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

OBJECTIVE: 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. DESIGN: Single-site prospective cohort study; validated age-specific baseline screening, parent-reported outcomes at 6 weeks and 6 months. SETTING: General paediatric outpatient department, secondary hospital, Ireland. PARTICIPANTS: 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. INTERVENTIONS: The HTK comprises six evidence-based components practised for 5 minutes morning and evening, introduced during routine outpatient consultation. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.