Abstracts for the 15^th International Conference on Child and Adolescent Psychopathology (ICCAP 2023), Kuching, Sarawak (on Borneo Island), August 7 – 9, 2023

Online Self-Help CBT for Child and Adolescent Anxiety: Community Uptake and Changes in Anxiety and Interference

Arlen K Rowe¹, Jocelyn L Evans¹, Caroline L Donovan², Susan H Spence² & Sonja March¹

¹University of Southern Queensland, AUSTRALIA

²Griffith University, Mt Gravatt, AUSTRALIA

Background: BRAVE Self-Help is an open access, iCBT program for the treatment of child and adolescent anxiety. The program has been accessed by over 72,000 Australian families, and although significant reductions in anxiety symptoms are demonstrated following the program, the effects on life interference, or functional impairment are unknown.

Aims: This study provides an overview of the uptake of the BRAVE Self-Help program in the Australian community and examines changes in both anxiety symptoms and anxiety-related impairment following participation in the program.

Methods: Descriptive statistics will be utilised to show the uptake and use of the BRAVE Self-Help program in Australia between 1 July, 2014 and 1 March, 2023. A single group, pre-post study to examine changes in anxiety interference and anxiety symptoms was conducted in a sample of 1198 children (mean age 9.66 years) and 721 adolescents (mean age 13.66 years) participating in the BRAVE Self-Help program in Australia between 7 June, 2019 and 18 July, 2021.

Results: Results demonstrated that both children and adolescents showed improvements in anxiety symptoms, with effect sizes ranging from η_p²=.194 - .318. Children experienced reductions in life interference (η_p²=.008 - .044), particularly later in the program, however adolescents did not show the same effects. In the low completer group (completing 3-5 sessions of the program), adolescents showed increases in at-home interference (η_p²=.038).

Conclusions: Self-help iCBT can bring about reductions in anxiety symptoms. However, young people, particularly adolescents, may require more sessions before entrenched life interference, can be overcome.

Stepped-Care Models of Internet Cognitive Behaviour Therapy for Child and Adolescent Anxiety: What’s the Verdict?

Sonja March^1,2, Susan H Spence², Larry Myers^1,2, Martelle Ford^1,2, Genevieve Smith² & Caroline L Donovan²

¹University of Southern Queensland, AUSTRALIA

²Griffith University, AUSTRALIA

Background: BRAVE Stepped-Care is an internet-based CBT program for the treatment of child and adolescent anxiety that integrates self-help and therapist-support stages as needed. Though face-to-face stepped-care programs show promise for childhood anxiety, digital stepped-care models have not been examined and provide much greater scope and scalability.

Aims: The aim of these two studies was to determine the efficacy of stepped-care when delivered within a digital iCBT program, using two modalities of therapist support, email and videoconferencing.

Methods: Two non-inferiority randomised controlled trials were conducted examining the efficacy of BRAVE Stepped-Care compared to BRAVE Therapist-Supported (gold standard therapist support for all 10 sessions), with outcomes measured at baseline, mid-treatment, 12-weeks and 9-months later. Participants included 274 clinically anxious children and adolescents, receiving one of four treatment conditions. Participants in BRAVE Stepped-Care first completed five sessions of self-help iCBT and were stepped-up to receive therapist support for the remaining five sessions if they did not respond at mid-treatment. Support was provided via either email or videoconferencing. Efficacy was examined via loss of primary anxiety diagnosis and reductions on anxiety symptoms and impairment.

Results: Results demonstrated that BRAVE Stepped-Care (email) was non-inferior to BRAVE Therapist-Supported (email), with 77% free of primary anxiety diagnosis at follow-up in both groups. BRAVE Stepped-Care (videoconferencing) was inferior (68% diagnosis free) to BRAVE Therapist-Supported (videoconferencing; 88% diagnosis free) at follow-up.

Conclusions: Stepped-care delivered within iCBT programs is effective, acceptable and can be equivalent to full therapist-supported iCBT. Videoconferencing appears to enhance effectiveness of iCBT.

Understanding Outside School Hours Care (OSHC) Educators’ Knowledge and Capability to Support Children’s Mental Health and Well-Being

Sarah Murray, Sonja March, Yosheen Pillay, & Emma-Leigh Senyard

Centre for Health Research & School of Psychology and Wellbeing, University of Southern Queensland, AUSTRALIA

Background: Outside School Hours Care (OSHC) services provide childcare before and after school and during vacation to nearly 25% of Australian children. OSHC educators are ideally placed to promote the development of children’s social, emotional, and behavioural wellbeing, however, little is known regarding their knowledge or capability in supporting children’s wellbeing.

Aims: Study 1 aimed to understand what interventions have previously been introduced in OSHC settings to address or promote children’s emotional, behavioural, or social wellbeing and how effective these were. Study 2 aims to establish a baseline understanding of educators’ knowledge and support capabilities relating to child mental health and wellbeing.

Methods: Study 1 conducted a systematic literature review guided by the PRISMA protocol and reviewed research examining mental health or wellbeing interventions delivered in OSHC settings. Study 2 conducted a cross-sectional, mixed-methods vignette survey study with OSHC educators.

Results: Study 1 revealed only six interventions that had been introduced into OSHC settings worldwide, of varying methodological quality and evidence. No reports of educator levels of confidence, capability, and/or self-efficacy in identifying and supporting children with mental health difficulties were identified. Preliminary results from study 2 will be presented, including educator accuracy in recognising common mental health concerns and baseline levels of capability and confidence.

Conclusions: OSHC educators are ideally placed to support children in the development of strong social, emotional, and behavioural wellbeing. There is a clear need to identify potential solutions to improve OSHC educator capability, so they are able to support children in their care.

Effect of Mindfulness-Based “Super Skills for Exams Program” on Test Anxiety: Sample of Ugur Schools’ Students in Turkey

Karadeniz, Ş.¹, Cetinkaya, O.², Alver, E.³, Yildiz, E.D.¹, Uzun, B.¹, & Essau, C.⁴

¹Bahçesehir University, TURKEY

²Ugur Schools, TURKEY

³Turkish National Police Academy, TURKEY

⁴Roehampton University, UK

Background: A high percentage of children and adolescents have high level of test anxiety which have a negative impact on their academic performance. A program was required to reduce test anxiety for students.

Aims: To evaluate the effectiveness of “Super Skills for Exams” program in reducing test anxiety of students who were preparing for their national examinations.

Methods: “Super Skills for Exams” (SSE) program is a co-adapted version of the Super Skills for Life program to include additional sessions that are specifically designed to provide skills that students need to cope with their test anxiety. The SSE was implemented over 16 weeks throughout 2022-2023 academic year (spring and fall semesters) to students enrolled in 7th, 8th, 11th, and 12th grades in the classroom environments. The students were completed a set of questionnaires a week before and a week after the intervention (Baltas, 1999).

Results: The results of the MANOVA analysis showed that the program was effective in decreasing students’ (enrolled in 7^th, 8^th and 11^th grade) test anxiety level. However, this positive result was not found among 12^th graders. Significantly more females than males benefit in taking part in SSE.

Conclusions: The data collected from the students and feedback obtained from the teachers indicated that SSE was successful in reducing test anxiety among children and adolescents in 7^th and 11^th grades (pre-exam group) and 8^th graders. The use of SSE among students in the 12^th grade need to be reviewed.

Childhood Anxiety Management: A Feasibility Trial of Super Skills for Life Program in Pakistan

Nazia Mustafa & Aneela Maqsood

Fatima Jinnah Women University, PAKISTAN

Background: Despite the incredible exertion in evidence-based practices for childhood anxiety, there is an extreme dearth of empirical evidence for such preventive interventions in Pakistan.

Aims: To translate and adapt Super Skills for life Program (SSL) in cultural context of Pakistan along with establishment of fidelity, acceptability and feasibility of adapted protocol in reducing anxiety symptoms and comorbid conditions among primary school children.

Methods: Study comprised of two phases: Phase-I involved the translation and adaptation of SSL by considering the cultural dynamics of Pakistani society by following Planned Adaptation (PA) approach. Phase II involved testing the fidelity, acceptability, feasibility and the efficacy of SSL in the sample of 18 private primary school children. These children completed a set of questionnaires, including scale to measure anxiety symptoms (i.e., the Screen for Child Anxiety Related Emotional Disorders (SCARED)), self-esteem, social skills, prosocial behaviour, and quality of life, and socio-demographic characteristics.

Results: Findings provided initial evidence to the fidelity of the program with good inter-rater reliability (r=.99**); high acceptability from children, parents and teachers through quantitate and qualitative measures and feasibility to run RCT. At post-intervention, anxiety and depressive symptoms as well as generalized emotional and behavioural difficulties showed significant reduction; significant improvement in self-esteem, social skills and quality of life were found at post-intervention, whereas no significant improvement was found on prosocial behaviour. Qualitative data from acceptability feedback interviews complement the findings.

Conclusions: The adapted SSL has implementation fidelity, acceptability and effectiveness for childhood anxiety in Pakistani cultural context.

Eye Movement Desensitization and Reprocessing Versus Cognitive Behavioral Therapy: Which Works Better for Post-Traumatic Stress Disorder in Pakistan? A Two-Year Longitudinal Study

Anwar Khan & Amalia bt Madihie

Universiti Malaysia Sarawak, MALAYSIA

Background: Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder, triggered by traumatic events. Evidence-based psychotherapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) are widely used to treat PTSD, however, little evidence exists regarding the comparative efficacy of these two psychotherapies, especially in Pakistan.

Aims: Keeping this research gap in view, the current randomized controlled pilot study has determined the comparative efficacy of EMDR and CBT in Pakistan.

Methods: A Single-blinded two-group randomized controlled pilot study was adopted. Data were collected from (n = 50) consecutive patients admitted in two mental health rehabilitation centers in Pakistan. Data were analysed both by descriptive and multivariate statistics.

Results: PTSD symptoms gradually reduced from very high during baseline (i.e., CAPS-5 cumulative mean score 72.25) to very low at follow-up stage (i.e., CAPS-5 cumulative mean score 3.43), however, overall, the EMDR therapy was found to more efficacious than CBT.

Conclusion: EMDR is more efficacious in reducing PTSD symptoms in Pakistan.

Surfing the Waves: A Resilience Programme for Schools

Carmel Cefai

University of Malta, MALTA

Background: More than ever before, the Covid-19 pandemic has shown us the importance of resilience in promoting mental health and wellbeing in the face of unexpected challenges, and the need for equipping children with the necessary psychological resources to address and manage challenges in their lives effectively.

Aims: This presentation will first define the meaning of resilience for children and young people and then introduce the revised edition of RESCUR Surfing the Waves, a resilience programme for early years and primary schools, developed by six European partners and revised in 2022. The programme provides a curriculum for classroom teachers on how to help school children, particularly those from marginalised backgrounds, develop such skills as communication and developing healthy relationships, developing a growth mindset, developing self-determination, developing positive self-esteem, developing self-regulation, and turning challenges into opportunities.

Methods: The presentation will be a practical one, providing details on the programme with some practical activities.

Children of Mentally Ill Parents (CHIMPS-NET) and Children Affected by Rare Diseases and their Families (CARE-FAM-NET) – Two German Health Care Networks to Enhancing Resilience in Children, Siblings, Young People, and Families

Silke Wiegand-Grefe

University Medical Center Hamburg Eppendorf, Hamburg, GERMANY

Background: An individual’s mental or physical illness affects their entire family. Nonetheless, families often hesitate to seek conventional psychosocial care, as services are high-threshold, while individual-centered care is often insufficient in meeting the families’ needs. Two German research networks aim to improve the situation of affected families via implementing and evaluating new family-based interventions. Young people who grow up in families with a mentally ill parent have an increased risk of developing a mental illness themselves. However, not all affected families need the same form of care.

Aim/Method: The “Children of mentally ill parents-network” (CHIMPS-NET) was created to provide affected families with needs-based and family-based care throughout Germany. Numerous consortium partners are united under the umbrella of the project to implement and evaluate four new forms of care – CHIMPS-Therapy, CHIMPS-Multi-Family-Therapy, CHIMPS-Prevention, and the online intervention iCHIMPS. Results on the effectiveness of CHIMPS-Therapy based on a randomized-controlled multicenter trial that involved seven clinics in Germany and Switzerland will be compared to a group receiving TAU.

Results: Families with children affected by rare diseases (= 5 out of 10,000 people affected) are at risk for mental disorders and reduced quality of life, especially during the COVID-19 pandemic. The “Children affected by rare disease and their families-network” (CARE-FAM-NET) bundles numerous partners like health insurances, evaluators, and clinicians to improve psychosocial care for affected families. In a rater-blinded 2x2 factorial randomized-controlled multicenter study, two new interventions were implemented into routine care with 687 families. While CARE-FAM is a psychodynamic face-to-face intervention for the entire family, WEP-CARE is a cognitive-behavioral online intervention for parents only. Psychosocial outcomes were assessed at baseline and 6, 12, and 18 months later from different perspectives.

Conclusion: Evidence for effectiveness of these new family-based forms of care will facilitate their long-term integration into routine care. Thus improved German health system would (1) have enormous health economic advantages, (2) consider the families’ complex situations, and (3) enable low-threshold accessibility of family-based care.

I Can Handle That: The Role of Self-Efficacy in Exposure Treatment for Paediatric Anxiety

Krystal Lewis, Paia Amelio, Parmis Khosravi, & Daniel Pine

National Institute of Mental Health, USA

Background: Paediatric anxiety disorders are common among youth and associated with significant impairment. Self-efficacy is at the core of resilience in youth and has been found to be negatively associated with anxiety. Youth with mood and anxiety symptoms report lower levels of self-efficacy. Cognitive Behavioural Therapy (CBT), specifically exposure, is an effective intervention for youth with anxiety.

Aims: To explore the relationship between self-efficacy and anxiety and the role of self-efficacy in exposure therapy with youth.

Methods: Sample includes 175 youth between the ages of 8 and 17 (Healthy Volunteers and Patients). Patients received a 12-week CBT intervention along with an active or placebo attention training task. SPSS analyses were utilized to run bivariate correlations and generalized linear models.

Results: Total self-efficacy was significantly correlated with child reported anxiety (r=-.32, p=.004) and depressive symptoms (r=-.36, p=.001) for the healthy volunteers whereas there were no significant correlations at baseline for the patients. There were significant increases in both emotional efficacy (t (91) = -4.95, p<.001) and social efficacy (t(91)=-3.57, p<.001) from baseline to post-treatment. In addition, pre-treatment emotional efficacy was a significant predictor of child reported anxiety post-treatment.

Conclusions: Self-efficacy is an important mechanism for anxiety reduction in exposure therapy. Youth resilience is a global concept and can be a protective factor for youth mental health. This research further supports the notion that self-efficacy is an important target of treatment and can be increased through exposure therapy.

Delivering a Universal School-Based Mental Health and Well-Being Programme to Primary School Aged Children in South Africa: Findings from the 4 Steps to My Future (4STMF) Pilot Feasibility Study

Bronwynè Coetzee¹, Maria Loades², Suzanne Human¹, Hermine Gericke¹, Gerrit Laning³, Martin Kidd¹, & Paul Stallard⁴

¹Stellenbosch University, South Africa

²University of Bath, UK

³Community Keepers, Stellenbosch, South Africa

⁴University of Bath, UK

Background: In South Africa, vulnerability and risk for a mental condition among children and young people is high yet, treatment is limited. To date, no universal school-based mental health intervention has been delivered in South African primary schools.

Aims: To determine the feasibility and acceptability of a CBT-based, universally delivered classroom-based programme for the promotion of mental health in young adolescents called, 4 Steps To My Future (4STMF).

Methods: We pilot tested 4STMF in two schools in the Western Cape to determine outcomes related to feasibility, acceptability, and the utility of secondary outcome measures. Participants were grade 5 learners (n=222; M_age=10.62 (SD=0.69)). 4STMF was delivered in class time by psychology postgraduates. Feasibility, acceptability, demographic and utility data were collected at baseline, pre-intervention, post-intervention and at 1-month follow up.

Results: Most eligible learners at both schools agreed to participate (85% - school 1; 91% - school 2) and more than 80% completed post-intervention measures. Learner attendance and programme fidelity were high. Within group analysis showed significant pre-post differences on self-esteem (<0.01, ES=1.36 (large effect)) and emotion regulation (<0.01, ES=0.44 (medium effect)), maintained at 1 month follow up at school 1. Within group analysis of school 2 showed significant pre-post differences on emotion regulation (<0.01, ES=0.57 (medium effect)), maintained at 1-month follow up.

Conclusions: 4STMF can feasibly be delivered in primary schools in South Africa. As this feasibility trial was not powered to detect significance, we conclude that a larger, definitive, cluster randomized control trial is warranted.

Super Skills for Exam: Study Protocol for Uğur Schools in Turkey

Karadeniz, Ş.¹, Sezgin, B.², Alver, E.³, Yildiz, E.D.¹, Uzun, B.¹, & Essau, C.⁴

¹Bahçesehir University, TURKEY

²Ugur Schools, TURKEY

³Turkish National Police Academy, TURKEY

⁴Roehampton University, UK

Background: Examination stress is the most frequently reported stressor by adolescents. Exam stress not only has a negative impact of adolescent’s academic performance, but it could also lead to physical and mental health problems, suicidal intention, school absenteeism or dropout. Although exam stress is a common problem globally, this type of stress is particularly high in Turkey where education is highly valued and thus the expectations of parents, teachers, and adolescents themselves to excel academically can be a source of intense stress. However, programs that are specifically designed to help young people with exam stress are lacking.

Aims: To present the study protocol on the implementation of the “Super Skills for Exams” (SSE) to support children and adolescents cope with examination stress.

Methods: The SSE was co-adapted from an evidence-based psychosocial program to prevent anxiety and depression in young people (called “Super Skills for Life”; SSL). The co-adaptation was done with teachers and staff at Uğur schools. As SSE was implemented as part of the academic curriculum for those in grades 7th, 8th, 11th, and 12^th, 8 new sessions were added that focus specifically in coping with exams stress. SSE was implemented in 245 Uğur schools across Turkey by the school’s psychological counsellors who have completed the necessary training. The participants were administered a set of questionnaires that are used to measure self-efficacy for learning and test anxiety, academic stress, emotion regulation, health-promoting behaviours, and sociodemographic characteristics before and after participating in SSE.

Developing and Implementing Adolescent Mental Health Interventions in Low-Resource Contexts: Lessons Learned from the ‘Premium for Adolescents’ (PRIDE) Programme in India

Daniel Michelson

Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK

Background: India has the world’s largest adolescent population and mental ill-health is the leading health concern for this group, causing distress and disruption to education, employment and community participation. These impacts have far-reaching implications in a country where youth productivity drives social and economic growth. Fewer than 10% of youth with common mental health problems (anxiety, depression and conduct difficulties) can access care due to resource constraints and demand side barriers such as pervasive stigma.

Aims: The ‘Premium for Adolescents’ (PRIDE) programme aimed to develop and test a suite of scalable, transdiagnostic interventions addressing the major share of the adolescent mental health burden (anxiety, depression and conduct difficulties) in India.

Methods: PRIDE was implemented by Sangath NGO and a team of international collaborators over a period of seven years (2016-22) with funding from the Wellcome Trust. The formative development of the PRIDE intervention model involved qualitative studies with diverse stakeholders from local secondary schools and low-income urban communities in Goa and New Delhi. Subsequently, a transdiagnostic problem-solving intervention was piloted and trialled as a first-line treatment (‘Step 1’) for adolescents with mixed mental health presentations. A digital version of the problem-solving intervention was also developed and evaluated in a pilot trial. Other PRIDE studies included a stepped-wedge, cluster-randomised controlled trial of a classroom-based sensitisation intervention (‘Step 0’) designed to generate demand for school counselling, as well as a pilot evaluation of a more intensive ‘Step 2’ intervention for adolescents with persistent mental health problems. A final randomised controlled trial evaluated the learning outcomes of digital training for prospective PRIDE counsellors without prior experience in psychological therapies.

Results: The PRIDE intervention model incorporates three design innovations. First, the content is built around a core set of active ingredients that were systematically identified by matching evidence-based practices to common adolescent problems found in the local context. Second, PRIDE employs non-specialist (‘lay’) counsellors as the primary delivery agents, in line with evidence for the cost-effectiveness of task-sharing for mental health care in diverse low-resource settings. Third, a stepped care architecture allows for further resource efficiency. A first-line problem-solving intervention had a significant effect on self-reported psychosocial problem severity at 6 and 12 weeks, with the effect sustained over twelve months. The problem-solving approach was also adapted and tested in a digital, gamified format (‘POD Adventures’), which demonstrated high levels of engagement and user satisfaction when provided on school premises using loaned digital tablets. Remote delivery, relying on adolescents’ personal devices, proved more challenging in the COVID-19 context. The PRIDE programme also generated evidence for the feasibility and acceptability of shared decision-making procedures within a more comprehensive stepped care protocol. Scalability of the programme was enhanced through a digital training platform, with engagement and learning outcomes augmented by the addition of remote coaching.

Conclusions: Lessons learned will be considered in relation to further implementation and adaptation of the PRIDE interventions in India, including a new Wellcome Trust-funded programme centred on university student populations in New Delhi; applications to other low- and middle-income countries; and relevance to underserved populations in high-income countries. It will be argued that task-sharing approaches have the potential to play an important role in growing service capacity and re-shaping services to be more responsive to local community needs and assets in diverse global settings.

Embedding Rational Emotive Behaviour Therapy Tool in the University’s Core Module Learning and Assessment for First Year Students

Delicia Ng Ly Ann & David Wong Kin Woon

Taylor’s University, MALAYSIA

Background: Taylor’s University is equipping Year One Semester One students the skill to manage emotions through a core module. During the pandemic, classes were conducted 100% online. Previous experiential learning activities designed were adversely affected. Thus, a new assessment integrating the use of clinical tool was introduced to create a self-directed learning experience that goes beyond head knowledge, allowing students to manage emotions in their daily lives.

Aims: To understand the effectiveness of embedding Rational Emotive Behaviour Therapy (REBT) Tool in improving university students’ ability to manage emotions.

Methods: The assessment was adapted from REBT tool named ABCDE. The ABCDE reflection sheet contains guided questions that is used by mental health professionals to equip individuals to manage emotions. At Life Skills, we adapted this tool by adding in more directed reflection questions to scaffold students’ reflection. Students went through formative and summative assessments using the tool.

Results: Findings from a sample group of 28 students showed that 82.1% agreed that the ABCDE model was cognitively engaging. 75% reported that their behaviour changed as they now learned to pause when there is an activating event, increased in their self-awareness and are equipped with a tool to self-manage.

Conclusions: The embedment of ABCDE in learning and assessment is highly recommended across institutions as a reflective tool to improve student’s ability to manage emotions. Future study can have a deeper analysis on the measures of students’ wellbeing.

Student Counsellors: Supporting Mental Health and Well-Being in Schools

Yosheen Pillay

University of Southern Queensland, AUSTRALIA

Background: The prevalence of mental health disorders amongst high school students is an increasing problem accounting for 16% of the global burden of disease and injury in young people aged 12 to 18 years. This contributes a growing demand on school counsellors. School counsellors report feeling unprepared and under resourced when supporting student mental health concerns.

Aims: This study aimed to improve postgraduate student counsellor knowledge in interventions for school students identified with depression, anxiety, Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder, self-harm, and bullying.

Methods: Two focus groups were conducted, one with school leadership teams comprised of 25 participants and one with masters in guidance and counselling students comprised of 210 students. Based on focus group outcomes, a mental health case study assessment task was developed to explore identifiable behaviours, impact on the school student, and suggested interventions. The assessment task was embedded in a Masters level counselling course to address gaps in knowledge in supporting mental health in school students.

Results: Thematic analysis of the learning experience using Padlets showed most postgraduate students developed in-depth skills in identifying core mental health behaviours and implementing empirically validated interventions. Postgraduate students also identified the need for ongoing professional development in the area of mental health at a school level and increased access to linking and referrals to community support agencies.

Conclusions: Including key education stakeholders to inform postgraduate student counsellor training was beneficial in informing the development of current counselling course content and can contribute to improved school counsellor capabilities.

Hope-Based Intervention for Filipino Perfectionistic Adolescents and their Hope Narratives During the Pandemic

Patricia Simon^1,2 & Roseann Tan-Mansukhani¹

¹De La Salle University Manila, PHILIPPINES

²The University of Hong Kong, Hong Kong

Background: As perfectionism has been linked with negative mental health outcomes, perfectionists were deemed to be particularly vulnerable during the COVID-19 pandemic.

Aims: We aimed to test a single-session hope-based intervention anchored on Bernardo’s Locus of Hope Theory (2010), specifically targeting perfectionist undergraduate students.

Methods: Phase one surveyed undergraduate students to screen high scorers on personal standards perfectionism. In phase two, selected participants were randomly assigned into three groups (hope, mindfulness, control), and underwent either a hope or mindfulness intervention. Students’ narratives of hope and general experiences amidst the pandemic were collected during the intervention. All participants were administered hope and anxiety scales three times (immediately at post-intervention, after one month, after three months) and a between (hope, mindfulness, control) and within-groups comparison were conducted.

Results: Anxiety decreased from pre-test to post-intervention for both the hope and mindfulness conditions, and these reductions were maintained after one month. More importantly, participants in the hope condition exhibited less anxiety than participants in the waitlist-control condition. Analysis of narratives yielded themes of self-improvement, survival, personal agency, seeking support, appreciation of the present and anticipation of a better future. Qualitative findings provide support for the Locus-of-Hope Theory that positions the attainment of valued goals in the context of the personal, relational, and spiritual.

Conclusions: Both quantitative and qualitative findings are helpful in understanding the processes and sources of hope specifically among perfectionist adolescents during a global health crisis. Implications for the development of hope-based interventions are discussed.

Enhancing Caregiving Practices Among Grandparents: Co-Development of the LEarning To Support Play (LET’S Play) Programme and Implementation Strategies in Singapore

Moong Li Chu¹, Cheryl Seah^1,2, Evelyn Tan^1,2, Keri McCrickerd^1,3, Gayatri Kembhavi-Tam^1,2, Shang Chee Chong^1,4, Adrian Sandler¹, Bryce McLeod⁵, Robyn Mildon^1,2, & Esther Goh^1,2

¹National University of Singapore, SINGAPORE

²Centre for Evidence and Implementation, SINGAPORE

³Singapore Institute for Clinical Sciences, A*STAR, SINGAPORE

⁴National University Hospital, SINGAPORE

⁵ Virginia Commonwealth University, USA

Background: A large proportion of young children are cared for by their grandparents in Singapore. Given that promoting healthy relationships with young children is critical for development in the early years, there is a need for contextualised family-centred approaches tailored to grandparent’s caregiving needs.

Aims: LET’S Play is a brief coaching intervention designed to promote caregiver sensitivity and play between grandparents and young children. We will describe the process of co-developing this programme and selecting implementation strategies with key stakeholders in Singapore.

Methods: A provisional outline of the LET’S Play programme was developed through a synthesis of 49 primary research papers evaluating the effectiveness of interventions using video-feedback to coach sensitive caregiving among caregivers of children aged 0-12. Using this, we will co-develop the pilot programme through Focus Group Discussions (FGDs) with grandparent caregivers of 0-3-year-old children and workshops with key stakeholders from implementing agencies. The Consolidated Framework for Implementation Research will be used to guide these sessions and explore needs, intervention characteristics and barriers/facilitators to implementation. Learnings will be used to refine programme content and implementation strategies. Both implementation and caregiver outcomes will be measured during the pilot rollout of this programme (expected to occur in July 2023).

Results: We will present the co-design process of LET’S Play and describe the final programme and implementation strategies to be piloted with grandparents in Singapore.

Conclusions: Findings will increase our understanding of the needs of grandparents providing childcare in Singapore and highlight barriers to implementing effective interventions among this population.

From Evidence to Implementation: Enhancing Social, Emotional, Behavioural and Executive Function Outcomes for Preschool Children in Singapore Through the EASEL Approach

Evelyn Tan^1,2, Cheryl Seah^1,2, Moong Li Chu¹, Keri McCrickerd^1,3, Gayatri Kembhavi-Tam^1,2, Shang Chee Chong^1,4, Adrian Sandler¹, Bryce McLeod⁵, Robyn Mildon^1,2, & Esther Goh^1,2

¹National University of Singapore, SINGAPORE

²Centre for Evidence and Implementation, SINGAPORE

³Singapore Institute for Clinical Sciences, A*STAR, SINGAPORE

⁴National University Hospital, SINGAPORE

⁵Virginia Commonwealth University, USA

Background: Providing high-quality early childhood care and education is key to maximizing children’s potential to succeed later in life (The Lancet, 2016). It equips young children with the essential skills and competencies needed for their development. Despite governmental efforts to support early childhood educators, they continue to report difficulties in implementing classroom practices that promote these outcomes, particularly in supporting children’s social, emotional, behavioural, and executive functioning (SEB+EF) outcomes. To enhance educators’ skills in these domains, we developed the Enhancing and Supporting Early development to better children’s Lives (EASEL) Approach, a set of universal educator-led practices for use with 3-6-year-old children to improve SEB+EF outcomes.

Aims: Through a cluster randomized controlled trial, we aim to evaluate (i) the effectiveness of the EASEL Approach in improving early childhood educators’ teaching practices and children’s SEB+EF outcomes, and (ii) the supports that educators require to implement the EASEL Approach.

Methods: The trial involves 18 childcare centres across Singapore. To help educators implement the EASEL Approach, we will provide training, practice-based coaching, educator self-assessments and data monitoring. Outcomes include educators’ teaching practices, children’s SEB+EF outcomes and acceptability and feasibility of the EASEL Approach.

Results: We will present preliminary learnings from the trial, including facilitators and barriers to implementing the EASEL Approach in early childhood classrooms.

Conclusions: Findings from this study will provide significant evidence on the implementation of the EASEL Approach in early childhood classrooms in Singapore alongside the effectiveness of EASEL in improving educators’ teaching practices and children’s SEB+EF outcomes.

Creating Sustainable Ripples: Strengthening Support for Students with Social-Behavioural Difficulties in Singapore Mainstream Schools Through TRANsition Support for InTegration (TRANSIT)

Pui Meng Choi & Mariam Aljunied

Ministry of Education, SINGAPORE

Background: In 2021, following a series of prototyping in several mainstream primary schools, the Ministry of Education of Singapore announced the introduction of TRANsition Support for InTegration (TRANSIT), targeted intervention to provide support for students with SEN to develop social-behavioural skills that are important to access learning in mainstream schools. TRANSIT will be available to all mainstream primary schools in Singapore by 2026 (ref: https://www.channelnewsasia.com/singapore/transit-programme-p1-social-behavioural-needs-primary-schools-254911).

Aims: The goal of TRANSIT is to build self-management skills among students entering their first year of elementary/primary schools in Singapore, which helps them acquire adaptive skills and build resilience. At the systems-level, TRANSIT also aims to strengthen school-based support for implementation of inclusive practices for students with social-behavioural difficulties. Taking reference from Active Implementation Frameworks (Farmer et al., 2023) in implementation science, the 4 papers on TRANSIT illustrate a practitioner research approach to study the impact of direct teaching and infusion of Evidence-Based Interventions of self-management skills for students identified with social and behavioural needs, using the modality of manualised treatment protocol implemented in school-based settings.

Results/Conclusions: This presentation shares the adoption of a manualised school-based intervention protocol, TRANSIT aims to develop social-behavioural skills in children with developmental needs and SEN in inclusive settings. This paper will first provide an evaluation of the merits of manualised intervention protocol approach (Truijens et al., 2018), and the critical features of TRANSIT built into implementation development to ensure fidelity. Secondly, the use of schools as “locations of choice” for the implementation of interventions for social-behavioural skills are discussed, both in terms of its implications for sustainability, as well as ecological validity. Risks and challenges (e.g., appropriate and adequate triaging of cases) in implementation, as well as how we mitigate them, are also highlighted.

The Development of SMS Curriculum as a Critical Evidence-Based Intervention (EBI) Component in Designing the Manualised Treatment Protocol for TRANSIT

Mastura Mohd Hashim, Esther Kuek, Hui Wen Wong, Seok Hui Teo, Samantha Seah, Ivonne Pang, & Pui Meng Choi

Ministry of Education, SINGAPORE

Background: The Self-Management Skills (SMS) Curriculum is the critical component in designing the manualised treatment protocol for TRANSIT. Based on evidence-based intervention (EBI) for social-behavioural skills, it comprises areas of classroom work habits, social and communication skills, and emotional regulation, identified as key adaptive skills required for effective learning in schools.

Aim and Method: Through practitioner research, we conducted lesson-studies (Lewis, 2011) on the delivery of SMS Curriculum through teaching self-management skills to students explicitly during dedicated class lessons. An important aspect in delivering the SMS Curriculum is the generalisation of the skills through planned infusion in subject class lessons when opportunities to practise within and beyond the class and school settings are organically provided.

Result: Data collected on students’ progress and teachers’ observations showed that students generally demonstrated lesser social and behavioural challenges than before. They were also reportedly able to self-regulate and learn in classroom settings more independently than before. These positive outcomes are also sustained beyond the initial years of their primary/elementary schooling years (i.e., after intervention in TRANSIT has been faded out).

Conclusion: For the manualised treatment protocol adopted in TRANSIT to work well, the anchoring component for treatment delivery, SMS Curriculum is highly instrumental. Through the scope and sequence in delivery this component, we learn that the acquisition of self-management skills appears to be the way to go in building classroom adaptive skills and resilience among students to facilitate effective learning. The use of the Lesson Study protocol is useful in helping teachers, as implementers of the TRANSIT manualised intervention, to reflect and effect strategies that enable sustained outcomes and generalisation of skills beyond the intervention phases.

The Use of Implementation Science to Effect and Maintain Intended Outcomes for Students with Social and Behavioural Needs Through TRANSIT

Han Xian Wong, Samantha Seah, & Pui Meng Choi

Ministry of Education, SINGAPORE

Background: While there are clear merits in adopting a manualised treatment protocol approach in TRANSIT, there were risks and challenges to overcome, largely due to the varying needs and existing support systems in different schools. Truijens and colleagues (2018) also warned about how high adherence to a manualised treatment protocol will not automatically entail higher treatment effectiveness, when implementation is not adequately adaptive. As such, while using a manualised treatment protocol approach in our study, we ensured implementation fidelity with practitioners in each school by adopting a research frame that organises concurrent research and practitioner work well in implementing TRANSIT. This not only develops clarity and efficiency in implementation through a manualised treatment protocol approach, but it also serves to facilitate continual review and improvements through the various implementation drivers.

Aim: To evaluate the processes, tools, and resources used to facilitate TRANSIT implementation with high fidelity in schools (e.g., TRANSIT Implementation Rubrics, Behaviour Coach Validation Rubrics)

Method: Using the Active Implementation Frameworks (Farmer et al., 2023), we check for appropriate development and use of processes, tools, and resources to support schools in implementing TRANSIT with close partnership from Behaviour Coaches based in MOE HQ.

Result: Results from our fidelity assessment tools reflected that more than half of the schools could implement TRANSIT with fidelity by approximate the end of their first year. This paved the path for schools in strengthening whole-school support for students with social and behavioural needs from their second year of implementation onwards.

Conclusion: Processes for implementing TRANSIT (or other similar manualised protocols in school settings) needs to be empowering and collaborative in nature to ensure sustainability. The use of fidelity assessments tools allows implementors to understand different school needs and profiles to customise support to ensure (a) high fidelity implementation, (b) achieve long-term positive outcomes in supporting students with social and behavioural needs, while also reaping the (c) merits in the manualised treatment protocol approach.

Enablers to Build Supportive Learning Environments: Looks at the Systematic Structures that Were Put in Place Within TRANSIT and Evaluates the Ecological Validity and Sustainability of these Efforts

Ng Mei Yun, Ananthi d/o Chandramohan, Hui Wen Wong, Seok Hui Teo, Samantha Seah, Ivonne Pang, & Pui Meng Choi

Ministry of Education, SINGAPORE

Background: Implementing a manualised treatment protocol in school contexts requires the consideration of various implementation drivers. It requires a holistic approach in which the emphasis is also placed on working with school leadership to build supportive learning environments. As a key driver in implementation science, school leaders play a key role in building supportive learning environments, which in turn directly impact organisation and competency drivers (e.g., teacher competency and confidence; school climate) and student outcomes (e.g., prosocial behaviour and learning among students).

Aim & Method: TRANSIT was initiated in response to primary/elementary school needs in supporting social and behavioural needs across Singapore. As such, we adopt a practitioner research approach in our study, relying on principles in the Active Implementation Frameworks (Farmer et al., 2023). In the process, we sharpen our competency drivers through developing tools, such as Behaviour Coaches’ Validation Rubrics, and TRANSIT Implementation Rubrics, and also work closely with school teams to build learning environments in schools. A case study approach is used to illustrate how experienced school leaders in two schools (i.e., one school that implemented a pull-out approach with another that used the push-in model) strengthen leadership, competency, and organisation drivers to work towards implementation fidelity. At the same time, they customise the operationalisation of the treatment protocol to fit the unique demands and needs in each of their schools.

Result & Conclusion: Strengthened school systems, processes, and structures through effective school leaderships remain important in ensuring effective whole-school support for students with social and behavioural needs.

The Boy Who Risks His Life to Kill Jabberwocky

Anita Codati

Hospital Tunku Azizah (Women & Children’s) Kuala Lumpur, MALAYSIA

Background: This young teenage boy is precocious and a parentified child. He is enmeshed with his mother, who replaced her husband with her son. He began to lose control of his limbs, and became wheelchair bound, in the very year that would determine his future, as it is his final school year. The Paediatric Neurologist diagnosed him with fibromyalgia, and he was experiencing pain score 10/10.

Aims: To use psychotraumatology informed care as an approach in managing patients with functional neurological symptoms and to alleviate pain.

Methods: The psychotraumatology approach was used to work on his “Invisible Attachment Trauma” (D’Hooghe-Brack, 2022).

Results: He was able to start walking with reduced pain score and seem to show remarkable progress in his acceptance of his relationship with his parents. The understanding of the various traumatic consequences was useful in mapping the treatment possibilities.

Conclusions: Psychotraumatology informed care can be explored with patients that present with functional neurological deficits in addition to the standard care.

Suicidal Risk in Adolescents Who Assault their Parents: Results from the EPISAM-School Study

Wala Ayad-Ahmed¹, Adriana Garcia-Ramos², Maria Camila Varela-Mora², Claudia Sanchez-Gomez², Paula Arias-Rodriguez², Paola Marin-Santos², Alberto Sanchez-Fernandez-Quejo², Nicole Frontero³, Marta Velazquez⁴, Veronica Fernandez-Rodrigues^1,2, & Alejandro de la Torre-Luque.^1,5

¹San Carlos Clinic Hospital, SPAIN

²Complutense University of Madrid, SPAIN

³Polytechnic University of Madrid, SPAIN

⁴Autonomous University of Madrid, SPAIN

⁵CIBERSAM ISCIII, SPAIN

Background: Child-to-parent violence (CPV), is one of the most significant issues with major implications for the adolescent population at the national level. However, it is understudied compared to other forms of family violence, and there is limited understanding of its association with suicide, emotional regulation, and perfectionism.

Aims: The aim of the study was to examine the association between child-to-parent violence, suicidal behavior, and other emotional risk factors, specifically emotional regulation difficulties and perfectionism, in a community sample of adolescents aged 12-16 in Madrid.

Methods: The EPISAM-School study constitutes a prospective study to detect suicidal at-risk adolescents aged 12-16 years (N = 1,022 adolescents, 44.8% male; M = 13.86 years, SD = 1.36), in Madrid. Data on suicidal risk (Paykel scale), Child-to-parent Violence Questionnaire (CPV-Q), and emotional regulation (DERS, FMPS) were collected.

Results: 89.7% of the adolescents reported that they had engaged in physical and psychological aggression towards their parents. Significant positive correlations were found between risk factors and child-to-parent violence (r = .35, p <.001). Higher levels of child-to-parent violence were associated with increased suicidal ideation (r = .27, p <.001) and difficulties in emotional regulation (r = .32, p <.001). No significant relationship was observed between perfectionism and child-to-parent violence.

Conclusions: The relationship between suicidal ideation and emotional regulation emphasizes the need to investigate their potential contribution as a risk factor in child-to-parent violence. This study highlights the high prevalence of filial violence among minors and emphasizes the need for increased research and societal attention to develop community-based prevention and intervention programs.

Framing the Psychological Well-Being of Residents in Orphanage: A Review

Nadzirah Mawi, Asma Perveen, & Hazalizah Hamzah

Sultan Idris Education University, MALAYSIA

Background: The number of children and adolescents who had been orphaned in Malaysia continued to rise sharply day by day particularly when COVID-19 outbreak managed it way among Malaysians. In Malaysian context, the orphans have gained significant attention from different authorities, such as government and private agencies. Though a lot of studies were conducted on minorities such as disabled people and single mothers, only a few scattered studies have examined mental or behavioral health of Malaysian children and adolescents living in orphanages.

Aim: To review and summarize findings of previous studies on the way in which resilience, perceived social support, anxiety and depression determines psychological well-being of orphans.

Results: Most studies conducted outside Malaysia employed survey method and some did incorporate interview and observation in their research. This review will extend current literature by accumulating findings on psychological well-being of orphans in Malaysia in term of their emotional states. Furthermore, it is hoped to provide insight on the values and skills that the orphanage committee equip the children before they step out from the orphanage to prepare them to live independently and have good psychological well-being.

Conclusion: New multi-method research integrating both qualitative and quantitative research design should be conducted in the future as most of the studies in Malaysia that involved orphans mainly used quantitative (survey) method.

Views on Sexual Education at Home: A Qualitative Exploration Among Malaysian Adolescents

Noor Azimah Muhammad¹, Teh Rohaila Jamil¹, Farah Umairah Sallehudin², Rosnah Sutan¹, Khansa’ Abd Halim³, Wan Nur Baiti Sudin³, & Mohd Al Adib Samuri¹

¹Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA

²Faculty of Human Development, Universiti Pendidikan Sultan Idris, Perak, MALAYSIA

³National Population and Family Development Board Wilayah Persekutuan, Kuala Lumpur, MALAYSIA

Background: In Malaysia, sexual education is expected to be formally done by the teachers at school and only a few parents do that at home with their children.

Aims: This study aimed to explore adolescents’ views on sexual education at home by their parents.

Methods: This was a qualitative study conducted from February to June 2022. Using purposive and snowballing techniques, 15 adolescents aged 16 to 19 years old residing in Kuala Lumpur underwent individual online in-depth interviews using a semi-structured interview protocol. Data were digitally transcribed verbatim and subsequently underwent thematic analysis.

Results: In general, sexual education was not common in their homes. Although the adolescents felt it was inappropriate and shameful to talk with their parents about sexuality and related issues, the conversation was necessary for their well-being, values, and knowledge. The adolescents preferred the sessions to be planned, structured, individualized, parental gender specific for certain topics like puberty, along with explanation and scientific evidence rather than just making prohibitory statements that focus on moral or religious values. They felt that sexual education is best to be done during adolescence, when they were at secondary school and after puberty. Sexual topics are to be discussed openly and in two-way communication.

Conclusions: Sexual education at home should move from just focusing on religious and moral values to a healthy open discussion between parents and adolescents. It is timely that parents are made aware of the adolescents’ view on sexual education and parents are to be empowered with reliable resources in order to liberate the sexual education.

Parental Mental Health and Self-Efficacy as Predictors of Emotional and Behavioural Problems in Malaysian Early Adolescents

Anis Raihan Dzeidee Schaff & Nor Sheereen Zulkefly

Universiti Putra Malaysia, MALAYSIA

Background: Parental mental health (PMH) and self-efficacy (PSE) can have crucial impact on emotional and behavioral development of early adolescents. Parents with poor mental health and self-efficacy could pose long-term health risk for their children to develop emotional and behavioral problems (EBP). There is, however, a need to refine the understanding on the inter-relationships among these factors in Malaysia.

Aim: The study aims to examine the relationships between PMH and PSE among parents in Malaysia and the predictive value of PMH and PSE on EBP of early adolescents.

Methods: Parents (N=478) of early adolescents aged 10 to 14 years completed an online questionnaire measuring sociodemographic characteristics, PMH, PSH, and children’s EBP. Structural equation modelling was used to examine the inter-relationships amongst the PMH, PSE, and EBP.

Results: Findings revealed that PMH and PSE are negatively correlated (r = -0.365, p = <0.001). Additionally, structural analysis revealed that PMH (ß = 0.364, p = <0.001) and PSE (ß = -0.379, p = <0.001) significantly predicted EBP. As expected, parents with poor mental health have low levels of parental self-efficacy which increases their children’s risk of EBP. Multigroup analysis indicated that the relationships between these variables did not vary across sex.

Conclusions: PMH and PSE are vital in ensuring early adolescents’ emotional and behaviour well-being. Parents who are mentally healthy will have stronger belief in their ability to perform their parenting roles, hence curbing children’s EBP. Parenting programs should thus incorporate PMH and PSE as an important element of the program.

Trends of Gadget Use and Impact on Children’s Social-Emotional Development: A Pilot Study

Noorma Razali¹, Abdul Rahman Ahmad Badayai², & Norulhuda Sarnon@Kusenin²

¹Universiti Malaysia Sabah, MALAYSIA

²Universiti Kebangsaan Malaysia, MALAYSIA

Background: The presence of gadgets in children’s environments has made them an inevitable and increasingly normative component of 21st-century life. Over the last three decades, the accessibility and usage of gadgets have increased among young children. One effect of gadget usage on children is self-isolating from social life and lack of emotional management.

Aim: To examine the frequency of gadgets use among pre-schoolers.

Methods: Forty parents of preschooler, aged 4 to 6 years, participated in the study. Twenty-two of the children are boys and 18 are girls. Majority of the sample were Malays. This study employed the Family Media Ecology model to understand the way in which media is used by the family members and to determine the extent to which media patterns either promote or interfere with early learning. The parents were administered the Malay version of the Developmental Profile 3 (DP-3) to measure a child’s development on five life domains: physical, adaptive behaviour, social-emotional, cognitive, and communication.

Results: Most families own a smartphone (95%), paid TV/ASTRO (72.5%) and a laptop/desktop (70%). The duration of gadgets use among children was much lower during the school holidays than during the school days. Specifically, during school days, 70% and 17.5% of the children used gadgets at a moderate and high level, respectively. During school holidays, 32.5% and 57.5% of the children used gadgets at a moderate and high level, respectively.

Conclusions: The findings have important implications to take necessary steps toward regulating gadget use among children in Malaysia.

Unlocking the Genetic Code of Effective Parenting: Personalized Guidance Through DNA Profiling in Malaysia

Norzila Zakaria, Mohamad Sabri, & Yusra Afiqah

Universiti Sains Malaysia, Malaysia

CareXera Health Sdn Bhd, Malaysia

Background: Parenting plays a crucial role in a child’s emotional development, and there is a growing need for personalized guidance that takes into account an individual’s inborn nature. While numerous parenting guidance exists, they lack specificity based on an individual’s genetic makeup.

Aim: This study highlights the pioneering efforts of CareXera Health, the first company in Malaysia that provides a structured personalized parental guidance based on each child’s DNA profiling. By conducting an extensive literature review, researchers have collected a diverse range of research papers related to parenting practices as a basis of an evidenced based approach. Genetic insights enable the customization of personalized parental guidance to the individual’s specific genetic profile.

Method: The study will involve a sample of parents who have committed to CareXera Health’s DNA profiling services and received personalized guidance.

Result and Implication: The findings of this study will shed light on the value of integrating DNA profiling with parental guidance to create a more personalized and targeted approach. Hence, improving the parental nurturing strategies, which could ultimately lead to positive outcomes for both parents and their children.

Introducing the PLUTO Program: A Pilot Trial of an Online, Parent-Led, Psychosocial Intervention for Parents/Carers of Children with Developmental Language Disorder

Annabel Burnley^1,2, Michelle C. St Clair^1,3, Rachael Bedford^1,4, Samuel M. Waldron^1,5, Yvonne Wren^6,7, & Charlotte Dack^1,8

¹University of Bath, UK

⁶University of Bristol, UK

Background: Children with Developmental language Disorder (DLD) experience an increased rate of psychosocial difficulties than typically developing children. Despite this, there are few psychosocial interventions tailored for their language difficulties. The PLUTO intervention was developed using a person-based approach: A 12-week, online psychosocial intervention for parents of children with DLD. Modules included child anxiety-management, emotion regulation, self-esteem, and parent wellbeing.

Aims: This pilot aims to explore the acceptability, feasibility, and efficacy of the PLUTO intervention.

Methods: A mixed-methods, case series approach was used. Eleven parents of children diagnosed with DLD (6-12 years old) were randomised to three groups, creating a staggered multiple-baseline design (Mage = 8.3; male children n = 7). Validated measures of childhood anxiety, emotion regulation, self-concept and parent wellbeing were collected for 24-26 weeks (four-to-six-week baseline; eight-week follow-up). Weekly qualitative feedback was collected during the intervention (12 weeks) to understand the acceptability, feasibility and preliminary efficacy of PLUTO.

Results: Ten children reported clinical levels of emotional difficulties at baseline (Strengths and Difficulties Questionnaire; emotion subscale total M= 5.3), with nine experiencing high levels of state anxiety (State and Trait Anxiety Inventory; state subscale total M = 11.0). Quantitative data collection and analysis is ongoing. Qualitative results indicate a positive response to the intervention materials; interim themes include ‘initiating conversations’, ‘increased understanding of child emotions’, and ‘confidence approaching emotional situations’.

Conclusions: This study provides evidence of how children with DLD respond to psychosocial intervention materials. Findings have important implications for the ongoing evaluation of, and improvements to, the PLUTO intervention.

Cognitive Function Deficits in Type 1 Diabetes Mellitus: An Observational Cross-Sectional Study

Ibrahim El Bayoumy

Tanta University, Tanta, EGYPT

Background: Previous studies have shown that Diabetes mellitus (DM) is associated with an increased risk of cognitive impairment, but little data is available on Arabic populations, in spite of their remarkably high prevalence of diabetes mellitus in all countries including Egypt.

Aims: To examine the effect of DM on cognitive performance in both types of diabetes mellitus.

Method: Observational cross-sectional study. The study was conducted at the Diabetes Clinic, Tanta University Hospital in Egypt. From a total sample of 250 patients with type 1 diabetes, aged 16± 9.6 years, 151 who met the study criteria were included in the study and 100 patients without diabetes was selected as a control group. The cognitive assessment was conducted using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Test (MoCA).

Results: The prevalence of mild cognitive impairment was 62.5% among patients with type 1 diabetes. The score of Mini-Mental State Examination (MMSE) was 22±2.1 for the diabetes group compared to 28.33±2.7 in the control non-diabetic group). Patients with type 1 diabetes also showed mild cognitive deficits using the Montreal Cognitive Assessment and that this cognitive score had negative correlation with HbA1c, lipid profile and high sensitivity C reactive protein.

Conclusion: Cognitive deficits was observed in type 1 diabetics, and it is associated with long duration of diabetes.

Usability of Virtual Reality Learning in Mental Health: Insights, Challenges and Perspectives

Abdul Rahman Ahmad Badayai, Marhani Midin, Nik Ruzyanei Nik Jaafar & Suzana Mohd Hoesni

Universiti Kebangsaan Malaysia, MALAYSIA

Background: Virtual reality (VR) is relatively a new technology and playing significant role in the treatment of mental disorders.

Aims: To systematically review the current evidence of the usability of a virtual reality technology in the treatment of mental disorders.

Methods: Systematic literature review searches via PsycINFO and PubMed were conducted for the following areas of mental disorders: behavioral and emotional disorders, social anxiety disorder, panic disorder, specific phobias, and agoraphobia, generalized anxiety disorder and attention-deficit/hyperactivity disorder, and autism spectrum disorder. A manual search of the references of ‘virtual reality’ contained in the papers resulting from this search was conducted and relevant periodicals were searched respectively.

Results: Many studies using ‘virtual reality’ technologies were identified, and majority of them were case studies. Several other studies employed experimental research design and involved patients with several phobias such as agoraphobia, fear of flying, fear of spider, fear of heights, and social phobia/public speaking anxiety.

Conclusions: Although virtual reality-based therapy appears to be superior to no treatment, the effectiveness of this form of therapy requires further research through randomized clinical trial and rigorous procedure.

REAL_TM Module, a Social Emotional-Based Learning (SEL) Tool Utilising Virtual Reality for Malaysian Adolescents: From Development to Implementation

Aimi Nur Athira Putri Bharuddin, Nik Ruzyanei Nik Jaafar, Abdul Rahman Ahmad Badayai, Hajar Mohd Salleh Sahimi, Nur Husna Ismail, & Marhani Midin

National University of Malaysia, MALAYSIA

Background: SEL provides the pathway to increase mental health literacy through the acquisition of knowledge and skills to manage one’s emotion in a healthy and adaptive way. REAL_TM (“REad And Learn emotion”) is an evidence-based initiative to develop a SEL module as a learning tool for lower secondary students to promote emotional well-being.

Aims: To describe the development and implementation of REAL_TM module, which is based on SEL, for Malaysian adolescents.

Methods: REAL_TM module considers Malaysian sociocultural factors in its development, based on the findings derived from quantitative and qualitative local studies which formed its framework. In the process, a series of focus group discussion, mini-workshop, and documentary reviews were conducted. Furthermore, REAL_TM utilises Virtual Reality (VR) to facilitate SEL by enhancing the engagement of adolescents through this medium. Next, the content validity of REAL_TM module was examined to obtain the experts’ consensus via the modified Delphi method. Subsequently, a pilot study was conducted that involved delivering the REAL_TMto 15 lower secondary school students in a classroom setting. The aim of the pilot study was to examine the feasibility of REAL_TM module as a learning tool. This included the assessment of its receptiveness by students and teachers, ease of delivery by the facilitators, the participants’ engagement of the module in a school setting and suitability of the instruments to be used for measuring future effectiveness study.

Results: The REAL_TM module, consists of 4 chapters (recognise emotion; manage emotion; regulate emotion; and literate emotion) to teach SEL for Malaysian adolescents was developed and finalized. Each chapter takes about 90 minutes duration and to be delivered weekly and consecutively in a classroom setting. The pilot study showed that the module had high participants’ engagement, was feasible for classroom setting delivery by trained facilitators and was well received by the teachers as well.

Conclusions: REAL_TM has the potential to be part of a solution for future stakeholders to empower the youth to become emotionally resilient. A randomised control trial study needs to be conducted to determine the effectiveness of REAL_TM module as a SEL tool to improve Malaysian adolescents’ emotional wellbeing.

Exploring Emotion Regulation in Malaysian Adolescents for the Development of a Culturally Sensitive Social Emotional Learning (SEL) Module

Norsinar Adilun, Marhani Midin, Seng Fah Tong, Lai Fong Chan, Abdul Rahman Ahmad Badayai, Hajar Mohd Salleh Sahimi, & Nur Hazwani Abd Hadi

Universiti Kebangsaan Malaysia, MALAYSIA

Background: Skills of emotion regulation (ER) are important protective factor from psychological problems and contributes to psychological well-being. These skills are widely taught through Social and Emotional Learning (SEL) programs in the western countries and proved to improve social and emotional competencies (SECs) and academic performance. Unfortunately, implementation of SEL is still lacking in non-western societies. This study is an important part of the development of a culturally sensitive SEL-based Module for Malaysian adolescents.

Aims: To explore the way in which Malaysian adolescents regulate their emotions.

Methods: Using purposive sampling, this study interviewed 25 Malaysian adolescents (15 girls and 10 boys), who were currently attending Malaysian secondary schools and aged 13- 14 years. The interviews employed both of focus-group-discussion (FGD) and in-depth-Interview (IDI) approaches and done through an online platform.

Results: Analyses produced three main themes of skills used to regulate emotions: Self-Awareness (ability to identify emotion, self-perceptions, and self-interests), cognitive strategies (reappraisals) and behavioural strategies. Cultural values played an important part in cognitive strategies of adolescents.

Conclusions: Findings highlight the complex relationship between self-awareness, and cognitive and behavioural strategies to achieve emotional congruence in Malaysian adolescents with employment of cultural values playing an important part in the process. These findings act as part of a blueprint in the development of a culturally sensitive SEL Module for Malaysian adolescents.

Mental Health Portal: The Student’s Psycho-Emotional Support

Ross Zahit & Nur Alias

Universiti Malaysia Sarawak (UNIMAS), MALAYSIA

Background: The prevalence of students’ mental health problems has increased in recent years. The digitalization of mental health care has made it possible to connect with students in new ways, hence, more focus has been placed on mental health portals. However, the usability of the portal is crucial to ensure that it meets the student’s needs and expectations.

Aims: This study aims to develop a mental health portal using Rapid Application Development (RAD), and subsequently to evaluate its usability.

Methods: Heuristic Evaluation and System Usability Scale (SUS) were conducted to assess the expert’s and 189 students’ experience in manoeuvring the portal, respectively. Design and content improvisation were made based on the expert’s insight.

Results: The portal’s usability score was 71.11, which indicates good usability. A score above 70 indicates high usability, whereas a score below 70 indicates poor usability and requires further improvement. The results of this study offer the first evidence about the usability of the mental health portal but there is still potential for advancement.

Conclusions: Developing an engagement-enhancing mental health portal is essential. The portal should strive to consolidate and present resources in a navigable and accessible manner to suit the needs and expectations of students seeking mental health support.

Through the Looking Glass: Psychotraumatology Implementation in Child Psychiatry and the Self of the Therapist

Anita Codati

Hospital Tunku Azizah (Women & Children’s) Kuala Lumpur, MALAYSIA

Background: Our most current diagnostic manuals for child psychiatry has made some progress to evolve from a purely categorical approach to acknowledging the continuum/ spectrum of symptomatology. Child psychiatrists and psychologists are traditionally trained to evaluate these symptoms and diagnosis are established based on criteria fulfilment. However, disorders are merely consequences of a much more complexed, chronic and deep wound rooted in invisible attachment trauma and inter/multigenerational trauma. The self of therapist is the tool to enable change, and their own processing of trauma plays an important role in treatment outcomes in addition to medications.

Aims: To offer a perspective of psychotraumatology approach to manage children and families who present with difficulties.

Methods: Using the concept of reflection (the mirror-looking glass) to manage dysfunctional patterns maintaining disorder and to guide a cohesive and therapeutic approach.

Results: Case studies of lived experiences from both the patient’s and therapists of both success and failures that lead to reclamation of their authentic self.

Conclusions: “One must still have chaos in oneself to give birth to a dancing star” - Friedrich Nietzsche.

Addressing an Unmet Need: Establishing a Research-Informed, Multi-Disciplinary Centre for Early Child Development

Cheryl Seah^1,2, Moong Li Chu¹, Evelyn Tan^1,2, Keri McCrickerd^1,3, Gayatri Kembhavi-Tam^1,2, Shang Chee Chong^1,4, Adrian Sandler¹, Bryce McLeod⁵, Robyn Mildon^1,2, & Esther Goh^1,2

¹National University of Singapore, SINGAPORE

²Centre for Evidence and Implementation, SINGAPORE

³Singapore Institute for Clinical Sciences, A*STAR, SINGAPORE

⁴National University Hospital, SINGAPORE

⁵Virginia Commonwealth University, Virginia, USA

Background: In Singapore, there is a strong national ambition to ensure a good start for every child, as demonstrated by increased government investment, the convergence of early intervention and early childhood sectors, and the scaling of evidence-informed programmes. Despite this, early childhood policies and programmes must be better linked to the full range of emerging sciences to ensure that children and families benefit from research.

Aims: In 2020, The Centre for Holistic Initiatives for Learning and Development (CHILD) was established in Singapore to improve the lives of children and families in Singapore and the region, with a central focus on the emotional, cognitive, and social well-being of children from conception to early primary school years. CHILD strives to close the 17-year gap between research and practice (Robinson et al., 2020), ensuring that knowledge from research is transferred more rapidly to practice through co-designing and co-producing research with policymakers and practitioners.

Methods: CHILD was established with core partners who bring deep expertise in translational and implementation research, with a team of practitioners and researchers from various disciplines. CHILD is uniquely positioned to draw on years of longitudinal research highlighting important factors in pregnancy and early childhood that shape trajectories of child development (Soh et al., 2014).

Results: This presentation will focus on why CHILD was established and how it is designed to address current gaps in evidence to practice and policy.

Conclusions: The goal of CHILD’s work is to benefit children and families in Singapore and the region and enhance the systems in place to support them.

Sensorimotor Rhythm (SMR) Neurofeedback Training on Anxiety: A Case Study on Archery Athletes

Chua Bee Seok¹, Jasmine Adela Mutang¹, & Walton Wider²

¹Universiti Malaysia Sabah, MALAYSIA

²INTI International University, MALAYSIA

Background: According to some studies, a putatively calming effect of EEG neurofeedback training could be helpful to as a therapeutic tool for anxiety. With the aim of elucidating this possibility, we tested the efficacy of neurofeedback training.

Aims: To test the efficacy of neurofeedback training in reducing anxiety symptoms and improving sport mental toughness in two archery athletes.

Methods: A pre-post design neurofeedback training on two archery athletes, with the following dependent variables, was applied: (i) psychometric measures of anxiety State-Trait Anxiety Inventory (STAI) and Sport Anxiety Scale-2, General Anxiety Disorder-7; (ii) Sports Mental Toughness.

Results: After completing the eight neurofeedback training sessions, both participants demonstrated noticeably: 1) improvements in sports mental toughness, including enhanced confidence, constancy, and control. 2) reducing symptoms related to sports anxiety, including somatic manifestations, worry, and disruptions in confidence. 3) reducing state-trait anxiety and generalized anxiety disorder symptoms.

Conclusions: This study provided evidence supporting the effectiveness of neurofeedback training in reducing anxiety symptoms and improving sports mental toughness. However, it is essential to note that this study was a case study, and the findings cannot be generalized. The results provide valuable insights into the potential benefits of neurofeedback training for anxiety management and sports performance, but further research involving more extensive and more diverse samples is needed to establish the broader applicability of these findings.

Therapeutic Play and Art Programme for Foster Children – Sharing of 2 Case Studies from a Singapore Fostering Agency

Noor Aaqilah Abdul Latiff & Intrisaridewi Ali

PPIS Oasis Centre for Fostering, SINGAPORE

Background: PPIS Oasis, an appointed fostering agency by the Ministry of Social and Family Development (MSF) in Singapore offers case management services and conducts programmes for foster parents and foster children. Studies show that therapeutic art activities could contribute to positive mental well-being (Zarobe & Bungay, 2017). PPIS piloted a therapeutic play and art programme in 2022 to help foster children better express their feelings and thoughts safely and non-verbally (Malchiodi, 2020; Pliske et al., 2021).

Aims: Two case studies would be shared on foster children’s progress in the programme. Limitations of the programme will be discussed.

Methods: For therapeutic play, Goodman’s Strength and Difficulties Questionnaire (SDQ) was administered to the foster parents before and after the programme. Foster parents were also interviewed on their foster children’s challenging behaviours. For art therapy, social workers interviewed the foster children and obtained feedback from the art therapist. The therapist also reviewed the artwork of the foster children and social workers were able to understand the foster children’s issues.

Results: The findings showed that for foster children who had undergone therapeutic play, prosocial scores increased, and difficulties score decreased. Feedback from foster parents were also positive, as they reported that the foster children were generally more confident and open to make friends.

Conclusions: Therapeutic play and art therapy allow foster children to express their feelings and thoughts non-verbally. Foster children who attended the programme had better social interactions and positive sense of self. Further research could be how therapeutic play and art therapy contribute to resilience in foster children.

Effectiveness of Project Grit in Building Resilience Among At-Risk Adolescents: A Case Study

Narash Narasimman & Calvin Leong

Impart Ltd, SINGAPORE

Background: Project Grit, a 12-week youth resilience program implemented by Impart and Spartans Boxing Club, aims to help at-risk adolescents develop resilience through psychoeducation and mental health techniques for dealing with everyday stressors and adversity. The programme consists of two parts: 1.5 hours of group therapy followed by 1 hour of boxing. Due to the novelty of the study, six male participants, aged 13 to 18, were recruited.

Aims: This case study aims to examine the effectiveness of Project Grit in building resilience among at-risk adolescents.

Methods: A 15-year-old male participant with a history of behavioural challenges, delinquency and gang involvement was selected for the study. Teacher, parent and child versions of the Strengths and Difficulties Questionnaire (SDQ) were administered to the facilitators, parents and participants, respectively, before and after the programme. Relevant themes from the qualitative interviews will be discussed.

Results: Scores from all raters revealed improvements in most domains of the SDQ. Total difficulties scores across all raters have improved from “very high” to “close to average”. High interrater reliability was observed (Ҡ= .81). The participant reported learning methods to effectively deal with his everyday concerns using healthy coping strategies, developing a supportive social network, and building on his self-efficacy. Themes from the subject’s report will be included during the presentation.

Conclusions: The findings suggest that Project Grit is a promising intervention for promoting resilience among at-risk adolescents. The positive psychology framework and the combination of sports engagement and future orientation may be particularly effective in fostering resilience among this population.

Revisiting Student Well-Being: Fostering Resilience and Embracing Life

Siti Norhedayah Abdul Latif¹, Siti Noor Naasirah Syahiirah Abdullah Teo², Dk Sri Muliaty Pg Mohamed², & Zuraifah Mohd Tahir²

¹Universiti Brunei Darussalam, BRUNEI

²Ministry of Education, BRUNEI

Background: No students desire to be discovered or labelled with diminishing well-being. The deficit model of screening the student with impaired functioning restricts access to resources that target students, overlooking those who may remain unidentified for future challenges. A shift to positive psychology lens beings forth opportunities for individuals to experience flourishing and growth. By cultivating a sense of personal growth, students can thrive in the face of challenges, rather than merely accepting life as it unfolds.

Aim: The study aims to delve into the well-being development of students and examine the predictive role of coping strategies in relation to their well-being in Brunei Darussalam.

Method: The study employed a sequential exploratory mixed method approach. A total of 3,616 students from five schools responded to the EPOCH questionnaire and in addition, five focus groups were conducted to gather further insights.

Results: In general, students’ well-being exhibited moderate levels of positive experience. Notably, this trend is more pronounced among older students and boys compared to girls. The EPOCH measure of Perseverance, Optimism, and Happiness was found to positively predict an increase in students’ resilience levels. Praying and a sense of school connectedness partially mediated the relationship between resilience and the total well-being of the EPOCH measure. Despite life adversities, students persist to thrive by embracing optimisms, choose silent treatment over chaos and drawing inspiration from motivational quotes and versus from the Holy Quran.

Conclusion: This study carries the hope of promoting a realization that a balance approach, valuing and supporting both well-being and the broader aspect of student development, is ideal for promoting holistic growth and success.

Developing REAL_TM Module, Social Emotional-Based Learning for Malaysian Adolescents Using the Modified Delphi Approach

Aimi Nur Athira Putri Bharuddin, Nik Ruzyanei Nik Jaafar, Abdul Rahman Ahmad Badayai, Hajar Mohd Salleh Sahimi & Nur Husna Ismail

Universiti Kebangsaan Malaysia, Malaysia

Background: Mental health problems among adolescents have escalated alarmingly in Malaysia. Difficulties in regulating emotions have been identified as one of the important contributing factors. Therefore, there is a need to develop a social emotional learning module based on the Malaysian own framework of emotional regulation difficulties, to implement and evaluate its effectiveness as an intervention which aims for good mental health and emotional wellbeing of Malaysian adolescents.

Aims: The purpose of this study is to achieve expert consensus on the REAL_TM module for social emotional - learning for Malaysian adolescents.

Methods: A modified Delphi study was performed. In this study, nine specialists were invited to participate as experts, including psychiatrists, psychologists, schoolteachers, social emotional learning experts, and linguists. All questions were distributed through email in each of the three rounds. Four chapters and twelve stations were distributed to the panel for content validation. The panel was asked to rate each item on a 5-point scale from ‘very poor’ to ‘great’ for each question. The same approach was utilised for each Delphi round.

Results: Consensus was obtained after three rounds of Delphi. The findings showed that all of the items for practice have been agreed upon by the experts while one station in chapter four has been rejected.

Conclusions: This study formed a module for social emotional-based learning for Malaysian adolescents, which contribute to the establishment of Malaysian own framework of emotional regulation difficulties module.

Developing Socio-Emotional Competence Youths Through Community Mental Health Program

Chase Tan Yen Zhong

Thrive Well Sdn Bhd, MALAYSIA

Background: The rates of mental health problems amongst Malaysian teenagers have been noted to be quite high. At present, the percentage of emotional problems is 49% and aggressiveness is 41%. These findings were highlighted by the Ministry of Health’s Healthy Life-Style Campaign National Mental Health Survey in 2000. Introduction Researchers portray the possibility that emotional competency issues among adolescents can cause behavioural problems in future. Evidence showed children and adolescent that attended community mental health programs experienced significant improvements in functional impairment, behavioural and emotional symptoms.

Aims: The aim of the study is to determine the effectiveness of a community mental health program on enhancing the wellbeing of marginalized youths.

Methods: 20 youths age ranged between 11–16-year-olds from People Housing Program were recruited for the community mental health program (KAMI Juara). They completed a set of questionnaires that are used to assess wellbeing, including the General Self-efficacy Scale (GSE), Emotional Regulation Questionnaire (ERQ-CA) and Brief Resilience Scale (BRS).

Results: Results showed no significant difference between the youth’s wellbeing before and after the program. These findings may be affected by the small sample size and stress caused by returning to school. Upon closer look, while results were insignificant, positive changes were being observed and reported qualitatively two weeks after the program.

Conclusions: Despite the limitations of the study, it represents a promising approach for extending the reach of mental health programs community programs for youth. Similar research should be replicated further with larger sample size for better implication.

When Kids Say No to School: School Refusal Intervention Program at Hospital Permai Johor Bahru

Nor Rahidah Abd Rahim¹, Farahidah Md Dai², & Abd Kadir Abu Bakar¹

¹Hospital Permai Johor Bahru, MALAYSIA

²Hospital Sultanah Aminah, Johor Bahru, MALAYSIA

Background: School refusal (SR) is described by anxiety and emotional distress at the outlook of going to school. The umbrella term “SR” incorporates concept of truancy, SR, and school phobia. However, it primarily refers to emotionally based absenteeism and frequently will result in an anxiety disorder. In Johor Bahru, MALAYSIA, these cases were seen in the Child and Adolescent Psychiatric Clinic of Hospital Permai, however there was no proper assessment and intervention for children who was referred for SR behaviors. Therefore, the overall aim of this presentation is to describe a comprehensive assessment and intervention that are used to help these children.

Methods: The initial step of the assessment will include history taking and physical examination, child report and parent/teacher measures, direct observation, and consultation with the school officials to determine the reasons of SR. Academic achievement report may be needed, particularly if there are academic difficulties contributing to the SR behaviours. The multidisciplinary team will look at the probable cause of the SR and determine the most appropriate intervention.

Results: The patients referred were predominantly male and from secondary school. The most diagnosis made were learning difficulties followed by anxiety disorders. There were limitations in carrying out the program such as lack of understanding from parents and/or teachers, and untrained therapist.

Conclusions: Better care can be given to children with SR. Hopefully with the establishment of the SR team, the numbers of children going back to school will increase and the initiation of community-based intervention with help the reduced the number of children with SR behaviours.

Emogamification to Reduce Emotional and Behavioural Risk of School Dropout Among Primary Students

Asma Perveen

Sultan Idris Education University, MALAYSIA

Background: Slow learners and dropout are the main concern of education system around the world. With the increase of dropout rate among students especially slow learners, the education system such as education and research institute are working to explore factors that are related to an increase in dropout cases.

Aims: The objective of this study was to test the Emogamification apps among the primary school children in reducing their emotional and behavioural risk of dropping out from school.

Methods: The research method was Quasi experimental design, with 60 participants age range 7 to 12 years (male, n=29; female, n=31) from primary level of education of school in Selangor, were recruited for the study. Students were divided randomly to either the control group (n=30) or therapy (n=30) group to play with the Emogamification app. Emotional and Behavioural Risk Scale of School Dropout among Primary School Children was administered at pre- and post-intervention.

Results: Results reveals that there was mean difference among the score of pre and post among control (m=81.23) and therapy group (m= 73.03) of Emogamification. There was significant group difference p <0.05) F= (2, 57) Wilk’s Λ = 0.38, partial η² = .61), showing significant reduction in risk of dropping out of school among children in the therapy group who participated in the Emogamification activities.

Conclusions: The emotional and behavioural risk of school drop score was significantly decreased after the application of Emogamification activities. Emogamification app is an effective tool to enhance emotional competency and behavioural management among primary school children. The research provided evidence that the application has usability and efficacy to be administered in school and counselling settings.

Evaluating a Prototype Digital Mental Health Literacy Intervention for Young People Aged 11-15 Years in Java, Indonesia: A Mixed Methods, Multi-Site Case Study Evaluation

Helen Brooks¹, Irman Irmansyah², Armaji Kamaludi², Rebecca Pedley¹, Laoise Renwick¹, Atik Puji Rahayu² & Christa Manik²

¹University of Manchester, UK

²National Research and Innovation Agency, BRIN, Indonesia

Background: The IMPeTUs intervention is a co-produced, evidence-based digital intervention designed to improve mental health literacy and depression self-management among young people aged 11-15 in Java, Indonesia.

Aims: To evaluate the usability, feasibility and preliminary efficacy of our intervention from the perspective of young people, their parents and families, and intervention facilitators.

Methods: Mixed methods, multi-site case studies based on a theory of change (ToC). Pre-and post-assessments of a range of outcomes and qualitative interviews/focus groups with a range of stakeholders (78 young people, 76 parents and 21 facilitators). The IMPeTUs digital mental health literacy intervention was evaluated in 8 health, school and community sites across Java, Indonesia (Megelang, Jakarta, and Bogor).

Results: Qualitative data analysis indicated high levels of usability and acceptability in terms of the interface aesthetic, personalisation, message presentation and navigation. Usability was impacted by the perceived identity of the intervention and whether its primary function was considered to be an interactive game or a mental health intervention. Participants reported minimal burdens of engaging with the intervention and no negative outcomes were identified.

Conclusions: Digital applications to support mental health literacy and self-management are an acceptable and feasible way in which health, community and education settings can attempt to prevent future, and treat existing, burdens of common mental health problems amongst children and young people in Indonesia.