Who Supports the Caregivers? Perspectives on Mental Health Screening in Paediatrics

Objectives

To explore caregiver and clinicians perspectives on implementing mental health conversations and supports for caregivers of children with chronic conditions in paediatric outpatient clinics. Specifically, views were sought on (a) screening approaches and measures (phase 1) and (b) how feedback and support could be provided to caregivers experiencing mental health difficulties (phase 2).

Methods

Caregivers and clinicians from two outpatient clinics (neuromuscular and diabetes) at a tertiary paediatric hospital in Melbourne, Australia participated in online focus groups in July and August 2024. Caregivers were recruited from outpatient clinics and clinicians were recruited via email. Both groups were combined for phase 1 before separating into breakout rooms for phase 2. Two authors conducted reflexive thematic analysis of transcripts using NVivo.

Results

Sixteen participants (caregivers n = 8; and clinicians n = 8) took part in in two semi-structured focus groups. Analysis generated two overarching domains, each comprising multiple themes. Domain 1, “Addressing caregiver mental health,” captured themes of overwhelm and invisibility, diverse caregiving roles, and the need for time and resources to support wellbeing conversations. Domain 2, “Housing the mental health conversation,” encompassed themes of screening preferences, caregiver agency in confidentiality, delivery of feedback, and access to tailored supports.

Conclusions

Caregivers and clinicians support routine caregiver mental health discussions in paediatric outpatient settings. Caregivers favour screening at diagnosis and key transitions, with clear, and actionable feedback delivered away from the child. Questions about record-keeping warrant further exploration, as do the perspectives of fathers.

Article Summary

This study explored parents’/caregivers’ and clinicians’ perspectives on mental health screening and support for parents of children with chronic conditions accessing paediatric outpatient clinics

What’s known on this subject

Parents/caregivers of children with chronic conditions have a high mental health burden, with researchers calling for routine mental health screening in paediatric healthcare settings. Despite growing recognition of this, there is limited data on the implementation of screening methods and referral pathways.

What this study adds

Direct consultation with caregivers and clinicians demonstrating they support mental health conversations and being embedded in routine paediatric care. It also demonstrates that caregivers need agency in screening preferences, feedback delivery, confidentiality in records and useful support services.

Contributors Statement Page

Dr Nadia Coscini conceptualized and designed the study, designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript.

Associate Professor Melissa Mulraney and Dr Anneke Grobler conceptualized and designed the study, supervised data collection and critically reviewed and revised the manuscript.

Professor Rebecca Giallo and Professor Harriet Hiscock conceptualized and designed the study, facilitated the focus groups, supervised data collection and critically reviewed and revised the manuscript.

Dr Nicole Pope led the qualitative analysis including debriefing sessions and iterative theme development, drafted the initial manuscript, and critically reviewed and revised the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.