Happiness Toolkit in a paediatric outpatient setting for children with social, emotional, behavioural and/or mental health difficulties: a prospective cohort study.

Authors

Kate Eustace, Sarah Alexandra McCrory, Farhana Sharif

Published in

BMJ paediatrics open. Volume 10. Issue 1. Sep 19, 2026. Epub Sep 19, 2026.

Abstract

To evaluate the feasibility, acceptability and clinical outcomes of the Happiness Toolkit (HTK), a structured, low-intensity, family-delivered intervention for children aged 0-16 years screening positive for social, emotional, behavioural and/or mental health difficulties (SEMHD) in a paediatric outpatient setting.
Single-site prospective cohort study; validated age-specific baseline screening, parent-reported outcomes at 6 weeks and 6 months.
General paediatric outpatient department, secondary hospital, Ireland.
Consecutive paediatric outpatient attendees screening positive for SEMHD on the Ages and Stages Questionnaires: Social-Emotional, Second Edition (under 6 years) or Screen for Child Anxiety Related Emotional Disorders questionnaire (6-16 years) were enrolled for intervention.
The HTK comprises six evidence-based components practised for 5 minutes morning and evening, introduced during routine outpatient consultation.
Primary: consent rate, positive screen rate and 6-week response rate (feasibility); parental willingness to recommend (acceptability). Secondary: parent-reported functional changes at 6 weeks and 6 months, component uptake and adverse events.
240 of 277 families approached across 16 outpatient clinics consented (86.6%); 94 children screened positive for SEMHD (39.2%) and received the HTK. At 6-week follow-up (n=46; 48.9% response rate), 95.2% of parents reported a positive or very positive experience, 73.9% noted improved mood in their child, 43.5% reduced screen time and 37.0% improved sleep patterns. 97.8% would recommend, with no adverse events. At 6-month follow-up (n=13; 13.8% response rate), 61.5% reported sustained child mood improvement and 92.3% would still recommend.
This study demonstrates strong feasibility and high parental acceptability for the HTK when embedded in routine paediatric outpatient care. Parent-reported improvements at 6 weeks and no adverse events at both time points support progression to a controlled evaluation. In Ireland, 4462 children await Child and Adolescent Mental Health Services and over 28 000 await primary care psychology; the HTK represents a promising, pragmatic early and bridging support for emerging SEMHD.

PMID:
42763108
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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