title: Cluster-randomised controlled trial of an occupational therapy group intervention for children designed to promote emotional wellbeing: study protocol.
abstract: BACKGROUND
  Symptoms of anxiety and depression are common in childhood, as are risk factors that undermine wellbeing: low self-esteem and limited participation in daily occupations. Current treatments focus primarily on modifying internal cognitions with insufficient effect on functional outcomes. Occupational therapists have a role in measuring and enabling children's functional abilities to promote health and wellbeing. To-date there is no evidence for the use of occupational therapy as an intervention to promote mental health or increase self-esteem, participation and wellbeing in a preventative context. The aim of this cluster-randomised controlled study is to investigate the effectiveness of an 8-week occupational therapy group intervention (Kia Piki te Hauora) at reducing symptoms of anxiety and depression and improving self-esteem, participation and wellbeing in children aged 11-13 years.
  
  
  METHODS
  In this two-arm, pragmatic, cluster-randomised controlled trial, 154 children will be recruited from 14 schools. All mainstream schools in the region will be eligible and a convenience sample of 14 schools, stratified by decile ranking (i.e. low, medium, and high) will be recruited. Eight to twelve students aged 11-13 years from each school will be recruited by senior school personnel. Following consent, schools will be randomised to either the intervention or waitlist control arm of the trial. The study will employ a parallel and one-way waitlist-to-intervention crossover design. Each cluster's involvement will last up to 19 or 31 weeks depending on allocation to the intervention or waitlist respectively. The primary outcome is symptoms of anxiety and secondary outcomes are symptoms of depression, self-esteem, participation in daily occupations and wellbeing. Outcome measurement will be repeated at baseline, post-intervention and again at 8-9 weeks follow-up. Planned statistical analyses will utilise repeated measures analysis of covariance. The primary analysis will be based on an intention-to-treat analysis set and include only parallel data. The crossover data will only be used in secondary analyses.
  
  
  CONCLUSIONS
  This is the first cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. Results will contribute to the limited evidence base for occupational therapists in this field and potentially support investment in these services.
  
  
  BACKGROUND
  Australia/New Zealand Clinical Trials Register: ACTRN12614000453684.
authors.affiliation: Auckland University of Technology, Centre for Person-Centred Research, AUT University, Private Bag 92006, Auckland, 1142 New Zealand.
authors.forename: Ema
authors.initials: E
authors.lastname: Tokolahi
authors.affiliation: Centre for Person-Centred Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand.
authors.forename: Clare
authors.initials: C
authors.lastname: Hocking
authors.affiliation: Centre for Person-Centred Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand.
authors.forename: Paula
authors.initials: P
authors.lastname: Kersten
authors.affiliation: Department of Biostatistics and Epidemiology, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand ; Health Intelligence & Informatics, Ko Awatea, Counties Manukau District Health Board, Private Bag 93311, Auckland, 1640 New Zealand.
authors.forename: Alain C
authors.initials: AC
authors.lastname: Vandal
keywords: Anxiety; Children; Depression; Health promotion; Occupational therapy; Participation; Schools; Self-esteem; Wellbeing