The intervention, known as Supporting Adolescents with Self-Harm, or SASH, was evaluated in a multicentre randomised controlled trial across three NHS mental health trusts and nine Emergency Departments in London. It comprises three components: Therapeutic Assessment, in which practitioner and young person collaboratively build a personalised formulation of the self-harm; Enhanced Safety Planning, which co-constructs an individualised safety plan using the young person’s own words and preferences; and Solution-Focused Brief Therapy follow-up sessions that help the young person identify their preferred future, recognise existing strengths and take small, achievable steps towards change. Up to six sessions can involve parents or carers, either jointly with the young person or in individual sessions.

The new study forms part of the qualitative process evaluation of the SASH trial. Researchers conducted semi-structured interviews with 15 practitioners who delivered the intervention and four senior staff members, analysing the transcripts thematically. The practitioners came from varied professional backgrounds, including mental health nurses, social workers, psychiatrists, assistant psychologists, an occupational therapist and a support worker, and each had delivered SASH to between one and seven young people. From 549 line-by-line codes, the analysis distilled six overarching themes that together map how a brief intervention can reshape crisis care.

The first theme was a transformation in practice. Practitioners described SASH as bridging the gap in crisis care, the period in which young people are typically discharged to their GP or placed on a lengthy waiting list for community Child and Adolescent Mental Health Services. Median wait times for CAMHS treatment run to eight months, with some young people waiting over a year, and evidence shows that mental health problems often worsen while young people wait. By offering immediate therapeutic intervention and continuity over multiple sessions, SASH meant young people did not have to repeat their story to a new practitioner, and clinicians had time to build rapport and work with the system around the young person, including carers, schools and sometimes social services.

The second theme centred on patient-centred care that builds shared understanding. Practitioners emphasised how the Therapeutic Assessment validated and acknowledged the young person’s difficulties rather than medicalising them, positioning the young person as the expert in their own experience. Co-constructing the self-harm cycle, a visualisation of the thoughts, feelings and behaviours that feed into self-harm, was described as enlightening, helping young people distinguish between the internal processes that drive their actions. For many, it was the first time anyone had broken down self-harm in this way, and the shared formulation also gave practitioners a stronger foundation for risk assessment and onward referral.

The third theme captured how the intervention harnesses young people’s strengths and motivates change. The Enhanced Safety Plan begins with a section on what the young person is like when they are well, drawing out values and resilience in a way that standard safety plans, which focus on restricting access to means and crisis helplines, do not. Coping strategies are broken into small categories such as distractions, environment, trusted people and professionals, and practitioners stressed the importance of the young person generating their own solutions rather than being told what to do, a process one practitioner compared to motivational interviewing. Solution-focused scales, asking where the young person sits on a one-to-ten scale towards their best hope, helped break change down into granular, realistic steps, and practitioners repeatedly noticed small progress between sessions that they could draw attention to.

Carer involvement emerged as the fourth theme, with practitioners describing better outcomes when involvement was personalised. Not all young people wanted their carers in sessions, and practitioners respected those wishes unless risk management made involvement essential. Where carers did participate, joint sessions using the self-harm cycle helped parents understand why their child had reached the point of self-harm, often softening anger into empathy. Individual sessions gave carers their own containing space, and practitioners noted that some parents began using solution-focused language at home, asking questions such as what difference would that make, which helped the young person feel more understood and supported.

The fifth theme was more sobering. Practitioners felt SASH worked well for most young people, particularly those motivated to change, able to express their emotions, or who had recently started self-harming, for whom the intervention could be eye-opening. But it was seen as less suited to those who struggled to articulate their feelings, had complex or enduring difficulties, or whose problems lay largely outside their control, such as bullying or family breakdown. Views on suitability for autistic young people were mixed; some valued the clear structure, which reduced anxiety, while others found the Therapeutic Assessment and safety planning challenging when young people struggled to identify and discuss feelings, suggesting adaptations such as visual supports and more concrete language may be needed.

The sixth theme described a paradigm shift for practitioners themselves. Accustomed to risk-averse, problem-focused crisis work, some initially worried that a solution-focused approach might feel invalidating or repetitive. Over time, however, they gained confidence in balancing validation of distress with strengths-based conversations, and many reported feeling more optimistic and hopeful in their clinical work, with some describing the approach as becoming second nature. Most practitioners continued to use components of SASH, including the self-harm cycle, the Enhanced Safety Plan and solution-focused techniques such as scales and best hopes questions, and some team members who had not been involved in the trial adopted the approach, suggesting it was preferred to usual practice.

The study’s authors argue that SASH offers a feasible model of post-crisis support that can be integrated within routine CAMHS crisis services, with the Therapeutic Assessment and Enhanced Safety Plan achievable within the seven-day follow-up window recommended by national guidance. They caution that effectiveness cannot yet be determined because outcome data from the randomised controlled trial are not yet available, and that insights from young people and carers who received the intervention are still being analysed. Implementation would also require investment in training, supervision and service configuration. Nevertheless, the findings suggest that a brief, collaborative, strengths-based intervention delivered in the aftermath of a self-harm crisis can bridge the gap between emergency care and longer-term treatment, offering continuity, shared understanding and hope at a moment when young people are at their most vulnerable.

Subject of Research: adolescent mental health

Article Title: Supporting adolescents with self-harm: practitioners’ experiences of delivering a rapid brief psychological intervention to adolescents presenting to Emergency Departments

Article References: O’Keeffe, S., Long, M., Saour, T., & McCabe, R. (2026). Supporting adolescents with self-harm: practitioners’ experiences of delivering a rapid brief psychological intervention to adolescents presenting to Emergency Departments. Frontiers in Child and Adolescent Psychiatry, 5, Article 1959051. https://doi.org/10.3389/frcha.2026.1959051

Image Credits: AI Generated

DOI: 10.3389/frcha.2026.1959051

Keywords: self-harm, adolescent mental health, Emergency Department, brief intervention, Therapeutic Assessment, safety planning, Solution-Focused Brief Therapy, CAMHS, crisis care, qualitative research, carer involvement, suicide risk

One of the useful contributions of the review is its international scope. By drawing together studies from the Netherlands, the United States and Norway, the authors capture three quite different implementation philosophies. The Dutch systems described, such as EPR-Youth and Iuvenelis, sit within a national tradition of integrated youth records, where child health, education and social care information has long been coordinated across agencies. The Norwegian adolescent-accessible electronic health record portals reflect a Scandinavian policy emphasis on patient autonomy and digital infrastructure, with adolescents granted direct portal access to their records as a matter of entitlement. The American shared plans of care and patient portals, by contrast, emerged largely from patient-centered medical home models and pediatric chronic disease management, where the plan of care is deliberately written with the family rather than about them. That these three traditions converge on similar design principles—transparency, contribution, and communication—suggests that jointly held documentation answers a need that transcends any single health system’s organization.

The developmental framing that the authors emphasize deserves particular attention. In adult mental health care, shared documentation can be introduced on the assumption that the service user is the primary, and often sole, stakeholder in their record. Childhood and adolescence complicate this considerably. Decision-making capacity is not a fixed attribute but something that matures gradually, and legal frameworks such as those governing consent and confidentiality in the United Kingdom recognize graduated autonomy rather than a single age threshold. A jointly held document must therefore navigate a moving boundary: what a thirteen-year-old consents to share with parents may differ from what a sixteen-year-old chooses, and both may differ from what the parents themselves feel entitled to see. The review’s finding that young people and parents generally view these documents positively, while professionals remain ambivalent, may partly reflect this unresolved boundary work. Professionals worry, with some justification, about information that could distress a young person if read directly, about third-party information contributed by family members, and about the medico-legal status of text that multiple parties can edit.

The professional ambivalence identified in the review also connects to a broader literature on clinical documentation and defensive practice. Clinicians in adult services have historically expressed concerns that open records could inhibit their candor in writing, lead to sanitized notes, or generate additional workload. Yet studies in adult open-notes initiatives, such as those following the widespread adoption of patient portal access to clinical notes in the United States, have largely found these fears to be overstated in practice, with most clinicians reporting minimal changes to their writing habits and patients reporting benefits in recall, understanding and trust. Whether that experience transfers to child and adolescent mental health is precisely the kind of question the review’s evidence base is too thin to answer definitively, and the authors are appropriately cautious on this point. The seven included studies used a range of methodologies—qualitative interviews, surveys, and evaluations of acceptability and engagement—rather than controlled trials of clinical outcomes, which means the field currently knows more about what people think of jointly held documents than about what those documents actually change.

This gap between acceptability and effectiveness is a recurring feature of digital health innovation in mental health. Interventions that improve satisfaction and perceived transparency do not automatically improve symptoms, engagement or outcomes, and the mechanisms linking them remain poorly specified. A plausible causal chain runs from transparency through trust to engagement to better adherence and outcomes, but each link requires empirical testing. The review’s narrative synthesis, rather than meta-analysis, reflects the heterogeneity of the available studies, and this is a reasonable methodological choice given that the interventions themselves differ substantially in structure, access permissions and the degree of genuine co-creation involved. A portal that merely allows a young person to read their clinician’s notes is a different intervention from one that requires the care plan to be drafted jointly in session, and the review is careful to encompass both under its umbrella term.

The multi-agency dimension highlighted in the background section is particularly relevant to the United Kingdom context, where young people’s care often spans health, education and social care. A young person with emotional difficulties may simultaneously be known to CAMHS, a school counselor, a social worker and their general practitioner, each holding separate records that may contradict one another. Fragmentation of this kind is repeatedly cited in policy reviews as a source of distress for families, who must repeat their story to each new professional and reconcile conflicting advice. A jointly held document, in principle, offers a single narrative that travels with the young person, reducing duplication and giving the young person some authorship over how their story is told. The review’s observation that transitions—between clinicians, teams, and from child to adult services—are common vulnerability points in CAMHS gives this function added weight, since continuity of information at transition is a well-documented weakness of current systems.

The methodological rigor of the review itself merits comment. The authors searched thirteen databases alongside grey literature sources, including think tank and policy organization repositories, which is appropriate for a field where implementation learning often appears in reports rather than journals. The use of an adapted Hawker critical appraisal tool, chosen specifically because it accommodates non-traditional study designs and qualitative work, is a sensible fit for a literature dominated by small qualitative and mixed-methods studies. The dual independent screening, extraction and appraisal, with third-reviewer arbitration for disagreements, follows established good practice, and the prospective registration with PROSPERO in February 2025 provides transparency about the review’s intended scope. The screening funnel—from 2,715 initial results down to seven included studies—is steep but not unusual for a narrowly defined intervention in a specialized population, and the authors note that no studies were excluded at full text after initially appearing eligible, which suggests the inclusion criteria were applied consistently.

The finding that barriers concentrate among professionals rather than families has practical implications for implementation. If young people and parents are ready and willing to engage with shared documents, then the limiting factor is professional training, workflow design and organizational culture. This mirrors experience from adult shared decision-making initiatives, where the evidence consistently identifies clinician attitudes, time pressures and uncertainty about medico-legal boundaries as the principal obstacles, rather than patient reluctance. For CAMHS, this suggests that implementation efforts should focus on clinician education, clear governance guidance about what can and cannot be shared, and electronic record systems designed so that co-creation is easy rather than burdensome. The practicalities of co-creation mentioned in the review—how and when a document is drafted jointly, who mediates disagreements between a young person’s and a parent’s preferences, and how the document is updated over time—are precisely the operational questions that future implementation research should address.

The review also sits within a wider policy trajectory. The NHS Long Term Plan and the Topol Review, both cited by the authors, have positioned digital access to records as a core expectation of modern health care, and patient portal access is now standard across much of the National Health Service for adults. Extending meaningful access and co-creation rights to young people is a logical next step, but the review makes clear that it cannot simply be a matter of switching on existing adult infrastructure. Developmental considerations, parental involvement, safeguarding responsibilities and the multi-agency character of child health care all demand youth-specific design. The authors’ identification of this as the first systematic review in the area means that their map of the existing evidence, sparse as it is, will likely serve as the reference point against which future studies position themselves.

For researchers, the review implicitly sets an agenda. The field needs controlled or at least longitudinal evaluations of clinical and service outcomes, studies that disaggregate effects by age and developmental stage, investigations of how confidentiality and information governance frameworks interact with shared documents, and implementation studies that document what happens when jointly held documentation is introduced into real CAMHS teams. For clinicians and service leaders, the immediate message is more modest but actionable: young people and families are receptive, the international experience suggests feasibility, and the obstacles are organizational rather than attitudinal on the service user side. As digital record systems continue to evolve, the question is less whether young people will eventually hold their care documents jointly with professionals, and more how quickly the evidence base can mature enough to guide that transition safely and well.

Subject of Research: Jointly held care documents in child and adolescent mental health services

Article Title: Jointly held care documents in child and adolescent mental health services: a systematic review

Article References: Jones, N., Roe, J., & Holland, J. (2026). Jointly held care documents in child and adolescent mental health services: a systematic review. Frontiers in Child and Adolescent Psychiatry, 5, Article 1863944. https://doi.org/10.3389/frcha.2026.1863944

Image Credits: AI Generated

DOI: 10.3389/frcha.2026.1863944

Keywords: CAMHS, jointly held care documents, systematic review, shared decision-making, patient portals, electronic health records, adolescent mental health, digital health, care planning, youth mental health, Jointly, held

The scale of the population involved gives the finding national significance. Nearly 50,000 children and young people in England are currently on child protection plans, and around 84,000 are in care. Because their backgrounds and circumstances frequently involve abuse and neglect, these young people are at markedly increased risk of mental health difficulties, and previous studies have suggested that up to half will experience mental health problems at a clinically significant level. Against that baseline of need, contact rates of roughly 9 to 18 percent with specialist services represent a profound gap between risk and provision.

The researchers, based in the Department of Public Health and Primary Care, examined data for the whole of England over the five-year study window. During that period, almost two million children and young people came into contact with mental health services, with figures rising year on year. The most common recorded reasons for referral were anxiety, accounting for 13 percent of cases, followed by presentation in crisis at 10 percent, depression at 7 percent, neurodevelopmental conditions at 6 percent and self-harm at 6 percent. Notably, the primary reason for referral was not recorded in two-thirds of cases, a data gap that itself complicates efforts to plan and evaluate services.

For context, just under one in five children and young people in England, around 18 percent, are estimated to have a probable mental health disorder. Because a third of mental health problems begin before the age of 14, timely access to appropriate services is widely regarded as a key public health priority. Yet fewer than half of children and young people with a probable mental health disorder receive a referral at all. Children on child protection plans or in care were found to be two to three times more likely than their peers to have contact with mental health services, which the authors note is still far below what their elevated levels of need would predict.

One possible explanation lies in the behaviour of child and adolescent mental health services, commonly known as CAMHS, which the researchers suggest can be hesitant to accept referrals for children and young people involved with children’s social services. When referrals are declined, the consequences fall on social services departments and families, who are left to manage shortcomings in mental health provision without clinical support. Recent work by the same team found that individuals in this group were often rejected from services because their needs were viewed as too complex or as relating primarily to their social situation rather than to a treatable condition.

The case studies documented by the researchers illustrate how this reasoning plays out in practice. In one example, a 12-year-old girl living in residential care who had been referred to CAMHS following a suicide attempt was deemed too complex to receive intensive specialist support. In another, a 12-year-old boy was brought to an accident and emergency department after a suspected overdose and after running away from a new foster placement; his access to CAMHS was rejected on the grounds that his problems related to his social situation and were therefore a matter for child social services. Professor Robbie Duschinsky, Head of the Child Health and Development Research Group at the Primary Care Unit, said that through their work the team had encountered countless cases of children and young people with mental health difficulties not being offered treatment because their living situation was judged too complex or a matter for child social services.

The study also identified a troubling pattern at the transition to adulthood. Contact with mental health services appeared to plateau or decline at ages 17 and 18, even though late adolescence is a high-risk period for the onset of mental illness. The researchers propose several possible reasons for this drop-off, including a lack of advocacy for young people at this age, as well as the fact that older adolescents who do not wish to engage with services will have their wishes respected in a way that younger children’s refusals might not be. Either way, the result is that support thins out precisely when epidemiological evidence suggests it is most needed.

Evidence of health inequalities emerged along ethnic lines as well. Children and young people who identified as Asian or Black were less likely to be in contact with mental health services than would be expected based on population estimates, a disparity consistent with broader findings about unequal access to specialist care in England. Combined with the findings on children in the social care system, the data suggest that the groups facing the greatest psychosocial risk are often the least likely to reach, or be reached by, formal mental health provision.

Dr Barry Coughlan from the Department of Public Health and Primary Care at the University of Cambridge, the study’s first author, said that demand for mental health services in England is rising steadily, but many children and young people, particularly some of those who are most at risk, are not getting the referrals or the support they need. He emphasised that many mental health problems first arise during the teenage years, making early intervention crucial. If services are unable to help young people when they first need it, he warned, these difficulties risk becoming long-term problems that persist into adulthood, often growing increasingly severe and including self-harm and attempted suicide.

There was some evidence, though the researchers describe it as not fully conclusive, that children and young people on child protection plans or in care were more likely to be in contact with mental health services in 2020-21 compared with the previous year, suggesting that the impact of the COVID-19 pandemic and associated public health measures was felt more sharply by these vulnerable individuals. The team notes that this is the first time child mental health data from NHS Digital has been used for research in this way, demonstrating the power of routinely collected data to expose significant health inequalities that would otherwise remain invisible. The research was funded by Wellcome and the British Academy. In the UK and Ireland, anyone struggling can contact Samaritans on freephone 116 123, or PAPYRUS HOPELINE247 on 0800 068 4141.

Subject of Research: Mental health service contact and referral rates among vulnerable children and young people in England

Article Title: Thousands of most vulnerable children and young people missing out on mental health support

Article References: Thousands of most vulnerable children and young people missing out on mental health support. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: child mental health, CAMHS, child protection plans, children in care, NHS Digital, health inequalities, referral rates, University of Cambridge, adolescent mental health, social care, England, COVID-19

The research, led by occupational therapist Kim Tang of Curtin University together with colleagues in Australia, the United Kingdom and South Africa, used a constructivist grounded theory approach, a qualitative methodology designed to build understanding from the ground up, rooted in the perspectives of people with lived experience rather than pre-existing hypotheses. The team recruited 23 participants: 12 neurodivergent young people aged between 19 and 28, all formally diagnosed with autism or ADHD and with a co-occurring mental health condition; six parents, all mothers, two of whom disclosed their own ADHD diagnoses; and five health professionals, one of whom was also autistic. Semi-structured interviews lasting between 25 and 72 minutes formed the primary data source, followed by feedback workshops in which participants reviewed and refined the research team’s initial interpretations.

The stakes of this transition are considerable. Mental health difficulties are now the leading cause of disability among people aged 12 to 25 worldwide, and neurodivergent young people are up to three times more likely than their neurotypical peers to develop a co-occurring mental health condition. They are also more likely to need continued care into adulthood, yet paradoxically less likely to make a successful move from Child and Adolescent Mental Health Services, known as CAMHS, to Adult Mental Health Services, or AMHS. In most Australian jurisdictions, as in the United Kingdom, that handover occurs at the upper age boundary of 18, a threshold that participants described as arbitrary and developmentally mismatched.

The numbers within the study itself are telling. Although 11 of the 12 young participants, more than 91 per cent, had technically completed their transition to adult services, only four, roughly a third, felt they had been prepared for it. That gap between procedural completion and genuine readiness sits at the heart of the study’s findings. Young people who transition successfully to adult services tend to have better mental health outcomes than those who fall out of care, and the transition period is widely recognised as a moment of heightened risk of disengagement. For neurodivergent young people, the risk is amplified by services that often lack training in how mental health difficulties actually present in autistic people and those with ADHD.

From the analysis, three overarching categories emerged. The first concerns the provision of what participants across all three groups called neuro-affirming care, meaning care that recognises and accommodates sensory, cognitive and communication differences rather than treating them as problems to be managed away. Participants identified transparent communication about why the transition was needed and what it would involve, shared decision-making about which adult provider to see, and choice over what information was passed on in handover summaries as critical features. When clinicians understood neurodivergence, young people could spend their sessions preparing for the future rather than educating their own therapist about what autism means. As one young participant named Cameron put it, describing a therapist he had now seen for two years: “I felt heard, especially with autism. The new therapist that I’ve been seeing for two years now, understood autism.”

Where that understanding was absent, the consequences were concrete. Young people described therapeutic alliances that collapsed under the weight of preconceived ideas about how a neurodivergent person should present. “The way psychiatrists view neurodivergence and the way I present is often at odds with what they think I should be like,” said Felix, another participant. In some cases the mismatch was severe enough that young people took extended breaks from adult services altogether, precisely the disengagement that the transition literature identifies as dangerous. Others described care that felt fundamentally mismatched to their needs. “The help that was given to me wasn’t for me,” Cameron reflected. Participants also flagged the fragmentation of services into separate mental health and neurodiversity camps, with one health professional, Vivienne, observing that “knowledge is sitting in two camps, and people are very much like it’s mental health or it’s autism and ADHD, and it’s actually both.”

The second category concerned the accessibility of the mental health system itself, and here the participants’ accounts were blunt about structural failure. Access varied sharply by state and by geography, with rural young people facing fewer options than those in metropolitan areas. More strikingly, several participants reported that a formal autism or ADHD diagnosis functioned, in practice, as a barrier to referral. “It almost seemed that in WA, autism and having that diagnosis was almost an exclusion criteria for children accessing CAMHS in WA, whereas that was less so in Queensland,” one health professional, Ursula, recalled. Others described referrals that were rejected outright because of a neurodivergent diagnosis, or that simply never got completed, leaving young people feeling they had “fallen through the gap.” One participant, Ian, described being “constantly being handballed between services.”

The rigidity of the age boundary itself drew sustained criticism. Participants and parents argued for flexible or overlapping age ranges, with one parent, Olivia, suggesting “an 18 to 25 or 16 to 25 area, just for those sort of young adults, as opposed to children and adults being so separate.” Without that flexibility, some young people described feeling “kicked out of services” the moment they aged out of CAMHS, underprepared for a system that expects adults to take full agency over their care and often limits caregiver involvement, an expectation that sits awkwardly with the needs of many neurodivergent young adults who still rely on parental advocacy.

That reliance points to the study’s third and perhaps most poignant category: the informal supports, overwhelmingly parents and peers, that bridge the gap the formal system leaves open. Caregivers described providing administrative support such as completing documentation and liaising with services, practical support such as transport to appointments, informational support such as researching options, and emotional support throughout. This work reduced the cognitive load that the system otherwise dumps on young people at 18, an age at which they are legally adults but, as participants emphasised, may not feel developmentally ready to navigate complex referral pathways alone. Blake, a young participant, described his mother as “super helpful with all of that, and that took a significant weight off the struggle to access those services, because I had a parent who would advocate for me.” Peer support mattered too: Blake credited a classmate’s recommendation to a peer navigation program with making his transition “reasonably smooth.”

The study’s authors argue that these findings demand action at two levels simultaneously. At the provider level, clinicians need training in neurodivergence and in how mental health conditions present in this population, alongside the communication practices and shared decision-making that define neuro-affirming care. At the system level, they call for greater flexibility in age boundaries, clearer guidelines delineating each stakeholder’s responsibilities, and eligibility criteria that do not reject referrals on the basis of a neurodivergent diagnosis alone. They also recommend formally integrating informal supports, including peer navigators with lived experience of the transition, into transition guidelines, particularly for young people without family support. The study, co-designed with an advisory group of three neurodivergent young people who had themselves experienced the transition, acknowledges its limitations: the findings are specific to the Australian context, the sample may over-represent professionals already committed to neuro-affirming practice, and cultural and linguistic diversity was not explicitly explored. Yet the central message is hard to dispute. When formal systems constrain the care clinicians can deliver, the burden shifts silently onto young people and their families, and a system designed to support them instead depends on their unpaid resilience.

Subject of Research: The transition of neurodivergent young people from child to adult mental health services

Article Title: The Transition to Mental Health Services From the Perspectives of Neurodivergent Young People, Caregivers and Mental Health Professionals: A Constructivist Grounded Theory Approach

Article References: Tang, K., Wells, R., Thompson, C., Hill, E., Pellicano, E., & Myers, B. (2026). The Transition to Mental Health Services From the Perspectives of Neurodivergent Young People, Caregivers and Mental Health Professionals: A Constructivist Grounded Theory Approach. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07504-z

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07504-z

Keywords: neurodivergence, autism, ADHD, mental health services, service transition, CAMHS, AMHS, neuro-affirming care, grounded theory, caregivers, peer support, Australia

The scale of the problem motivating the research is striking. In Sweden, most children use the internet daily, and a recent report estimated that roughly 94 percent of children aged 8 to 12 play online games every day. A substantial proportion exceed the screen time limits recommended by the Swedish Public Health Agency. While digital media and gaming can confer real benefits, heavy and poorly regulated engagement carries notable mental health risks. The study distinguishes between excessive screen use, which simply describes a high amount of use, and problematic screen use, defined as poorly regulated digital-media use associated with functional impairment or negative consequences in daily life, such as difficulties at school, in social relationships, or in psychological well-being. Both patterns have been linked to inattention, poorer academic performance, depression, anxiety, stress, and sleep disturbance. Beyond these, gaming disorder stands as a distinct diagnosis in the ICD-11, characterized by impaired control over gaming, increasing priority given to gaming, and continuation despite negative consequences.

What sets P-FAME apart from many existing interventions is its target audience. Intervention research has traditionally focused on children and adolescents as the primary recipients of treatment, potentially overlooking how parental responses, emotional well-being, and everyday interaction patterns contribute to screen-related difficulties. The program is grounded in learning theory, emotion theory, and systemic developmental perspectives, and it integrates psychoeducation, structured homework assignments, support for generalizing strategies to everyday contexts, and peer support delivered through brief lectures, guided exercises, and therapist-led parent discussions. Across three sessions, parents first receive psychoeducation on screen use and its possible consequences, then learn to identify the behavioral functions, maintaining factors, and conflict triggers associated with their child’s screen use, and finally work on strategies to prevent and manage screen-related conflict, with emphasis on constructive family communication.

The study used a prospective single-group pre–post feasibility design. Participants were recruited from CAMHS outpatient clinics in Skåne during spring and autumn 2025, with clinicians informing families reporting screen-related difficulties about the study. Eligible participants were parents of children aged 6 to 12 who reported family difficulties related to the child’s screen use, spoke and understood Swedish, and had stable internet access. Three cohorts of families participated between April and November 2025, and questionnaires were administered two weeks before and two weeks after the intervention. In total, 29 parents of 22 children took part, with the children averaging 10.6 years of age. Notably, 95.5 percent of the children were boys, and 59.1 percent had an ADHD diagnosis, reflecting the profile of families seeking help for screen-related problems in this clinical setting.

The results were encouraging on several fronts. Attendance was high, with 52 percent of parents attending all three sessions and an average of 2.48 sessions completed, suggesting the online group format was feasible within routine outpatient care. On the primary outcomes, child weekly screen time fell by an adjusted 1,400 minutes per week after accounting for clustering within families, a difference that was highly statistically significant. Parent-reported screen time dropped from an average of roughly 3,509 minutes per week at baseline to about 1,936 minutes at post-intervention. Parental stress also declined significantly, with the total Parental Stress Scale score falling by 2.4 points and the stress subscale by 2.3 points. The largest standardized effect was observed for child weekly screen time, with a Cohen’s d of −1.81, followed by parental stress.

Not every outcome moved, however. Overall family functioning, measured with the SCORE-15 questionnaire covering family strengths, difficulties, and communication, did not change significantly from baseline to post-intervention. Reported screen-related rules, parental satisfaction, and most other secondary outcomes also remained statistically unchanged. The researchers note that a brief program may first influence concrete routines and parental stress, whereas broader relational functioning may require longer or more intensive family work, or simply more time before change becomes detectable. It is also possible that the SCORE-15 was insufficiently sensitive to short-term change in this context.

The team also explored whether a child’s ADHD diagnosis or age moderated the observed changes. Neither factor significantly altered the pre–post differences in the interaction models, with p-values ranging from 0.06 to 0.66. One age-by-timepoint interaction for family communication approached conventional statistical significance, with a descriptive pattern of greater reported improvement among younger than older children. The authors caution that the absence of significant moderation may reflect limited statistical power, restricted age variation, or measurement limitations, and that childhood includes age-sensitive periods for executive-function development, making age and self-regulatory capacity clinically plausible candidates for tailoring parent-mediated interventions in future, larger studies.

The researchers are careful about what these findings can and cannot establish. Because the study used a single-group pre–post design without a control condition, causal attribution is not possible; regression to the mean, expectancy effects, concurrent treatment, seasonal variation, and natural changes in family routines cannot be ruled out. Moreover, because parents received the intervention and reported many of the outcomes, expectancy effects, social desirability, and heightened awareness of screen use may have influenced the results, particularly for children under ten, for whom only parental reports were available. The measure of screen-related rules captured reported rule presence rather than enforcement, compliance, or effectiveness. The skewed gender distribution, with primarily boys and mothers participating, may also limit generalizability. The authors frame P-FAME as a promising low-threshold approach warranting further controlled evaluation rather than an established, scalable service model.

Despite these caveats, the clinical implications are significant. The observed reduction in screen time is theoretically meaningful given the documented associations between excessive screen use and inattention, poorer academic performance, depression, anxiety, stress, and sleep disruption, although its clinical meaning ultimately depends on what activities replaced screen time and whether the changes are sustained. The drop in parental stress is compatible with the possibility that structured guidance, peer support, and practical tools enhance parents’ perceived control, though this interpretation remains tentative. The study’s strengths include the use of standardized, validated measures, the inclusion of both parent and older-child perspectives, and delivery within a routine clinical digital format using Sweden’s Amni Care platform, with the Screens-Q questionnaire distributed in paper format.

Looking ahead, the research team calls for larger, more diverse trials with comparison conditions and longer follow-up periods to replicate the observed changes and test the mechanisms behind them. Future work could examine whether parent guidance can be tailored to baseline screen-use patterns, parental stress, child developmental stage, ADHD status, family functioning, or rule-setting practices, potentially leveraging personalization, real-time adaptive monitoring, and multimodal data integration, with attention to privacy and family burden. Implementation outcomes such as acceptability, engagement, adherence, technical access, and delivery fidelity also deserve explicit evaluation, since digital formats reduce access barriers but vary widely in effectiveness. Finally, because the study was conducted exclusively in a clinical CAMHS population, the authors recommend assessing P-FAME’s transferability to school health services, primary care, social services, and preventive settings before its reach can be extended beyond specialist mental health care. For now, the message for overstretched clinics and worried parents alike is cautiously optimistic: a short, online, parent-centered program may offer an accessible first step toward healthier family screen habits.

Subject of Research: A digital parent-focused intervention for problematic gaming and excessive screen use in children attending child and adolescent mental health services

Article Title: Effectiveness of the digital parental-family-centered program for problematic gaming and screen use in a clinical child and adolescent population

Article References: Claesdotter-Knutsson, E., Wilts, S., Werner, M., André, F., & Andersson, M. J. (2026). Effectiveness of the digital parental-family-centered program for problematic gaming and screen use in a clinical child and adolescent population. Public Health in Practice, 12, Article 100848. https://doi.org/10.1016/j.puhip.2026.100848

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100848

Keywords: problematic gaming, excessive screen use, parenting program, child mental health, CAMHS, digital intervention, parental stress, family functioning, gaming disorder, ADHD, screen time, public health

The study, led by Daráine Murphy with colleagues Caroline Heary and Eilis Hennessy, used semi-structured interviews with twenty-three mothers and seven fathers whose adolescents had experienced a mental health difficulty. The researchers then applied reflexive thematic analysis, a qualitative method in which researchers systematically code interview transcripts and iteratively develop themes while remaining consciously aware of how their own perspectives shape interpretation. This approach is particularly well suited to capturing the layered, subjective texture of family experiences that standardized questionnaires often flatten. The overarching metaphor that emerged from the data was striking in its consistency: for these parents, help-seeking was like navigating a labyrinth.

That labyrinth metaphor was not merely decorative. It captured a structural reality. Parents described entering the system through a single, narrow entrance—typically the family general practitioner—and then confronting a series of interdependent gatekeepers who each controlled access to the next stage. Referrals were delayed, criteria were narrowly interpreted, and waiting lists stretched across months during which the adolescent’s condition sometimes deteriorated. The authors frame this within the well-established gateway provider model, in which the first professional a family encounters profoundly shapes whether and how quickly young people reach specialist care. When that first gate is slow or uncertain, every subsequent stage inherits the delay.

Four major themes organized the parents’ accounts. The first, labeled ‘Knowledge is Power,’ concerned the decisive role of what parents knew about adolescent mental health and about the services that existed. Parents who could recognize warning signs, understand diagnostic terminology, and name the appropriate services felt equipped to advocate effectively. Those who lacked this mental health literacy described feeling lost at the very first step, unsure whether their child’s withdrawal, self-harm, or anxiety constituted a problem that services would even accept. The finding aligns with a growing body of evidence that parental mental health literacy is one of the strongest predictors of whether young people with difficulties ever reach formal care.

The second theme, ‘Gatekeepers to Services,’ documented how parents perceived the professionals and administrative structures standing between their family and treatment. General practitioners, CAMHS teams, school staff, and intake criteria all functioned as checkpoints. Parents described repeatedly having to prove the severity of their child’s distress, sometimes feeling that their adolescent needed to reach crisis point before services would engage. The third theme, evocatively titled ‘Cul-de-sacs,’ captured the dead ends of the system: referrals that went nowhere, services that declined cases as outside their remit, and pathways that looped families back to where they started. One parent’s description of the moment of realization—’it was like my world fell apart’—gives the paper its title and conveys the vertigo of discovering that the system you assumed would catch your child may instead leave you circling.

The fourth theme centered on persistence. Across interviews, parents who eventually secured help described a process that rewarded relentless follow-up: repeated phone calls, repeated appointments, repeated insistence. Help-seeking, in other words, was not a single decision but a sustained campaign that demanded time, emotional energy, and a degree of confidence that not all families possess. The researchers note that this creates an equity problem, because families with fewer resources, less flexible employment, or lower health literacy are systematically disadvantaged in a system that effectively selects for pushy, informed, and persistent advocates.

The technical significance of the study lies partly in its methodology and partly in its timing. Adolescent mental health has become a global public health priority: large-scale epidemiological work, including analyses of the Global Burden of Disease Study, indicates that roughly half of all mental disorders have their onset by the mid-teen years, and meta-analytic estimates place the peak age of onset for many conditions firmly within adolescence. Ireland’s own data, including a 2023 Mental Health Commission independent review of Child and Adolescent Mental Health Services, has documented serious capacity and quality problems. Against that backdrop, understanding the family-side of the help-seeking pathway is not an academic luxury; it identifies precisely where the pipeline from distress to treatment leaks.

Previous research had established that parents act as the primary gatekeepers to adolescent mental health services, and systematic reviews had catalogued barriers such as stigma, cost, and waiting times. What this study adds is a granular, process-level account of how those barriers are experienced sequentially and interactively by parents themselves. Rather than treating help-seeking as a single behavior measured at one time point, the interviews reveal it as a dynamic trajectory in which knowledge, gatekeeping, dead ends, and persistence feed into one another. A parent who hits a cul-de-sac may lose confidence; lost confidence erodes persistence; eroded persistence extends the duration of untreated illness, which is itself a known predictor of poorer outcomes across psychotic, mood, and anxiety disorders.

The authors draw practical implications from their findings at two levels. At the level of information provision, they argue for reliable, accessible, and centralized sources of guidance for parents—clear signposting about what services exist, what they treat, and how to access them—so that ‘knowledge is power’ does not remain the privilege of the already well-informed. At the level of service reform, they call for structures that reduce the burden of persistence: streamlined referral pathways, transparent acceptance criteria, and adequate capacity so that families are not forced into crisis before help arrives. They also point toward family peer support as a promising complement, consistent with emerging evidence that parents who have navigated the system can provide uniquely credible guidance to those just entering it.

The study’s limitations are acknowledged by its authors. The sample was drawn in Ireland, where the specific architecture of primary care and CAMHS shapes the labyrinth’s layout, and the predominance of mothers among participants means fathers’ experiences are less thoroughly represented, a common challenge in family mental health research. The interview data, involving sensitive disclosures about adolescents, was not made publicly available for privacy reasons. Yet the core insight travels well beyond one jurisdiction: in systems around the world, the first and most consequential navigator of a young person’s mental health journey is a worried parent, often untrained, frequently exhausted, and operating with incomplete maps. If adolescent mental health outcomes are to improve at scale, the evidence from this study suggests that supporting those navigators—with information, with responsive gatekeepers, and with pathways that do not dead-end—may be among the highest-yield interventions available.

Subject of Research: Parents' experiences of seeking professional support for an adolescent mental health difficulty

Article Title: “It was Like My World fell Apart” Parents Experiences of Seeking Support for an Adolescent Mental Health Difficulty

Article References: Murphy, D., Heary, C., & Hennessy, E. (2026). “It was Like My World fell Apart” Parents Experiences of Seeking Support for an Adolescent Mental Health Difficulty. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-026-02088-2

Image Credits: AI Generated

DOI: 10.1007/s10578-026-02088-2

Keywords: adolescent mental health, help-seeking, parents, qualitative research, reflexive thematic analysis, mental health services, CAMHS, gatekeepers, mental health literacy, service access, Ireland, child psychiatry