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Abstract
Child and adolescent mental health specialized services (CAMHS) are supposed to serve those who are most seriously disturbed and impaired. However, little is known about how children receiving treatment at different levels of care differ. The present study seeks to determine whether having a psychiatric disorder and resulting impairment measured in early childhood increases the odds of receiving help in CAMHS versus from community services during middle childhood or whether other factors (e.g., parenting stress, family functioning) also influence service utilization. A screen-stratified sample (n = 995 of the 2003–2004 birth cohorts) in Trondheim, Norway was assessed biennially from age 4–12 with semi-structured diagnostic interviews and recording of service use, family functioning, parental perceived need, and parenting stress. Behavioral disorders more strongly predicted CAMHS than community service use, whereas impairment predicted community service use. However, impairment increased the odds of receiving services in CAMHS if the parents perceived a need for help. Parental perceived need for help also increased the odds of CAMHS use independent of diagnosis and impairment. Having an emotional disorder, attention deficit/hyperactivity disorder (ADHD), parenting stress, previous service use, or family functioning did not predict service use at either level. Whereas children with behavioral disorders received help from CAMHS, children with emotional disorders did not receive services at either level. ADHD did not predict service use, indicating that young children with ADHD without comorbid disorders are not sufficiently detected. Efforts to detect, refer and treat emotional disorders and ADHD at the appropriate level should be increased.
Highlights
Psychiatric disorders in children are prevalent, with a current global estimated prevalence of 13% [1]
The results of studies exploring these factors as predictors of children’s use of Child and adolescent mental health specialized services (CAMHS) have been inconsistent [10,11,12,13]. While these studies have demonstrated that external factors, such as parental burden and ethnicity, influence service use, none have examined whether predictors of CAMHS and community services differ
Our findings indicate that these services are underutilized or that the children in our sample had severe behavioral disorders or comorbid psychiatric disorders warranting referral to CAMHS
Summary
Psychiatric disorders in children are prevalent, with a current global estimated prevalence of 13% [1]. Many children with psychiatric disorders do not receive treatment [2,3,4]. Mental health services are costly, but the consequences of not receiving help are even larger [5]. It is assumed that patients receiving treatment in CAMHS will fulfill diagnostic criteria and be admitted based on characteristics of their mental health problems. The results of studies exploring these factors as predictors of children’s use of CAMHS have been inconsistent [10,11,12,13]. While these studies have demonstrated that external factors, such as parental burden and ethnicity, influence service use, none have examined whether predictors of CAMHS and community services differ. The Method section provides more information about these services in Norway; the country where the present study was conducted
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