Showing papers in "Child and Adolescent Mental Health in 2004"

Bullying: Recent Developments

Abstract: As part of the increasing human rights agenda of the last century, the individual right not to be bullied or harassed in school has gathered considerable academic, social and political attention. This article reviews recent developments in this area, including: the definition and scope of bullying behaviours; roles in bullying; methods of study; correlates of bully and victim status; coping strategies, and peer support against bullying; the outcomes of large-scale intervention studies; and suggestions for future action.

The Home Observation for Measurement of the Environment Revisited

Abstract: This review describes the Home Observation for Measurement of the Environment (HOME). After describing the structure of the instrument, it shows how it has been used successfully in studies on normally developing children and on samples drawn from high-risk populations. These are followed by studies showing how the HOME has been used to evaluate interventions. Although most interventions are not designed primarily on the basis of the HOME outcomes, the instrument has been used as a measure of the effectiveness of the intervention schedule. HOME has been used extensively in research to reveal relationships between several aspects of the home environment and children's developmental outcomes. The very good relationship between HOME scores and children's measures of developmental competence has also been found in non-normative populations and research has attempted to identify the specific aspects of the home environment, as indexed by the HOME subscales that reveal the strengths or the weaknesses of homes of at-risk populations.

Multisystemic Treatment of Antisocial Adolescents in Norway: Replication of Clinical Outcomes Outside of the US

Abstract: BACKGROUND: MST is an intensive home- and community-based intervention for youths with serious antisocial behaviour and other serious clinical problems, which has been effective at reducing out-of-home placements and producing favourable long-term clinical outcomes in the US. The aims of the study were to determine the degree to which these outcomes would be replicated in Norway for youths with serious behaviour problems and to conduct a randomised trial of MST by an independent team of investigators. METHOD: Participants were 100 seriously antisocial youths in Norway who were randomly assigned to Multisystemic Therapy (MST) or usual Child Welfare Services (CS) treatment conditions. Data were gathered from youths, parents, and teachers pre- and post-treatment. RESULTS: MST was more effective than CS at reducing youth internalising and externalising behaviours and out-of-home placements, as well as increasing youth social competence and family satisfaction with treatment. DISCUSSION: This is the first study of MST outside of the US and one of the first not conducted by the developers of MST. The findings replicate those obtained by MST's developers and demonstrate the generalisability of short-term MST effects beyond the US. (Abstract Adapted from Source: Child and Adolescent Mental Health, 2004. Copyright © 2004 by The Association for Child and Adolescent Mental Health; Blackwell Publishers, Inc.) For more information on Multisystemic Therapy, a Blueprints for Violence Prevention Model program, see VioPro record number 2261. Norway Foreign Countries Offender Treatment Offender Substance Use Alcohol Use Effects Alcohol Related Violence Alcohol Use Treatment Drug Use Treatment Drug Use Effects Drug Related Violence Substance Use Treatment Substance Use Effects Substance Use-Violence Co-Occurence Juvenile Offender Juvenile Violence Juvenile Treatment Violence Treatment Family Based Community Based Multisystemic Therapy Blueprints Model Reference Program Effectiveness Program Evaluation Juvenile Behavior Juvenile Antisocial Behavior Behavior Treatment Multisystemic Therapy 02-06

Serious Emotional Disturbance in Children and Adolescents: Multisystemic Therapy.

Abstract: Part I. Essential Clinical Processes. Introduction to Multisystemic Therapy. MST Principles and Process. Family Interventions and Building Indigenous Family Supports. Social System Interventions: Service System, School, and Peer. Part II. Adapting MST to Treat Youths with Serious Emotional Disturbance. Addressing Psychiatric Emergencies: Staffing, Assessment, and Intervention Protocols, with Susan G. Pickrel. MST-Based Continuum of Care. Case Examples. Part III. Outcomes, Ongoing Research, and Program Development. MST Outcomes and Ongoing Research. MST Quality Assurance: Promoting Effective Implementation in the Field.

The Global Absence of Child and Adolescent Mental Health Policy

Abstract: Background: Few policies designed specifically to support child and adolescent mental health exist worldwide. The absence of policy is a barrier to the development of coherent systems of mental healthcare for children and adolescents. Method: This study collected data on existing policies from international databases, WHO headquarters in Geneva, Switzerland, and in consultation with experts in child and adolescent psychiatry from around the world. A set of criteria for ranking the adequacy of these policies was developed. Results: Though no single country was found to have a mental health policy strictly pertaining to children and adolescents alone, 35 countries (corresponding to 18% of countries worldwide) were found to have identifiable mental health policies, which may have some beneficial impact on children and adolescents. Though little has been achieved worldwide in this area, there has been a significant degree of movement towards policy development in the past 10 years. The policies identified vary greatly in terms of their provisions for delivering services, initiating research, training professionals, and educating the public. Conclusions: The development of mental health policies is feasible and would substantially aid in the expansion of service systems, the institutionalisation of culturally relevant data gathering, and the facilitation of funding.

Multi‐Agency Collaboration: The Challenges for CAMHS

Abstract: The importance of multi-agency collaboration has been emphasised in virtually every piece of recently published guidance relating to the development of children's services including CAMHS. The Government Green Paper, Every child matters (DfES, 2003), which proposes the development of Children's Trusts, will further impact on this agenda. Surprisingly, there has been much less written about factors contributing to the success of multi-agency collaboration than there has about barriers to it. Research is beginning to emerge informing on key criteria required for the development of multi-agency collaborations for children with mental health problems. Much work remains to be undertaken on the use of language and definitions between agencies before a common understanding about children's needs and the services they require can evolve.

Coping Strategies Employed by Adolescents with Gambling Problems

Abstract: Background: This study explored the relationship between coping styles, gambling behaviours and substance use amongst adolescents. Method: Five hundred and eighty-seven students, aged 12 to 17, volunteered to participate and completed all scales. Participants completed a gambling screen (DSM-IV-J), coping scale (CISS), and a questionnaire developed to assess types and patterns of gambling behaviours (GAQ). Results: The results suggest that those youths who gamble excessively exhibit coping styles that are more emotion based, avoidant, and distraction-oriented. Conclusions: The results suggest a need to teach high-risk youth more effective active coping strategies in order to minimise their potential for engaging in addictive behaviours. Such efforts should form a substantial part of school-based prevention initiatives.

The Interface Between Physical and Mental Health Problems and Medical Help Seeking in Children and Adolescents: A Research Perspective

Abstract: This paper addresses child and adolescent psychopathology as it presents to general practitioners and paediatricians, and explores psychosocial aspects of unexplained medical symptoms in children and adolescents. High rates of psychopathology have been identified amongst children and adolescents attending general practice and paediatric services, most of it ‘‘hidden’’ at presentation and emotional in nature. It is often linked to poor physical well being and to maternal stress focused on the child. It may be of special relevance to medical help seeking in socio-economically advantaged areas. Co-morbid psychopathology, mainly emotional disorders, is common amongst children with unexplained medical symptoms. However, there are specific psychosocial aspects that differentiate these children from those with emotional disorders. They involve disease beliefs, illness behaviour and predicament. The latter may be characterised by special reactivity to stress in children with personality vulnerability, in a context of parents with high levels of mental distress, unexplained medical symptoms and emotional over-involvement with the child. There is comparatively little interface work between CAMHS and primary health care. An important research priority would seem to lie in the development of interventions that can be adapted for use by primary care staff. Similarly, there are few dedicated CAMHS paediatric liaison teams. Their more extensive development should help attend in a more informed and focused way than at present to children and adolescents suffering from unexplained physical symptoms and disorders. Further research is needed into vulnerability mechanisms and maintaining factors, health beliefs, treatment engagement and interventions.

Providing Specialist Psychological Support to Foster Carers: A Consultation Model.

Abstract: Background: The task of fostering today is a complex one and foster carers need good quality support. This paper discusses a consultation service for foster carers. Method: It draws upon our qualitative experiences to explore the important themes that have emerged during the provision of the consultation service. Results: Foster carers are highly satisfied with the consultation service, which provides them with improved levels of access to psychological advice, a different understanding of the children, and continuing support if required. Discussion: The reasons for this satisfaction, together with some of the difficulties we have experienced, are explored. Experimental research is needed to investigate the complex relationship between consultation, support, confidence and understanding for foster carers and to consider the long-term effects of consultation for the carer and the child.

Child and Adolescent Mental Health within Primary Care: A Study of General Practitioners' Perceptions.

Abstract: Background: Primary Care teams play an important role in the provision of mental health care to children and young people. Methods: We developed and distributed a questionnaire to all General Practitioners within one Health Authority area. Results: Many of the respondents rated as less than satisfactory their competence and their knowledge and skills in important areas of child and adolescent mental health practice. A significant minority expressed a high level of interest in child and adolescent mental health and most respondents reported that they would value further training. Conclusions: General Practitioners should be provided with more training and support in their role as providers of child and adolescent mental health care.

Auditory Hallucinations in Nonpsychotic Children: Diagnostic Considerations

Abstract: Background: Auditory hallucinations in childhood and adolescence are not necessarily an indication of psychosis, but are more frequently associated with a range of other mental health problems. Although not specifically linked to abuse as an aetiological factor, the literature reporting on hallucinations in children alludes to a range of family dysfunction and disruption. Method: This study reports on the auditory hallucinations of 13 children referred to a community-based child and family mental health service exhibiting a variety of emotional and behavioural difficulties. The presence of the hallucinations was generally revealed during the course of the initial assessment. Results: None of the children were considered psychotic at initial presentation; however, all were experiencing high levels of stress and/or anxiety in their lives. Following the initial assessments children were given diagnoses ranging from generalised anxiety disorder, through adjustment disorder, to posttraumatic stress disorder. The hallucinations gradually disappeared over the course of therapy. Two case studies describe the hallucinations and family histories in more detail. Conclusions: The present study adds further confirmation of the presence of auditory hallucinations in nonpsychotic children. The clinical presentation of the children in the present study indicates an association between hallucinations and high levels of stress and anxiety, suggesting that mental health professionals should enquire more routinely about auditory hallucinations, particularly with those children from abusive and violent backgrounds.

Speech and Language Therapy: Its Potential Role in CAMHS.

Abstract: This review examines the implications of a recent systematic review of speech and language therapy interventions for child mental health services. The premise is that communication skills and mental health are closely related and that intervention in the one field may have an impact on skills and achievement in the other. The paper begins by discussing what we know about the relationship between speech/language and behavioural difficulties; it then reports results from the review, before examining the implications for practice and policy.

Dangerous Children: Assessment and Management of Risk

Abstract: Background: Workers in the field of child health appear to be presented with increasing numbers of young people who exhibit behaviours that pose a potential or actual risk to the safety of others. Method: A review of the current literature on the assessment and management of these children and adolescents was conducted. Results: A history taking check-list has been devised on the basis of what is known about current associations with background and current factors and violent acts directed to others. There is emerging evidence of interventions that may be effective in reducing long-term risks in such youths. However, these are often resource intensive and may be less effective in older children and adolescents. Conclusions: Faced with the challenge of assessing and managing severely conduct disordered children, child and family mental health teams should develop formalised assessment procedures and protocols for managing risk factors in a multi-agency context.

Working with Young People with Complex Needs: Practitioners’ Views

Abstract: Background: We report the findings of a descriptive study exploring the views of practitioners working with young people with especially challenging and complex problems, currently cared for by children's services across Yorkshire. We present data on a sample of 79 young people with complex needs, aged 7 to 16 years, in contact with one or more of the children's services. Method: We identified the practitioner working most closely with each of these young people. The practitioners were interviewed using a semi-structured interview schedule designed to encourage professionals to reflect on working practices. Interviews were recorded and transcribed and themes categorized using a coding framework. Results and conclusions: We describe and discuss the key themes in the context of current strategic developments of children's services.

School-Based Open Access Parenting Programmes: Factors Relating to Uptake

Abstract: Background: Many parents of children with conduct problems do not seek professional help. Method: A new questionnaire examining the beliefs about the problem behaviour, together with the Strengths and Difficulties Questionnaire, was administered to all parents of five reception year classes. They were then invited to attend school based group parent training. Results: Attendance was associated with the beliefs that there was potential for change and the child's behaviour adversely affecting the parent, but not with the child's behaviour adversely affecting the child. Conclusions: These findings may be of use when devising promotion for parent training.

A Home and School Support Project for Children Excluded from Primary and First Year Secondary School.

Abstract: Background: In the last 10 years the problem of exclusion has reached a crisis point. Research suggests that exclusion is a complex phenomenon that needs involvement from all the involved services such as Health, Education and Social Services. Method: One hundred and twenty-four pupils, aged 4–12 years who, through school and social exclusion, were at risk of developing more serious mental health difficulties, were randomly allocated to standard care (n = 62) or standard care plus the new intervention (n = 62). Results: There were no significant differences in the primary outcomes between the two groups at either of the outcome assessments. However, the intervention group with non-compliance cases removed from the analysis did significantly better ( p < . 014, 95%CI −12.8 to −1.4). Conclusions: The Home and School Support project managed to reduce the number of excluded days and the appearance of mental health symptoms for pupils who engaged fully with the intervention. The project also highlights the importance of multi-agency involvement at a very early stage.

Understanding children and young people's rights to confidentiality

Abstract: This article develops some themes in relation to young people and confidentiality by focusing on recent guidance from the Department of Health. The Child and Adolescent Faculty of the Royal College of Psychiatrists, Julian Sheather and Rebecca Mussell from the BMA, and Colin Hawkes and Eileen Vizard from the Young Abusers Project greatly assisted.

The Impact of Primary Mental Health Workers on Referrals to CAMHS

Abstract: Background: This paper describes the impact of a new primary mental health team within the existing child and adolescent health service on referrals and attendance rates. Method: 100 referrals to CAMHS from prior to the PMHT and 100 referrals prior to the evaluation were examined and classified as appropriate or inappropriate for CAMHS. Information was also gathered as to whether the child and/or family attended for their appointment with CAMHS. Results and Conclusions: a large increase in attendance and decrease in non-attendance rates to CAMHS was seen. The referrals to CAMHS have become more appropriate for a psychiatry service. However, the service provoked a mixed response from Tier 1 professionals. Recommendations are made for the skills needed by primary mental health workers and further evaluative techniques.

Need for Child Mental Health Consultation and Paediatricians' Perception of these Services: A Survey in the West Midlands.

Abstract: Background: High rates of psychopathology have been noted in children presenting to GP surgeries and paediatricians. However, paediatricians do not always recognise this and when they do the Child and Adolescent Mental Health Service (CAMHS) is often unable to meet their consultation needs. Method: This postal survey looked at paediatricians’ perception of the need for child psychiatry consultation in the West Midlands. Results: The survey confirmed that paediatricians see a significant proportion of children with mental health problems and the findings showed that their need for child psychiatry consultation was not being adequately met. Lack of access to CAMHS was a significant issue. Conclusions: This has implications not only for further development of consultation services within CAMHS but also for improving training in child psychiatry for paediatricians in a more formalised way.

The Role and Value of a Paediatric Specialist Neurodevelopmental Diagnostic Service: Parental Perceptions.

Abstract: Background: This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth. Method: Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance. Results: 87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents’ self-identified concerns about their child decreased.

Cognitive Therapy for Children, Young People and Families: Considering Service Provision.

Abstract: Background: This article presents a case for the development of cognitive therapy services for children, adolescents and their families. Method: The theoretical basis of cognitive therapy is described, and illustrated with a case. The article continues by exploring the context for service development, with a specific emphasis on evaluating the evidence-base for using cognitive therapy with children and adolescents. Consideration is also given to adapting cognitive therapy to the child's developmental level, and the evidence for the efficacy of cognitive-behavioural family approaches. Conclusions: The article concludes by arguing that there is a need to address mental health difficulties in young people by providing effective treatment approaches. The development of cognitive therapy services would support the further evaluation of this therapeutic approach.