Art and other group therapies with adolescents in inpatient mental health care

Transition from child-centred to adult mental health services has been reported as challenging for young people. It can be especially difficult for young people with autism spectrum disorder (ASD) as they manage the challenges of adolescence and navigate leaving child and adolescent mental health services (CAMHS). This study examines the predictors of transfer to adult mental health services, and using a qualitative analysis, explores the young people's experiences of transition. A UK sample of 118 young people aged 14-21 years, with ASD and additional mental health problems, recruited from four National Health Service trusts were followed up every 12 months over 3 years, as they were discharged from CAMHS. Measures of mental health and rich additional contextual information (clinical, family, social, educational) were used to capture their experiences. Regression and framework analyses were used. Regression analysis showed having an attention-deficit hyperactivity disorder diagnosis and taking medication were predictors of transfer from child to adult mental health services. Several features of young people's transition experience were found to be associated with positive outcomes and ongoing problems, including family factors, education transitions and levels of engagement with services. The findings show the importance of monitoring and identifying those young people that might be particularly at risk of negative outcomes and crisis presentations. Although some young people were able to successfully manage their mental health following discharge from CAMHS, others reported levels of unmet need and negative experiences of transition.

AimsTo investigate the themes within young people and parents/carers’ experiences of the admission process. A focus was placed on potential targets for change to improve experiences of CAMHS admission.MethodsYoung people and parents/carers with an experience of inpatient CAMHS admission within the past two years were approached by the Involvement team of an NHS trust. Focus groups and interviews were conducted capturing the views of 8 young people and two parents/carers. The notes and transcripts from these conversations were analysed using Braun and Clarke thematic analysis.ResultsTwo key themes were identified within the data. The first focussed on information provision and communication. This captured young people's experiences of both: what information was available to them, e.g., websites and leaflets, and how this information was conveyed to them. The second theme brought together the young people's interpersonal experiences during the admission process. Within this, the impact of consistent contacts as well as both positive and negative transient encounters was highlighted.ConclusionAdmission to a psychiatric ward is often a highly distressing time for young people and their families. The provision of easily accessible, clear, and correct information can improve their expectations and initial impressions of a unit. How this information is presented is also important. Consistent staff support and response to distress and difficulties during this time can also shape the perspectives of young people and their parents/carers.Clear, accurate, and young person friendly information about a unit and the admissions process could be an easily achievable change which units could make to improve young person experiences. Improvements to clinicians’ skills and response may represent a more complex and expensive goal.

Snakes and Ladders: The experience of being referred to and seen by Child and Adolescent Mental Health Services

The aim of this systematic review was to synthesise qualitative evidence on young people's conceptualisation, utilisation and experiences of the therapeutic alliance in individual psychotherapy or counselling and its role in bringing about change. The thematic synthesis method was used to synthesise data. The methodological quality of included studies was assessed using the CASP checklist for qualitative research. Four superordinate analytical themes were generated: (1) valuable therapist qualities, (2) conditions for the development and maintenance of the therapeutic alliance, (3) therapeutic processes and (4) barriers to the development of the therapeutic alliance. Findings indicate that young people appreciated the uniqueness of the therapeutic relationship that provided a sense of safety, choice and autonomy. Flexibility and accessibility were noted as important elements of therapeutic alliance building as they elicited a sense of agency. Young people emphasised the non-linear nature of therapy and prioritised process variables such as improvement in self-understanding, self-efficacy and self-worth. The current systematic review is a comprehensive overview of qualitative studies of experiences of therapy from young people's perspectives. Important practical implications derived from this review as the role of autonomy in the change process and the formation and maintenance of the therapeutic relationship were outlined as important elements in youth therapy.

The stories behind stories: Reflections on the role of voice in research with unaccompanied refugee youth

In 2020, Attend Anywhere video consultation service was introduced across the Irish public health service to facilitate the provision of health interventions remotely in light of COVID-19-related restrictions. This study aims to explore the experiences of young people, their parents and their clinicians, of using the newly introduced Attend Anywhere video consultation as part of their Child and Adolescent Mental Health Service (CAMHS). A cross-section of twenty-nine young people, their parents and clinicians working in CAMHS Clare completed a survey pertaining to their experiences of using Attend Anywhere as part of their service. A cross-disciplinary research steering group of CAMHS clinicians adapted the NHS Scotland evaluation of Attend Anywhere / Near Me survey to better capture experiences in a CAMHS setting. The survey included both quantitative and qualitative items. Descriptive statistics were used to examine quantitative data. Qualitative data was analysed using Thematic Analysis. Results demonstrated a decrease in the number of barriers reported by clients and professionals in accessing the CAMH service following the introduction of Attend Anywhere video consultation. Overall, the majority of professionals reported that they would use Attend Anywhere again, whereas almost a quarter of clients reported that they did not wish to use it again. Clients indicated a preference for receiving face-to-face services over other service provision options and this finding was associated with not having to rely on technology or manage connectivity issues and finding it easier to build the therapeutic relationship in-person. Findings suggest that both professionals and clients value face-to-face service provision while also acknowledging the benefits of Video Enabled Care in overcoming access barriers. We conclude that VEC be offered as an option in a blended service model, in conjunction with rather than as a replacement of face-to-face service provision.

This paper offers a review of how the role of Art Therapy is represented in four important areas: In Specialist (Tier 3) Child and Adolescent Mental Health Services (CAMHS) in England, in government and related documentation and polices, within broader literature pertaining to Child and Adolescent Mental Health Services, as well as in Art Therapy publications. The author found that there are shortcomings in the understanding of the profession including the unique role that art therapy offers, as well as an evident lack of inclusion across the range of literature. The author contends that central factors exerting influence include powerful socio-politico-economic agenda and influence, unprecedented change in the field of psychological therapies, unconscious processes, and limited self-promotion. The paper argues that lack of clarity and effective promotion of the unique role of art therapy may lead to there being a lack of consideration of art therapy or for art therapy to be decommissioned in CAMHS. The review has worldwide relevance to those concerned with practice, promotion and commissioning of art therapy in services that work children and young people with mental health and psychological needs. Keywords: socio-politico agenda, promotion, representation, NHS publications, child and adolescent mental health services

Nitrous oxide (N2O) use for intoxication among young people has increased in many parts of the Western world, including Denmark. The literature, however, primarily focusses on harms related to N2O use, and not on other aspects, for example modes of administration or effects such as different forms of pleasure or fun. Therefore, despite this increase, we still know very little about how and why young people use nitrous oxide for intoxication, including their experiences of N2O intoxication. Based on 45 qualitative interviews with young Danes age 18-25 years, who all were former or present N2O users, we explore their experiences of N2O intoxication. We do this by analyzing in-depth descriptions of where, how and with whom they use N2O. When analyzing these descriptions in relation to different modes of administration, intensity of use, combination with other substances (e.g. alcohol, cannabis), and use in different settings, we argue that N2O intoxication is experienced differently by the young participants. Some of the participants also searched for particular intoxication experiences with N2O. We unfold the participants' various descriptions of intoxication by differentiating between moderate and intensive use. Overall, our study shows that these differences in N2O use for intoxication are not equally risky or harmful. In general, young people's own perspectives and experiences with (illegal) drug use is increasingly emphasized as important to include when developing preventive interventions. Our analysis of the young participants' differing experiences with N2O for intoxication can inform future prevention initiatives in relation to harms of N2O intoxication.

BackgroundIn the UK young people attending child and adolescent mental health services (CAMHS) are required to move on, either through discharge or referral to an adult service, at age 17/18, a period of increased risk for onset of mental health problems and other complex psychosocial and physical changes. CAMHS transitions are often poorly managed with negative outcomes for young people. Better preparation may improve outcomes and experience. This study aimed to co-produce, with young people who had transitioned or were facing transition from CAMHS, a CAMHS Transition Preparation Programme (TPP), deliverable in routine NHS settings.MethodsEighteen young people, aged 17–22, from three UK National Health Service (NHS) mental health foundation trusts participated in creative, participatory research workshops. Seven parents completed short questionnaires. Thirty clinical staff from two trusts took part in workshops to ensure deliverability of young people’s ideas. Young people were offered co-research opportunities.ResultsMost young people felt anxious, fearful and uncertain on leaving CAMHS and perceived mental health services as uncaring. Participants outlined transition procedures and drafted a range of preparation activities, centred around dedicated Transition Peer Support and a transition booklet, which should be offered to all CAMHS leavers, irrespective of discharge or transfer to an adult service. Preparation should aim to build confidence to help young people take responsibility for themselves and flourish in the adult world: coping or getting through it was not enough. Some clinicians also felt anxious at transition and recognised the potential impact on young people of poor communication and lack of understanding between services. Parents would appreciate help to support their offspring during the transition period. Clinicians cited lack of funding and inflexible NHS procedures and policies as potential barriers to the implementation of young people’s ideas. Nine young people took up co-research opportunities.ConclusionsMental health services underestimate the anxiety of CAMHS leavers. Young people have clear ideas about the preparation they require to leave CAMHS with the confidence to take responsibility for their own health care. Close collaboration of NHS staff and researchers facilitates the implementation of research findings.

The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person’s care). To our knowledge, this is the first qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings to existing literature regarding barriers to transition and the effects of discontinuity of care.

BackgroundThere is little research on the process of transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). More recently, there is growing recognition that Attention Deficit/Hyperactivity Disorder (ADHD) may persist into adulthood requiring services beyond age 18. However, despite National Institute for Health and Clinical Excellence (NICE) Guidance which recommends specialist services for adults with ADHD, there is currently a lack of such services in the UK. The aim of the current study is to explore the experiences of young people with ADHD during transition from CAMHS to AMHS.MethodSemi-structured qualitative interviews with ADHD patients accessing CAMHS clinics in Nottinghamshire were analysed using thematic analysis.ResultsTen semi-structured interviews were transcribed and analysed. We found that patients’ relationships with their clinician were a key factor in both their reported experience of CAMHS and the transition process. Perceived responsibility of care was also pivotal in how the transition process was viewed. Nature and severity of problems and patients expectations of adult services were also contributing factors in the transition process. The need for continued parental support was openly accepted and thought to be required by the majority of young people with ADHD during transition.ConclusionsTimely preparation, joint working, good clinician relationships and parental support serve to facilitate the process of transition for young people with ADHD. Nature and severity of problems are perceived to impede or facilitate transition, with predominantly more ‘complex presentations’ with associated mental health problems more familiar to AMHS (e.g. self-harm, depression) making for smoother transitions to adult services. Transitions to AMHS were more difficult when ADHD was viewed as the main or sole clinical problem. Further exploration of young people’s experiences of transition and their engagement with and experience of adult services is required to provide an overall picture of facilitators to successful transition and integration into adult services.

BackgroundHearing voices is a common experience in young people, irrespective of diagnosis. This experience can be associated with distress, self-harm and an increased risk of attempting suicide. However, there are currently no evidence-based interventions which specifically target distressing voice hearing experiences in young people.MethodThis was a service evaluation exploring the engagement, outcomes and experiences of young people who were offered a brief 4-session intervention for distressing voices within a Child and Adolescent Mental Health Service (CAMHS) in the UK’s National Health Service. The intervention was based on the principles of Coping Strategy Enhancement (CSE).ResultsA total of 24 young people were offered the CSE intervention over a 20-month period. The intervention was completed by 15 young people. Pre-post outcomes suggested clinically meaningful reductions in the negative impact of voices for the majority of the young people. Qualitative feedback was positive and highlighted the value of both a space to talk about voice hearing experiences and a focus upon coping strategies.ConclusionsThe findings from this service evaluation suggest that CSE can be a brief, acceptable and helpful way for young people within a CAMHS context to start a therapeutic conversation about their distressing voice hearing experiences.

Collaboration and co-production with service users and providers in three National Health Service (NHS) mental health foundation trusts, was at the heart of our recent study. The aim was to...

Modern social work practice increasingly emphasizes the inclusion of service users in decision making during the service provision process. There is a growing movement within the child welfare system to include parents and the wider family network in decision making. However, children and young people's roles in child welfare system participatory processes where decisions are made about their lives have been understudied. The family group conference (FGC) is one such decision‐making process, which has been adopted internationally with the expectation that children and young people's voices and perspectives, along with their family members, will be elevated and influence decisions. As part of a 3‐year federal project of FGCs in one jurisdiction, this study collected fidelity data from professional and family member participants of FGCs, including children and young people. Descriptive data from a small sample of child and young people participating in FGC suggest differences in their perspectives regarding family empowerment, transparency, and inclusion in decision making, when compared with the perspectives of other family members and professionals for whom data are available. Suggestions for further reflection on FGC practice and additional ways to understand children and young people's perspectives about their involvement are noted.

Research on childhood epilepsy has predominantly used quantitative methodologies to examine the impact of epilepsy on young people and their families. These studies generally give a negative picture of the condition, which is at odds with a strengths-based social work perspective, and provide little understanding of young people's experiences of living with epilepsy. A systematic review of qualitative studies that explored young people's perspectives was conducted. Inclusion criteria were as follows: young people ages 13 to 18 years diagnosed with epilepsy, qualitative data collection methods, studies published in English-language peer-reviewed journals, and gray literature. Of 501 abstracts identified, 52 full-length texts were reviewed, with 17 studies being included for final analysis. The emergent themes were seizures and medications; relationships; issues and concerns involving their families, peers, and schools; and young people's reactions to epilepsy. It is essential to understand issues presented by young people for improving practice and developing services, as these issues highlight areas for potential social work interventions. It is also essential to adopt a strengths perspective when considering these findings and implications for hospital social work, as young people's experiences were not always negative.