization), and (4) Balance between support and independence.

Discussion

The findings suggest that youths with ADHD prefer stimulating and interactive treatment and are aversive to overwhelming, passive content. The intervention and therapist should encourage empowerment by supporting the youths autonomy in managing their ADHD. Future research is needed to investigate feasibility for person-based approaches to digital mental health treatments. Furthermore, parent perspectives on digital treatment for youths with ADHD should be investigated.

Factors that support children and young people to express their views and to have them heard in healthcare: An inductive qualitative content analysis

Despite development of healthcare charters supporting Article 12 of The United Nations Convention on the Rights of the Child, children and young people remain largely silenced in discussions about their healthcare. This article is based on the premise that children and young people should be able to exercise their right to express their views and be heard in all matters that affect their lives. This study examined children's and young people's experiences of expressing their views and having them heard in an Australian healthcare context. Using child-centred inquiry and 'draw, write, and tell' methods, data were collected from 20 children and young people. Five factors that supported children and young people to express their views and have their views heard were identified: time, relationships with health professionals, communication, teamwork, and family support. By paying attention to these factors, clinicians and others in health settings can better facilitate child-centred practices and support children and young people to express their views and have those views heard.

Children's and young people's experiences of expressing their views and having them heard in health care: A deductive qualitative content analysis

AIM

To gain an understanding of children's experiences of expressing their views and having them heard in Australian healthcare settings.

DESIGN

Child-centred qualitative research. A deductive qualitative content analysis was undertaken.

METHODS

Data were collected from 20 Australian children and young people between the ages of 7 and 18 years old using the 'draw, write and tell' method.

RESULTS

Children's experiences of 'space' and 'voice', and therefore the opportunity to express their views in health care were, in the main, positive. At the same time, their experiences of 'audience' and 'influence', the situations in which those views are given due weight, were overwhelmingly described as negative.

CONCLUSION

Australian paediatric health services appear to have responded to calls to provide children with the opportunity to express their views and thus are delivering on the elements of 'space' and 'voice', whereas the realisation of 'audience' and 'influence' has some way to go. Due weight is not always given to children's views.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The Lundy model can be used to facilitate a better understanding of the concept of voice, and the responsibility of health organisations in implementing the rights of children and young people, as articulated in Article 12.

IMPACT

Children and young people have a right to express their views and have them heard in health care, but their experiences in Australian health care are unknown. While children's experiences of expressing their views in health care were mostly positive, their views are not always taken seriously or given due weight. This research impacts child health professionals in Australia and internationally.

REPORTING METHOD

The study is reported using the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

Members of the Youth Advisory Council of two tertiary children's hospitals were consulted and invited to become members of the research team.

Children and youth's perceptions of mental health-a scoping review of qualitative studies

BACKGROUND

Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10-25) perceive and conceptualize mental health.

METHODS

We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

RESULTS

As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

CONCLUSION

We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

Implementing Article 12 of the United Nations Convention on the Rights of the Child in health care: a scoping review

Purpose

The purpose of this paper is to present the results of a scoping review on the implementation of Article12 in health care. The scoping review will provide a summary and overview of the key concepts and published literature on this topic internationally. Article 12 of the United Nations Convention on the Rights of the Child (1989) states that children have a right to express their views, to have them heard and for their views to be given due weight in all matters that affect them. Despite increased calls for Article 12 to be given attention in health care, there is little evidence to suggest this has been well implemented and embedded in Australian health-care delivery. The scoping review was undertaken to provide a summary and overview of the key concepts and published literature on this topic internationally.

Design/methodology/approach

A five-step methodological framework described by Arksey and O’Malley (2005) was used to undertake the scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used as a guideline for undertaking the study selection.

Findings

Children are still not routinely involved in health-care decision-making, are frequently left out of service planning and evaluation and the perception that they lack the capability to make rational decisions persists.

Originality/value

While there has been a focus on research that investigates children’s participation in health-care decision-making in recent years, there is little that directs attention specifically to the implementation of Article 12, particularly in Australian health care. Recommendations are made for further research in these areas.

Experiences of an Equine-Assisted Therapy Intervention among Children and Adolescents with Mental Illness in Sweden - A Nursing Perspective

Mental illness among children and adolescents is increasing globally, and prescription of psychiatric drugs for children and adolescents with mental illness is increasing worldwide, including Sweden. Holistic health-promoting interventions have shown promising long-lasting significant health benefits in young individuals with mental illness, but holistic health-promoting mental health interventions are often disregarded due to a lack of systematic theory-based knowledge. Consequently, the lack of scientific knowledge thwarts implementation of equine-assisted therapy as an established intervention in mental health nursing for children and adolescents with mental illness. The purpose of the study was to better understand experiences of equine-assisted therapy among children and adolescents with mental illness. The study adopted an inductive approach and data was collected using photovoice methodology. Six young persons, 7-18 years of age, referred by a psychologist to the equine-assisted intervention due to mental health issues, were included in the study. Data was analyzed using qualitative content analysis. The results could be summarized by an overarching theme, a physical, emotional, and social milieu for growth, consisting of three subcategories: feeling relief from everyday stress and anxiety; nurturing self-esteem in a mutual friendship; and strengthening self-reliance through synchronized interplay. The results indicate that equine-assisted therapy has essential values closely related to the goals of mental health nursing. Further research should strive to attain even gender distribution in study samples and focus on how equine-assisted therapy could be thoroughly integrated into established nursing intervention for children and adolescents with mental illness.

Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study

This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.

Parents' perspectives on user participation and shared decision-making in adolescents' inpatient mental healthcare

Background

Parents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision‐making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision‐making and delivery of high‐quality healthcare services.

Objective

The aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision‐making processes.

Design

This was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed.

Setting and Participants

This study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated.

Results

Four themes were identified: (1) self‐determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination.

Conclusion

User participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision‐making process. However, user participation and shared decision‐making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family‐oriented services to utilize the potential of parents as a resource and minimize conflicting interests.

Patient or Public Contribution

Two adolescent user representatives participated in designing the study.