Mapping Parents’ Priorities and Needs in Supporting their Childrens’ Mental Health: A Situational Analysis and Needs Assessment in Czechia

doi:10.21203/rs.3.rs-4939035/v1

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Mapping Parents’ Priorities and Needs in Supporting their Childrens’ Mental Health: A Situational Analysis and Needs Assessment in Czechia

https://doi.org/10.21203/rs.3.rs-4939035/v1

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Childhood mental health disorders, particularly anxiety, present a significant global challenge, affecting many young people worldwide. In Czechia, similar rates of mental health problems in children are observed, yet access to specialised care remains limited. This paper addresses the urgent need for comprehensive support systems in Czechia by focusing on parental roles in promoting children's mental health. Despite the pivotal influence of parents on children's well-being, research specific to parental perspectives and needs in Czechia is sparse. This study employs a situational analysis and needs assessment using the Consolidated Framework for Implementation Research to explore parental perceptions of mental health, self-efficacy, stigma, and experiences with professional support. It also examines available resources and services for children, emphasising the prevalence and severity of anxiety-related concerns. By highlighting these critical aspects this study underscores the necessity of overcoming financial and accessibility barriers to evidence-based mental health programmes for families and children in Czechia, advocating for the establishment of support structures through public health insurance to reduce the treatment gap.

Psychology

Child mental health

Parental needs and perceptions

Access to care

Mental Health Services

Anxiety

Implementation science

The study reveals gaps in Czech child mental health services, with missing evidence-based parenting programmes despite high anxiety rates.
Czech parents face barriers in accessing child mental health care, with inconsistent coverage, stigma, long wait times, and reliance on informal support.
Findings highlight the urgent need for systemic change in Czech mental health, emphasizing sustainable, family-focused, evidence-based care.
As the first study to map Czech child and parent mental health needs, it paves the way for future research, advocacy, and service co-development of services to bridge the existing treatment gap.

Nearly 50% of first episodes of mental illness emerge before the age of 18 (Solmi et al, 2021), with one-third of these cases starting as early as primary school (Kessler, 2005). According to the World Health Organization, 1 in 7 children and adolescents struggle with mental health disorder globally (WHO, 2021). Among the most common mental health disorders in children are anxiety, followed by behavioural, mood, and substance use disorders (Merikangas et al., 2009). The prevalence of anxiety in children and adolescents worldwide is 6.5% (Polanczyk et al., 2015), often emerging in late adolescence (Merikangas et al., 2009). Anxiety in children is especially significant as it is often associated with the development of comorbidities later in life, such as depression (Essau, 2003; Rice, van den Bree, & Thapar, 2004).

Results from a screening of ninth graders show that Czech students follow similar trends, with 50% reporting reduced levels of well-being, 40% signs of moderate to severe depression and 30% signs of moderate to severe anxiety (Duševní Zdraví Dětí a Adolescentů: DZDA, 2023). Mental disorders in children severely impact their lives, often leading to low self-esteem (Martinsen et al., 2016), poorer academic outcomes (Gustafsson, 2010), and problems with peers (Siegel et al., 2009), as well as an increased risk of mental illnesses later in life (Costa et al., 2020). However, less than 50% of children and adolescents receive professional support globally (Merikangas et al., 2009), and in light of the severe treatment gap present in the adult population in Czechia for mental illnesses (Kagstrom et al., 2019) it can be reasonably assumed that the treatment gap for children and adolescents is similar if not worse considering the underrepresentation of child and adolescent mental health professionals in country.

Czechia has a long-standing shortage of specialist care. According to the Czech Statistical Office, there were 2.2 million children and adolescents (up to 18 years of age) living in the Czech Republic at the end of 2023 (ČSÚ, 2023). Given the global estimates and prevalence of mental illnesses in children (13.4%, Polanczyk et al., 2015), this would mean that more than 290 000 children and adolescents in the Czech Republic struggle with a mental disorder, with more than 140 000 suffering from anxiety. However; there are currently 138 registered providers of outpatient care in child and adolescent psychiatry (ÚZIS, 2022) and only 529 hospital beds for children in psychiatric hospitals in the Czech Republic (Čihák, 2024). The Czech Medical Chamber reports only 180 child psychiatrists (almost half of them are at the age of retirement, Karasová & Košlerová, 2023) and according to the Association of Clinical Psychologists, there are 90 child clinical psychologists in the whole of Czechia. Additionally, a total of 11% of children under the age of 18 cannot reach a child psychiatrist within a 30-minute drive (ÚZIS, Národní portál psychiatrické péče), contributing to access disparities and inequalities.

Given the lack of support for children in Czechia, it is crucial to build holistic system-level support for CAMH, including carers. Parents play a crucial role in supporting their children’s psychosocial adjustment, resilience and overall wellbeing (Soenens et al., 2017) offering vital support for youth experiencing mental health difficulties (Yap et al., 2013), and playing a key role in both well-being and recovery from mental health disorders (Niemiec & Coulson, 2017). Despite the key role of parents in the mental state of their child, research on the needs and situation of parents in Czechia is lacking.

There is a pressing need for sustainable approaches to reducing the treatment gap for childhood mental illnesses, particularly anxiety disorders in Czechia. Due to the lack of evidence-based interventions for children with anxiety, it is crucial to develop solutions that involve not only professionals but also primary carers. Evidence-based parenting interventions using cognitive-behavioural therapy (CBT) have proven successful in other countries (Jewell et al., 2022), and offer a promising approach in the context of Czechia where services lack.

This study aims to conduct a situational analysis (SA) and needs assessment (NA) to identify the needs and knowledge of parents in Czechia as it relates to the mental health of their children.

The SA aimed to map relevant policies, financial resources, and implementation strategies for promoting mental health of families in Czechia. The NA broadly aimed to evaluate mental health literacy (MHL) among parents, with a focus on their understanding of child anxiety and treatments available, specifically CBT. The results will inform culturally and contextually relevant adaptations necessary for CBT parenting programmes as a sustainable approach towards reducing the treatment gap for childhood anxiety disorders in Czechia. This study is not designed to be comprehensive nor systematic as traditional and systematic literature search strategies are not appropriate to cover the range of topics included in the study aims. Therefore, the results should be considered as a foundational mapping of the field and target group to inform intervention development, intervention, and testing for parent supported child and adolescent mental health in Czechia.

2.1. Situational Analysis

The SA collates secondary data sources found online with a content review of policies and publications of governmental institutions and ministries. The following areas were mapped as they relate to promoting the mental health of families in Czechia: 1) Political support (i.e. existing plans and actions), 2) Legislation, 3) Funding, 4) Service availability and provision for carers. Two researchers (MF, MP) conducted the search supported by trained and supervised interns in Czech. The keywords search terms were applied across a range of sources including the Czech Statistical Office, the National Monitoring for Mental Health of Children and Adolescents, Government websites (Ministry of Education, Ministry of Health, Ministry of Labour and Social Affairs), Insurance companies websites, The Memorandum of Understanding regarding Education 2030+, and The Regional Mental Health Care Plan for Prague 2020–2030. Sources added based on expert recommendations include the National Portal for Psychiatric Care (ÚZIS), The National Mental Health Action Plan, and academic publications on the topic of mental health of children in Czechia.

2.2. Needs Assessment

Emerging information gaps identified in the SA were transformed into research questions within the NA. In order to achieve both a breadth and depth of understanding of needs surrounding parents as supporters in their children’s mental health, mixed-methods were used. Key informant interviews were held separately with each parent. Written or oral consent was obtained from all interviewees. The study was approved from Ethics Committee of the National Institute of Mental Health, Czech Republic (#132/23). Surveys were filled out anonymously online and stored in compliance with GDPR in a password-protected computer. Methods for the data sources, tools used, and analytical approaches for the quantitative and qualitative aspects of the NA are further described below.

2.2.1 Survey

Surveys from parents of children and adolescents across Czechia were collected online between June 2023 and April 2024. The surveys evaluated: 1) Perception of their role as a parent, 2) Sources of help when in need, 3) Feelings and perceptions of their parenting experience, and 4) MHL. These topics were assessed using a battery of questionnaires including the Brief Parental Self-Efficacy Scale (Woolgar et al., 2023), a culturally adapted version of the General Help-Seeking Questionnaire (Wilson et al., 2005), and the Parenting Stress Scale (Berry and Jones, 1995). Additional questions developed by the researchers were included in the survey to measure MHL of parents. All data from surveys were tabulated and only valid fully completed questionnaires were included in the analysis. Participants were recruited via social media. For the survey, see Appendix 1.

2.2.2 Interviews

30 in-depth interviews with parents were conducted using questions from the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2009). Parents were recruited via social media and provided either written or oral consent. The semi-structured in-depth interview covered three topics: 1) Manifestation and severity of worries in both parents and children; 2) Perception of the topic of mental health - MHL; 3) Information and support resources in parenting. Interviews were coded by two independent researchers (MP, MF) using Atlas.ti. The coding approach applied was an inductive/deductive hybrid thematic analysis in order to root the findings in the voices of the participants, while allowing for theory-led categorization of findings (Proudfoot, 2023). Researchers began with inductive analysis of the data, with two independent raters open coding a subset of interviews (26.7%), meeting 3 times to cross-check the emerging coding schemes to ensure the inter-coder reliability, and the rest of the interviews were coded accordingly. This was followed by a deductive approach where the open-codes were organised across pre-existing frameworks from the evidence base for respective topics. Codes were organised across the following groups: Mental Health Literacy, Techniques used by parents, Parent motivation and ideal platform, Barriers, Parent problems, and Consequences for parents. Mental Health Literacy was then further divided into 4 components according to Kutcher et al., 2016: Understanding of positive mental health, Understanding of mental disorders and their treatments, Stigma related to mental health disorders, Help-seeking. To categorise the group 'Techniques used by parents', an existing evidence-based structure was followed in line with parenting guidelines for the prevention of anxiety and depression (Cardamone-Breen et al. 2017). Finally, the following groups regarding the category of the Context of the child were coded: Manifestation of anxiety, Cause of anxiety, Area of fear, Comorbidities, Child traits. For the full interview guide, see Appendix 2.

3.1. Situational Analysis

The SA mapping of existing policies, financial resources, and implementation strategies dedicated to mental health promotion for families in Czechia is presented in the form of a narrative table of results according to respective areas in Appendix 3. Key findings are summarised below:

The National Mental Health Action Plan (NMHAP) serves as the key strategic document, guiding community-based care and promoting the involvement of informal support systems, such as families and carers, within the mental health system in Czechia.
Funding structures and allocations for family mental health services are available through health insurance companies and the Family Grant Scheme, which provides grants to NGOs for preventive and supportive family services.
Evidence-based programmes for parents are currently primarily implemented by NGOs, with a limited availability.
Families and carers of children with mental health problems receive limited support from public mental health services.
Despite the existing policies and initiatives, a significant gap persists between the provision of family mental health services and treatment uptake.

3.2. Needs Assessment

3.2.1. Survey

Data was collected online between June 2023 and April 2024 from 514 participants. The results of parents who fully completed the survey (N = 319) are presented as follows. Parents who completed questionnaires ranged from 24 to 60 years (M = 40.12, SD = 5.68) and their children’s age distribution was as follows: 172 aged 0–6, 325 aged 7–12, 110 aged 13–18, and 56 aged 18 and older (for full participant demographic breakdown see Table 1). The majority of the parents were female (95.92%), and from Karlovy Vary (27.5%) followed by Prague (12.5%), however 32.5% of participants did not specify their hometown.

Table 1

Demographics
Sample Characteristics	n	% n	M	SD
Age			40,12	5,68
Gender
Female	306	95,92
Male	12	3,76
Unknown	1	0,31
Region
Karlovarský	88	27,5
Praha	40	12,5
Jihomoravský	21	6,5625
Středočeský	18	5,625
Ústecký	9	2,8125
Jihočeský	7	2,1875
Královéhradecký	6	1,875
Liberecký	5	1,5625
Vysočina	4	1,25
Pardubický	4	1,25
Moravskoslezský	4	1,25
Plzeňský	3	0,9375
Zlínský	3	0,9375
Olomoucký	2	0,625
Outside Czechia	2	0,625
Unknown	104	32,5

The Brief Parental Self-Efficacy scale (BPSES) was completed by 290 parents. BPSES overall scores range from 5 to 25, with higher scores indicating higher parental self-efficacy. In our sample, results indicate that parents experience relatively high levels of self-efficacy (M = 20.676, SD = 2.4). The Parental Stress Scale (PSS) where the scores range from 18 to 90 (lower scores indicate lower levels of stress) was completed by 273 parents, reporting a mean score of 39.21 (SD = 10.43). For the overview, see Table 2.

Table 2

Brief Parental Self-efficacy and Stress
Scale	n	M	SD
Parental self-efficacy	290	20,676	2,4
Parental stress	273	39,21	10,43

In terms of seeking mental health support when in need, the majority of parents indicated they would go to their spouse or a friend. For a comprehensive overview of help-seeking sources of parents see Table 3. In case of having suicidal thoughts, the majority of parents would seek help from a mental health professional or their spouse.

Table 3

The General Help-seeking Questionnaire
	Personal/Emotional problems		Suicidal thoughts
Help sources	M	SD	M	SD
Spouses	3,26	0,95	2,92	1,13
Friends	3,07	0,93	2,68	1,08
Mental health professionals	3,01	0,98	3,33	0,98
Parents	2,50	1,14	2,02	1,16
Family other than parents	2,20	1,02	1,93	1,07
Doctors	2,23	0,95	2,11	1,12
Crisis helplines	2,03	0,92	2,62	1,18
Spiritual community	1,50	0,80	1,42	0,79
Spiritual leaders	1,32	0,69	1,34	0,79
Would not seek out help	1,37	0,79	1,39	0,84
Note: The greater the Mean, the more the respondent is willing to ask for help from that person. Scores are 1 (Extremely unlikely) to 7 (Extremely Likely).

Regarding the experiences of mental health service utilisation for children and parents, 198 out of 319 parents reported mental health service utilisation across a range of professional and community based providers with the majority (N = 120) mentioning Psychological counselling (See Table 4 with overview of parent reported service use). Additionally, 166 out of 319 parents reported having used some professional mental health services for their child at some point in their lives, the majority (N = 95) mentioning Pedagogical-Psychological counselling followed by Child Clinical Psychologist/Psychologist (N = 59) and School Psychologist (N = 55). For an overview of the specific child services reported, see Table 5.

Table 4

Self-reported Mental Health Service Utilisation of Czech Parents
Group	Name of code	Number of occurrences (N = 198)
	Psychological counselling	120
	Psychotherapy	95
	Psychiatrist	62
	Clinical psychologist	95
	Coaching	36
	Other types of support (e.g. spiritual leader, dramatherapy, courses, crisis centre)	12

Table 5

Parent-reported Mental Health Service Utilisation of Czech Children and Adolescents
Name of code	Number of occurrences (N = 166)
Pedagogical-Psychological Counselling	95
Child Clinical Psychologist/Psychologist	59
School Psychologist	55
Psychotherapy	53
Child Psychiatrist	35
Other Types of Support	4
Special Pedagogical Centres (SPC)	3
Kinesiology	2

3.2.1. Interviews

The results from the in-depth interviews with stakeholders including 30 parents are presented as follows across the relevant target group: 1) parents, 2) the child context.

3.2.1.a Parents

The Needs Assessment on the mental health literacy of parents revealed the following key points:

Parents primarily rely on informal resources when seeking support for their children.
There is a limited awareness and understanding of evidence-based treatments among parents.
Stigmatisation and a lack of openness to discussing mental health-related topics persist among parents.
Parents are generally keen and willing to support their children's mental health and seek available services.
The main barriers to accessing mental health care are the lack of available care and long wait times.
Parents often experience emotional stressors, such as feelings of despair and helplessness regarding their child's mental health difficulties.

Category and theme	Quotes
Understanding of mental disorders and their treatments
Awareness of Psychotherapy and CBT	"Long-term treatment for those who aren't fully ill, using methods that support the individual." (HT)
	"I have a general idea of what it involves, but I haven't tried it myself and lack personal experience." (AH)
Perception of Mental Health (MH)	"That the soul is healthy. One is at ease, functioning well without trouble or medication, and enjoying life without stress." (PV).

	"Being able to cope with unpleasant things is crucial. In good times, you likely don’t need resilience or mental strength, as it's easy to be happy when nothing is challenging. However, during difficult moments, that resilience becomes a true symbol of mental health." (AV)
Stigma related to MH disorders
Perceived MH Stigma	"I told my mother that my son and I were going to see a psychologist and that the therapy was going really well. I mentioned I felt positive about it, and she replied: 'You're taking him to therapy at 9? What will you do when he's 12?'" (E.Kl.)
	“I feel sorry that seeing a psychiatrist is viewed as a disgrace in our country." (JM)
Help-seeking
Seeking help for the child	“I generally lack primary prevention, the school never mentioned the option of a school psychologist.” (AH)
	“I would probably not know where to seek help for children; for school-related issues, I might consider pedagogical-psychological counselling, but for other specific difficulties, I'm unsure." (TŠ)
Parent motivation
To support my child	"How can I, as a parent, support my child at home when psychological care is so scarce?" (MVF)
Support for parents	"I was surprised that someone was interested in how parents are doing and how they feel, not just focusing on the child." (HT)
Barriers
Structural systemic	"The first private psychologist listened to us and referred us to a colleague who was a good fit, but she also had no capacity and sent us to yet another psychologist, who in turn referred us elsewhere." (P.KL.)
	"I’d love to pay for psychotherapy but there’s no one available to provide it." (MP)
Family resources	“...time and energy are scarce.” (JM)
	"It would take a long time for my son to get used to seeing a specialist…” (MK)
	"The psychological difficulties my son faces disrupt our daily life so much that I wouldn’t mind paying 4000 CZK per month for a psychologist." (E.Kl.)
Parent problems
Somatisation	“My stomach often hurts because of fear and I can't sleep because of it.” (VŠ)
Excessive worries	"I'm worried about my children if they don't come home on time; I need to know what's happening and have everything under control." (PK)
Consequences for parents
Helplessness	"I often fell into despair and yelled at him because I didn't know what to do and needed to go to work." (MP)
Sense of failure	"I regret not doing it better, not taking a pause, and not leading by example." (P.KL.)

Key results of the interviews from parents are narratively summarised below across the 4 components of MHL (see Table 6 in Appendix 4 for comprehensive findings).

Understanding of positive mental health

Within the MH Literacy component 'Positive MH', 3 themes emerged: 1) The use of informal resources with the majority of 'Internet' (26 parents mentioning it), followed by 'Books' (17) and Facebook (11), 2) The use of professional resources with the majority of 'other parenting programmes' (4), 3) Informal community with the majority of 'Other mothers' (2).

Understanding of mental disorders and their treatments

The second MH Literacy component was divided into 2 themes: 1) Awareness of Psychotherapy and CBT, and 2) Perceiving Mental Health. In the first theme, a larger group of parents (9) did not know what CBT is or have heard about it in the past but could not explain more, for instance: "I've heard of it—something about dealing with our behaviours—but I'm not sure what it actually is." (HT); "I've read about it somewhere, but I’m not sure how to explain it." (P.KL.) 4 parents mentioned having some knowledge of what psychotherapy is: "Psychotherapy is kind of like coaching. It's a place where you talk about your feelings and get advice on handling tough situations. It helps you look at things from a different angle and manage your emotions. If that doesn’t work, you might need to see a psychologist or psychiatrist. Coaching is more about motivation and pushing ahead, while psychotherapy helps you dig into and work through your stress and problems." (JŠ); "Long-term treatment for those who aren't seriously ill, using methods that support and help the person." (HT) 2 parents mentioned they knew what CBT entails.

In the second theme 'Coping and resilience' was mentioned the most (5) followed by 'It's normal children experience fear' (2).

In terms of the definition of MH, some of the quotes not included in the table above are as follows: "It's about my subjective sense of well-being and how I feel. It doesn’t mean I have to be perfectly healthy or free of a diagnosis or support. It’s knowing where to ask for help or what I can do for myself to feel better, even if I don’t always feel 100% well. I am powerful in this…” (AH); "Mental health is overall well-being, including both the mind and body, having good relationships, feeling like I belong, and experiencing love and acceptance, as well as being able to love others." (HO); "I think of psychological well-being as a state of comfort or discomfort, reflecting one's long-term mood and the factors that influence it, including mental well-being and resilience." (MP); “It's about feeling mostly at ease and being able to tackle problems in a way that helps you move past them. One has to solve the problem and not pretend that it doesn't exist. It's about facing issues head-on instead of pretending they don't exist, and having the inner strength to step back, figure out a plan, and tackle the problem.” (JŠ)

Stigma related to MH disorders

The third MH component included 2 themes: 1) Perceived MH Stigma and 2) Openness to talking about MH. In the first theme, the majority (18) indicated they perceive MH stigma, whilst 4 parents indicated they do not. In the second theme, 28 parents specifically mentioned they are open to talk about mental health with other people, with the majority (22) mentioning their 'close ones', followed by 'husband' (7) and 'children' (4).

Here are some quotes that came up for perceiving stigma around mental health: "...when it comes to seeing a psychologist or psychotherapist and the time dedicated to it—some people might say you can solve the problem by just going to the pub..." (HO); "Others believe it's about upbringing, that my daughter might need a different approach, and that I'm making too much of this." (JL); “My husband stigmatises and downplays the topic of mental health and we've had many arguments about our children's condition.” (IH)

Help-seeking

The fourth MH component consisted of 3 themes: 1) Seeking help for child, 2) Professional, 3) Community/Informal. In the first theme, 15 parents indicated they would use their 'General knowledge' when seeking help for a child, 3 indicated they do not know and 3 mentioned it is difficult to seek help for a child. In the second theme, 3 parents would seek help at school, 2 at a GP, and 2 would use a helpline. In the third theme, 6 parents would seek help via their acquaintances, 5 indicated 'internet search', and 3 'school'.

Some quotes of seeking help are the following: “I know of therapists, psychotherapists, psychologists, and also NGOs offer some programmes.” (RV); “I know that help lines are available.” (LS); “I would contact the school psychologist.” (LCh); “We eventually got to see a psychologist thanks to a paediatrician who knew them.” (MP); "I would search online and consult a GP." (HT)

The Needs Assessment on Techniques used by parents revealed the following key points:

When dealing with anxiety and other problems in their children, the majority of parents (N = 22) tend to speak with the child or use physical touch (N = 11).
In terms of involvement of the parents, the majority of parents (N = 6) use reassurance of the child.
When dealing with specific problems, parents mainly (M = 14) use problem solving techniques.
Regarding the risk factors, downplaying the child's problems was mentioned by 2 parents.

For the overview of the techniques used by parents, see Table 7.

Table 7

Techniques Used by Parents
		Number of parents	Occurrences
Parent-child relationship	Establish and maintain a good relationship with your child
	Spending time together	2	3
	Physical touch	11	12
	Speaking with the child	22	32
Risk factors	Downplaying the child's problem	2	2
Involvement	Be involved and support autonomy
	Listening	2	2
	Asking questions	3	3
	Reassurance	6	6
	Explaining	1	1
Relationships with others	Encourage supportive relationships
	Play	2	2
Family rules/Home environment/Health habits	Establish family rules and consequences, Minimise conflict in the home, Encourage good health habits
	Daily routine	1	1
	Rituals	1	1
	Activity	3	3
Dealing with problems	Help your child to deal with problems
	Problem solving	14	14
	Sharing own problem solving experience	4	4
Risk factors	Ignoring the child's problem	2	2
	Distracting the child	2	2
Coping with anxiety	Help your child to deal with anxiety
	Overcoming fears	4	5
	Breathing	3	3
	Praising the child	1	1
	Practising gratitude	1	1
	Mantras	2	2
	Accepting the child's difficulty	1	1

Parent motivation and ideal platform

In terms of ‘Parent motivation’ to participate in the in-depth interview 'To support my child' was mentioned 19 times by 18 parents, e.g.: "I'm struggling to understand how to handle this. I can process things rationally, but my 10-year-old doesn’t grasp it. That's why I was eager for this chance to learn how to help my son." (MP) Motivation due to 'Support for parents' was mentioned 5 times by 4 parents, e.g.: "Feedback from families can help the system adjust to their real needs, not just regarding long waiting times but also in terms of psychiatrists, child psychologists, and clinical psychologists." (P.KL.); 15 parents mentioned motivation due to their interest in the topic of mental health, 2 parents mentioned being interested in different approaches of upbringing, and 2 parents mentioned they wanted to participate due to having mental health difficulties in their wider family. 1 parent's motivation was their interest in family relationships.

Regarding the 'Ideal platform', which the parents would use when looking for information, 21 parents mentioned a website, followed by 6 parents who mentioned a signposting guide. 3 parents would use an app, 3 parents a combination of both - an app and a website, and 1 parent would appreciate having printed documents.

Barriers, Parent problems, and Consequences for parents

The category 'Barriers' included two themes: 1) Structural systemic, and 2) Family resources. In the Structural systemic, ‘Full capacities/long wait times’ were mentioned 13 times by 12 parents. ‘Unavailability of care’ was mentioned 11 times by 9 parents. 4 parents mentioned the ‘Lack of care covered by insurance/finances’ as a barrier. In the second theme - Family resources, 6 parents mentioned a barrier of ‘Time’, 4 mentioned ‘Commuting’, and the following were mentioned each once: ‘Babysitting’, ‘Quality of care’, ‘Professional conflict’, ‘The length of process’ - "It would take a long time for my son to get used to seeing a specialist…” (MK). 3 parents mentioned there were no barriers for them.

In the category 'Parent problems', somatisation was mentioned 14 times by 11 parents: "I often have stomach aches from fear, and it keeps me from sleeping." (VŠ) ‘Sleep problems’ were mentioned by 7 parents, 'Anxieties' were mentioned by 5 parents, and 'Excessive worries' were also mentioned by 5 parents. 2 parents mentioned being on medication and 2 mentioned having anger problems. The following codes were mentioned once: 'Claustrophobia', 'Migraines', 'ADHD', 'Speech disfluency', 'Socialising problems in childhood'. 6 parents reported no psychological problems: "When something makes me uncomfortable, I can find a reason for it—whether the answer is right or wrong—and that helps me return to a calm, normal state." (VB)

'Consequences for parents' was mentioned 27 times with the most common theme of 'Helplessness' mentioned 13 times by 10 parents. This was followed by 'Concerns about the child' mentioned 8 times by 7 parents, 'Getting angry with the child' mentioned by 3 parents, and 'Sense of failure' also mentioned by 3 parents.

3.2.1.b The child context

The Needs Assessment on The Child Context revealed the following key points:

Awareness of Symptoms: Parents are aware of the various manifestations of their child’s anxiety, citing sleep problems, crying, and physical symptoms as the most common signs.
School-Related Triggers: School-related situations are one of the main triggers and areas of children’s fears and anxieties.
Increased Sensitivity: Children’s increased anxieties are commonly accompanied by heightened sensitivity.

In the category 'The child context', there were 5 themes: 'Manifestation of anxiety', 'Cause of anxiety', 'Area of fear', 'Comorbidities', 'Child traits'.

In terms of 'Manifestation of anxiety', there were 4 types of manifestations: 'Behavioural', 'Somatic', 'Emotional', 'Thoughts'. The 'Behavioural' group included 14 groups: 'Sleep problems' mentioned by 14 parents, followed by 'Crying' (mentioned by 11 parents), 'Eating problems' (4), 'Perfectionism' (4), 'Speech disfluency' (3), 'Increased tiredness' (3), 'Restlessness' (2), 'Need for reassurance' (2), 'Regression' (2), 'Avoidance' (2), 'Nail biting' (1), 'Tearing nails' (1), 'Need for rituals' (1), and 'Finger sniffing' (1). 'Somatic' included 4 groups: 'Physical manifestation of fear' (23), followed by 'Panic attacks' (2), 'Teeth grinding' (1), and 'Fainting' (1). 'Emotional' included 8 groups: 'Strong emotions' (9), Low self-esteem (4), Aggression (4), 'High sensitivity' (2), 'Sensitivity to sounds' (2), 'Hates criticism' (2), 'Shyness' (1), and 'Nervousness' (1). 'Thoughts' included 2 groups: 'Suicidal thoughts' (2), 'Rumination' (2). For the sum of each type of anxiety manifestation, see Table 8.

Table 8

Manifestation of Anxiety in Children
Group	Number of parents mentioning it	Number of occurrences
Behavioural	51	53
Somatic	27	37
Emotional	25	29
Thoughts	4	4

In terms of the 'Cause of anxiety' among children, the most common difficulty reported by parents was 'Bullying at school' (mentioned 5 times), followed by 'Divorce in family' (4 times), 'Covid' (3 times), 'Bad classroom climate' (3 times), 'War in Ukraine' (2 times) and 'Problems with class teacher' (2 times). 'Death in family' and 'Illness in family' were both mentioned only once.

In the theme 'Area of fear', 'School' was mentioned the most (25 times by 23 parents), followed by 'Failure' (12 times by 10 parents), and 'Separation' (10 times by 7 parents). Things that were mentioned 6 times were: 'Relationships with classmates', 'Sleep', 'Fear for family'. Things that were mentioned less than 5 times were: 'Death', 'Darkness', 'New situations', 'Social situations', 'Family relationships', 'Travelling', 'Illness', 'Weather'. The following were each mentioned only once: 'Being judged by others', 'Arachnophobia', 'Claustrophobia', 'Fulfilling immediate needs', 'Blood', 'Unhealthy lifestyle', 'Dogs', 'Spook', 'Drunk people', 'Lifts', 'Loss of voice', 'Loss of belongings, 'Sounds', 'Public performance'.

In terms of 'Comorbidities', 5 parents reported their children having ADHD diagnosis, 2 parents reported ‘Asperger's Syndrome’ and 2 ‘Eczema’, and the following were reported only once: ‘Dysphasia’, ‘Gender identity crisis’, ‘Celiac disease’, ‘Asthma’, and ‘Epilepsy’.

In the theme 'Child traits', 11 parents mentioned that their child is highly sensitive: "Only now do I see just how extremely sensitive, anxious, and fearful he is. The extent of his struggles with feeling good enough or deserving of something is really surprising to me." 7 parents mentioned that their child does not talk about their fears, whilst 6 parents mentioned that their child communicates fears openly. Finally, 4 parents stated their child is gifted: "My son is very good at logical thinking, but he struggles more with social skills compared to others…" (MP)

This study presents results of a NA of Czech parents regarding child mental health and available support, contextualised and triangulated with the national mental health sector mapped via a SA. The NMHAP is highlighted as the primary strategic framework in the region, guiding community-based care and encouraging the inclusion of informal support systems into child mental health care. Currently, the most relevant funding allocations to enhance the accessibility of family mental health services are available through health insurance companies and the Family Grant Scheme. Nevertheless, the NA data revealed that, similar to global barriers in CAMH provision, coverage and conditions vary significantly (Benton et al., 2021), posing a potential barrier for parents navigating the complexities of accessing mental health care for their children.

The SA further illustrates that evidence-based programmes for parents and carers of children with mental health problems are currently primarily implemented by NGOs, with limited access equity and availability. These findings underscore a critical gap in specialised parenting interventions provided through public services in Czechia to address the high rates of anxiety in children (Polanczyk et al., 2015). Globally, evidence-based parenting interventions for child mental health problems are part of standard practice (Jewell et al., 2022), yet these interventions remain notably absent in Czechia.

Despite some existing initiatives, the NA illustrates a significant gap between the provision of family mental health services and treatment uptake, suggesting that Czech parents seek help for their children through informal resources (e.g., online websites, acquaintances, or school). High levels of stigma and a lack of openness to discussing mental health-related topics reported by parents can pose additional barriers to service use (Reardon et al., 2017). These challenges, combined with unavailability of care and long wait times, not only affect the child but also contribute to feelings of helplessness among Czech parents regarding their child's mental health difficulties. This finding shows that the current state of child mental health services poses a burden on parents, highlighting the need for systemic change through sustainable evidence-based interventions. Considering the bi-directional relationship between parent and child mental health, actively engaging the family system in the child's mental health treatment is vital (Johnco et al., 2021; Soenens et al., 2017).

Several limitations of this study are notable. The SA and NA were conducted as a scoping exercise to map the field and do not provide an exhaustive overview. Additionally, most parents interviewed were parents of children with anxiety from one region of Czechia, which limits the result's generalizability and application to wider target groups should be done cautiously. Further, the qualitative methodology, while offering in-depth insight into participating parents' experiences, should not be assumed to be representative of all parents of children with anxiety in Czechia. Further research is needed to gain a comprehensive understanding of the needs and experiences of Czech parents using a nationally representative sample. Despite these limitations, the current study lays the groundwork for future advocacy and development of both additional evidence and interventions for families in Czechia.

To the best of our knowledge, this study is the first to provide an overview and insights into the priority needs and areas in child and parent mental health in Czechia, addressing a significant evidence gap in this field. Our findings highlight the urgent need to overcome financial and accessibility barriers to evidence-based mental health programmes for families and children, particularly given the high anxiety rates in children. Establishing support structures through public health insurance companies is imperative to provide sustainable and scalable resources, ultimately reducing the treatment gap for child mental health problems in Czechia. This study thus sets the stage for the participatory co-development of services with families and stakeholders to meet the priority needs of Czech parents.

Acknowledgements

We thank Denisa Vaňková and Jan Pavlík for helping with data collection.

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The authors declare no competing interests.

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Mapping Parents’ Priorities and Needs in Supporting their Childrens’ Mental Health: A Situational Analysis and Needs Assessment in Czechia

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Highlights

1. Introduction

2. Methods

2.1. Situational Analysis

2.2. Needs Assessment

2.2.1 Survey

2.2.2 Interviews

3. Results

3.1. Situational Analysis

3.2. Needs Assessment

3.2.1. Survey

3.2.1. Interviews

3.2.1.a Parents

3.2.1.b The child context

4. Discussion

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Acknowledgements

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