Wed Aug 27

What is psychosocial therapy? And why is the government thinking about adding it to Medicare for kids?

Written by: Shawna Mastro Campbell, Assistant Professor in Clinical Psychology, Bond University

The government is considering new, bulk-billed health checks for three-year-olds, to pick up developmental concerns and refer kids that might need additional support.

The detail was buried in the announcement of the new “Thriving Kids ^[1]” program which aims to provide foundational support for autistic children and those with developmental concerns.

The government announced it is also considering creating new Medicare items to provide for children that health checks identify as needing additional support. These would be provided by allied health practitioners and include speech pathology and occupational therapy, but also a type of therapy you might be less familiar with: psychosocial therapy.

So, what is psychosocial therapy? Health and disability minister Mark Butler said ^[2] it will support social and emotional functioning.

Let’s take a look at what psychosocial therapy is, which children might benefit from it, and the evidence for offering these kinds of support.

Developmental milestones

Brain development in the first five years of life ^[3] is faster than at any other point in a human’s life. We can measure this rapid growth against developmental milestones ^[4]. These are key indicators parents can use to respond to their child’s changing needs, and can be observed across motor, language, speech, behavioural, and emotional skills.

The way a child develops involves a dynamic series of processes ^[5] that are a complex interplay of genetics and environmental factors. So there are natural variations between children in the timing of these developments.

There are guides ^[6] for roughly expected age ranges we would generally expect certain skills to emerge.

Examples of these early milestones ^[7] include seeking connection with trusted caregivers, crawling, jumping, counting and communicating. These all emerge by the time children are around two years old.

When parents, early childhood educators or health professionals identify an unmet need that is delaying the child’s development, it can indicate the need for supportive services, including psychosocial therapy.

What is psychosocial therapy?

Psychosocial therapies are treatments that focus on the psychological factors (emotions, thoughts and behaviours) and social factors (relationships, community and environmental) that affect a person’s wellbeing and mental health.

For example, for a three-year-old who is anxious at daycare drop-off, changing social interactions with educators or adjusting the physical environment may help reduce their anxiety.

By definition, psychosocial supports consider both the child and their environment – their family and their community. This is sometimes called a nested wellbeing approach ^[8].

There is good evidence ^[9] that psychosocial therapies are effective and are considered best practice treatment for health professionals working with children.

These are sometimes called biopsychosocial therapies ^[10] as they recognise the interaction of biological factors, such as genetics, as well as psychological and social factors that impact the child’s development.

Approaches that are suitable for very young children involve their family or caregivers. For instance, behavioural family therapy and parent training are programs that teach parents effective strategies to manage children’s behaviour and improve parent-child relationships.

These would be delivered by psychologists and/or occupational therapists.

For older children, psychosocial support could include cognitive behaviour therapy ^[11] (which focuses on reframing thinking and behaviour) and interpersonal therapy ^[12] (which focuses on improving relationships with others to alleviate mental health symptoms).

The evidence for psychosocial therapies

Psychosocial supports are not new to Medicare and are already part of the allied health items ^[13] for those eligible disabilities, such as autism or other neurodevelopment conditions, such as attention-deficit hyperactivity disorder.

For young children, there is good evidence that early psychosocial interventions (like those above) can lead to significant improvements. These include improvements in developmental delays ^[14] and behaviour ^[15], and self-regulation and executive functioning ^[16].

The evidence shows that early psychosocial supports work when parents are also supported ^[17] to facilitate responsive caregiving that is “good enough” (not perfect).

In some instances, this might include training and education for parents to better understand their child’s cues and preferences. In other instances, it might look like practical caregiver supports ^[18], such as in-home support, peer support or help navigating care options.

The evidence ^[19] shows if young children need more targeted and tailored support, including parents and caregivers ^[20] in these interventions lead to the best outcomes for children, family and community wellbeing.

However, in the current discussion about new supports and NDIS, early intervention should not be seen as a substitute or alternative for ongoing disability support. Some people may continue to need support for day-to-day living in later childhood and as adults.