ArticleBMJ paediatrics open2026
Happiness Toolkit in a paediatric outpatient setting for children with social, emotional, behavioural and/or mental health difficulties: a prospective cohort study.
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo 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.
designSingle-site prospective cohort study; validated age-specific baseline screening, parent-reported outcomes at 6 weeks and 6 months.
settingGeneral paediatric outpatient department, secondary hospital, Ireland.
participantsConsecutive 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.
interventionsThe HTK comprises six evidence-based components practised for 5 minutes morning and evening, introduced during routine outpatient consultation.
main outcome measuresPrimary: 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.
results240 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.
conclusionsThis 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.
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