Occupational therapy as a mental health promotion intervention for children in schools Ema Tokolahi, Prof. Clare Hocking, Prof. Paula Kersten, A. Prof. Alain Vandal Auckland University of Technology
Kia Piki te Hauora: Uplifting our Health and Wellbeing Development followed a four-step process: 1. Review theory 2. Review evidence 3. Incorporate expert opinion 4. Trial Tokolahi, E., Hocking, C., & Kersten, P. (2016). Development and content of a school-based occupational therapy intervention for promoting emotional wellbeing in children. Occupational Therapy in Mental Health (Accepted in press).
Kia Piki te Hauora: Theory Key time for targeting preventative interventions (Dadds et al, 1997, Horowitz et al, 2007), before self-esteem becomes more stable (Trzesniewski et al, 2003). Engagement in balance of occupations vital for optimal development, health and wellbeing (Bazyk & Basyk, 2009). Well Elderly Program described as Lifestyle Redesign developmental focus of children is Lifestyle Design (Mandel et al, 1999). Children lack knowledge or skills to determine the healthpromoting consequences of everyday activities (Jackson et al, 1998).
Kia Piki te Hauora: Evidence Key principles: Targeted more effective than universal Developing skills and competence is central Combination of behavioural and didactic strategies most effective Specialist clinical staff develop and disseminate initially, school staff must take-over for intervention to become sustainable and embedded Evidence supports short-term interventions (8-10 weeks) Better outcomes achieved if based on theory and evidence, have an explicit outcome and are manualised.
Kia Piki te Hauora: Content Introduction Sleep and rest occupations Active occupations Communication in occupations Disrupted occupations Coping occupations Values and identity occupations Celebration and close
Aims Is Kia Piki te Hauora effective in reducing (child-, parent- and teacherrated) symptoms of anxiety and depression and improving self-esteem and participation in children aged 10-13 years? Is Kia Piki te Hauora not inferior at follow-up of 8-9 weeks?
Study design Pragmatic, two-arm study intervention & waitlist control Cluster RCT randomised by school Cluster sizes ranged between 8-12 children/school who volunteered or were teacher nominated Blinding of participants until baseline measures only Blinding of outcome assessors Repeated measures baseline, [post waitlist, pre-intervention], post-intervention and follow-up Parallel and crossover designs
Study flow
Outcomes Anxiety (MASC10=Multidimensional Anxiety Scale for Children Short form; RCADS=Revised Children s Anxiety and Depression, parent form, SAS=School Anxiety Scale) Depression (CDI2=Children s Depression Inventory (2nd Ed), RCADS=Revised Children s Anxiety and Depression, parent form) Self-esteem (RSES=Rosenberg Self-Esteem Scale; SISES=Single Item Self-Esteem Scale) Participation (COPM=Canadian Occupational Performance Measure, child and parent rated, menu-driven) Wellbeing (SLSS=Student Life Satisfaction Scale)
Cluster RCTs
Cluster RCTs
Participants Intervention 69 children 31; 38 12.1 years old 142 children 77; 65 12.1 years old Control 73 children 47; 26 12.1 years old
Participants 60 40 20 Control Intervention 0 Maori Pakeha Pacific Island Asian Other Intervention 69 children 31; 38 12.1 years old 142 children 77; 65 12.1 years old Control 73 children 47; 26 12.1 years old
Findings Hypothesis There will be a difference in outcomes at postintervention between the intervention and control groups Child-rated p=0.038 Child-rated p=0.001 COPM Performance COPM Satisfaction Teacher-rated Overall anxiety p=0.001 Generalised anxiety p=0.039 Social anxiety p=0.008 Parent-rated p=0.029
Findings Hypothesis outcomes at follow-up will be not be inferior than at post-intervention All outcomes measuring anxiety and depression
Australia/New Zealand Clinical Trials Register: ACTRN12614000453684 Thanks for the support and funding from these organisations Thanks to my supervisors: Professor Clare Hocking, Professor Paula Kersten, Associate Professor Alain Vandal For any questions or information please email me at: ematokolahi@gmail.com