Adolescent Health Services Research Articles

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

ABSTRACT Background: Group programmes are a common component of treatment in inpatient child and adolescent mental health service (CAMHS) units. There is evidence for specific group interventions, however, comparison across a multidisciplinary group programme is under-explored. Aims: This research examines young people's experiences of, and satisfaction with, a multidisciplinary group programme on an acute inpatient CAMHS unit. Methods: Weekly surveys were distributed to young people, and 37 responses were gathered across four months in 2018. Rates of attendance, enjoyment and perceived helpfulness of groups were calculated. Content analysis was used to explore key themes in qualitative responses. Results: Young people rated a creative activities and games group (54.05%) and the art therapy group (48.95%) as the two most enjoyable groups. Art therapy was reported to be the most helpful group overall (45.65%). Young people also expressed their dislike for verbal psychotherapy groups (43.24%), finding these confronting relative to other modalities in the programme. Conclusions: Art therapy and arts-based groups received the highest positive feedback relative to predominantly verbal psychotherapy groups. A multidisciplinary group programme which integrates art therapy and other creative modalities has the potential to enhance engagement in acute inpatient settings which may result in improved mental health outcomes for young people. Implications for future research and practice: Future research should aim to foreground young people's perspectives and experiences of therapeutic programmes, and provide opportunities for clinicians to redevelop programmes responsively to service user feedback. Survey findings support advocacy for consistent art therapy roles and services within inpatient CAMHS units.

Tackling “half” of the non-communicable disease burden in Bangladesh: a diagonal service delivery model with a life-course approach

In the context of increasing morbidity and mortality due to non-communicable diseases (NCDs) globally and particularly in low-resource countries, it has become important to explore newer health systems delivery models. In low-and middle-income countries (LMICs) women traditionally challenged with multiple barriers in accessing health services, are at even greater disadvantage compared to men. In Bangladesh, women constitute almost half of the country’s population and are disproportionately affected by NCDs like other LMICs. The country’s reproductive, maternal, newborn, child and adolescent health (RMNCAH) services are well established and designed to reach women in their households through community health workers (CHWs). This paper discusses how NCDs screening and control measures could be integrated into the existing RMNCAH pathway and proposes a conceptual model for such diagonal service delivery integration. The paper also describes multiple RMNCAH service delivery touchpoints that could be utilized for screening and treating women for NCD risk factors, across their life-course.

A Psychoeducational Workshop for the Parents of Young Voice Hearers: A Preliminary Investigation into Acceptability and Outcomes in an NHS Child and Adolescent Mental Health Service.

Hearing voices is a common experience in young people and can be associated with distress, self-harm, and an increased risk of attempting suicide. Many parents lack confidence in supporting young people who are distressed by voices. However, there are currently no evidence-based interventions to support the parents of young voice hearers. This was an uncontrolled study exploring the preliminary acceptability and outcomes of a psychoeducation workshop for the parents of young people experiencing distressing voices within a Child and Adolescent Mental Health Service (CAMHS) in the UK's National Health Service. A total of 21 parents consented to participate, 15 attended a workshop and 10 provided complete data sets. Five workshops were delivered across a seven-month period. Qualitative feedback was suggestive of acceptability and highlighted possible adaptations in relation to inclusivity, content focus and delivery format. Participants reported increased confidence and improved attitudes and beliefs towards voice hearing. The findings from this study suggest that a psychoeducational workshop within a CAMHS context can be acceptable and helpful for parents of young people with distressing voice hearing experiences. Adaptations to the workshop are required to maximise inclusion, engagement, and outcomes.

Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study.

Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray. This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05. A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization. The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.

Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review.

In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap. This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review. From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents. This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.

Health Officer Behavior in Adolescent Caring Health Services (Adolescent Care Health Services) at the Health Center

Health problems in adolescents are so complex, one of which is unwanted pregnancies due to the low level of preventive promotive efforts in adolescents that must be carried out by health workers through the Adolescent Care Health Services program.This study aims to describe the behavior of health workers in implementing the Adolescent Care Health Servicesprogram at the Kapus. A qualitative method with a case study approach has been used in this study, researchers used interviews and observations to answer the research objectives. Interviews were conducted with informants who were determined through a purposive sampling technique, then observations were made to determine the completeness of the facilities and guidelines owned by the officers.This study found that the behavior of officers in Adolescent Care Health Services services did not meet the good standards of predisposing factors, reinforcing factors and enabling factors. Another problem is the double workload, geographical conditions which are in difficult territory.For this reason, it is recommended that apparatus and leaders form innovations to increase cross-sector collaboration as an effort to overcome geographical problems by providing infrastructure in the village, increasing youth empowerment, and conducting outreach regarding the Adolescent Care Health Servicesprogram specifically for youth.

Health and Wellbeing of Conflict and Disaster-Affected Population in Cox’s Bazar. Bangladesh

Cox's Bazar, Bangladesh, and northern Rakhine State, Myanmar, are two protracted humanitarian crises that are interconnected. A number of donor interventions are aimed at facilitating community resilience and social cohesion, both within the camps and in the host communities. This study aims to assess the progress and effectiveness of an activity based on an information base and establish benchmarks for impact evaluation. In order to conduct the study, both quantitative and qualitative survey techniques were used. A representative sample size was determined for a quantitative survey, including potential qualitative interview participants. For data collection, we used a structured questionnaire, a semi-structured interview guideline, and an unstructured topic guide. We used mostly descriptive statistics with a few inferential tests for our analysis. The triangulation work was developed with information from both methods to draw a credible conclusion. Based on the results, most of the community's health conditions are improving, which confirms the concept of prevention. In terms of vulnerability indices, the highest majority seemed not as much vulnerable as their family had much aware about the traumatize/stress condition. Pregnant/Lactating Women (PLW) were not pronounced as burden by their families as majority of them made visitation for 4 ANC check-up across the study areas. The knowledge level of prevent communicable diseases were found in optimum level in all study areas. An adequate number of beneficiaries responded that malnutrition was screened and diagnosing properly and referred them in time. Moreover, sufferings from psychological issues were found common in FDMN community. In participants’ discussion, It is emphasized that adolescent should be needs of different support and information to cope up with the changes. The study concluded that significant proportion respondents have confirmed about the knowledge of preventive measures, which they learnt mainly from available service provisions. However, it is implied of introducing improve adolescent health services including an adequate supply of necessary of hygiene kits.

Parental Rights Laws and the Impact on Mental Health Services and Counseling for Adolescents.

Parental Rights Laws and the Impact on Mental Health Services and Counseling for Adolescents.

Continence Problems and Mental Health in Adolescents from a UK Cohort

BackgroundAdolescents with continence problems experience unique threats to their psychological well-being, but long-term mental health sequelae are unknown. ObjectiveTo examine prospective relationships between incontinence/lower urinary tract symptoms (LUTS) and mental health problems in young people. Design, setting, and participantsA prospective cohort study of young people (n = 7332: 3639 males and 3693 females) from a population-based sample was conducted. Outcome measurements and statistical analysisWe estimated the association between incontinence/LUTS and mental health outcomes using multivariable regression models adjusted for sex, socioeconomic position, developmental level, intelligence quotient, stressful life events, maternal psychopathology, body mass index, and emotional/behavioural problems. Results and limitationsDaytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder (eg, odds ratio for daytime wetting = 3.01, 95% confidence interval [1.78, 5.09], p < 0.001) and/or higher anxiety scores. There was also evidence of associations with common mental disorder (eg, voiding postponement: 1.88 [1.46, 2.41], p < 0.001), depression (eg, urgency: 1.94 [1.19, 3.14], p = 0.008), depressive symptoms (eg, daytime wetting: 1.70 [1.13, 2.56], p = 0.01), self-harm thoughts (eg, voiding postponement: 1.52 [1.16, 1.99], p = 0.003), and disordered eating (eg, nocturia 1.72 [1.27, 2.34], p = 0.001). We are unable to generalise our results to minority ethnic groups, less affluent populations, and non-UK samples. ConclusionsYoung people with incontinence/LUTS are at an increased risk of mental health problems. Further research is needed to establish the direction of causality. Patient summaryWe looked at the association between continence problems and mental health outcomes in young people from a large population-based cohort. Young people with continence problems at the age of 14 yr were more likely to suffer from a range of mental health problems at the age of 18 yr, including common mental disorder, depression, anxiety, self-harm thoughts, and disordered eating. Paediatric continence clinics should address the mental health needs of young people and provide clear and effective care pathways to child and adolescent mental health services.

An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service.

Demand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?. Case notes of 20 children (1-16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs. 488 children (aged 21-195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41-1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs. Typical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity.

‘Safety Nets’: a community based social prescribing intervention involving combined physical activity and psychoeducation for young people on mental health service waiting lists: a pilot service evaluation

ABSTRACT Objective Young people can face long waiting lists when accessing UK Child and Adolescent Mental Health Services (CAMHS) with limited support whilst waiting. ‘Safety Nets' was developed as a social prescribing intervention that includes physical activity and psychoeducation for young people with anxiety, depression and low mood on CAMHS waiting lists. This mixed methods service evaluation aims to show the acceptability and impact of ‘Safety Nets’ on the mental health and wellbeing of these young people. Method This study conducted a mixed-methods service evaluation of ‘Safety Nets’. 24 young people on CAMHS waiting lists for support for anxiety, depression and low mood were recruited to an 8-week group intervention, ‘Safety Nets'; delivered in five groups across four sites. Participants completed a Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) at the first and final session and completed a qualitative exit interview. Results Results showed good acceptability and engagement from all stakeholders and young people gave high satisfaction ratings. Paired WEMWBS scores in 24 young people showed an improvement of 11.6 with a 95% confidence interval 7.5–15.6. Discussion This service evaluation showed acceptability and positive impacts of ‘Safety Nets’. A large-scale trial is warranted to test the clinical and cost-effectiveness of social prescribing for children and young people on CAMHS waiting lists.

Exploring the content of self-help toolkits as an intervention for non-suicidal self-injury in young people in England.

Non-suicidal self-harm has been increasing in young people over the last decade leading to several self-help interventions being developed. Self-help toolkits are given a variety of names, such as 'hope box' and 'self-soothe kit', but all seek to provide young people with the tools to manage thoughts to self-harm by bringing together a collection of personal items, distress tolerance activities and help-seeking prompts. They represent a low-cost, low-burden and accessible intervention. This study explored what child and adolescent mental health professionals working with young people are currently recommending as the content of these self-help toolkits. A questionnaire was sent to child and adolescent mental health services and residential units across England and received 251 responses from professionals. Sixty-six per cent described self-help tool kits as being effective or very effective for helping young people manage self-harm urges. The content was categorized into sensory items (subcategorized by sense), distraction activities, relaxation and mindfulness activities, seeking positives and coping strategies, with the caveat that all toolkits should be individualized. The results of this study help to inform the future manualization of the use of self-help toolkits in clinical practice as a self-harm intervention for children and young people.

Measuring Experience of Inpatient Child and Adolescent Mental Health Services (CAMHS).

There has been an important drive towards embedding feedback and experience data to improve health services in the UK. The current paper examines the gap in evidence and the lack of adequate measures of inpatient CAMHS experience. It presents the context of inpatient CAMHS and what factors influence care experience, before exploring the current practices for measuring experience and the implications for young people and families. The paper explores the dialectic that-given the nature of the work balancing risk and restrictions in inpatient CAMHS-it is essential that patient voice is at the centre of quality measures, and achieving this comes with a great complexity. The health needs of adolescents are unique, as are the interventions of psychiatric inpatient care, but current measures in routine use are often not developmentally adapted and lack validity. This paper looks to interdisciplinary theory and practice to consider what the application of a valid and meaningful measure of inpatient CAMHS experience might incorporate. It makes the case that the development of a measure of relational and moral experience of inpatient CAMHS would have significant implications for the quality of care and safety of adolescents during a period of acute crisis.

Yoga as a school health service for adolescents suffering from primary dysmenorrhea

Primary dysmenorrhea is a common pain issue among girls in adolescence and it is characterized by the fact that is not associated with other pathological conditions. Among professionals that work in adolescent sexual and reproductive healthcare, dysmenorrhea is considered to be a periodic pain issue that can be temporarily treated by medicine, but the recurrence of the pain and the monthly discomfort have a larger impact on the lives of the adolescent girls. The voices of adolescents that reflect the need for alternative solutions as complementary therapy become more intense. Yoga as a complementary therapy can educate and contribute to the management of menstrual pain and provide a better quality of life. This article provides information about the recent research on interventions of yogic science in schools, to enhance adolescent reproductive health and help them overcome menstrual pain. It highlights the importance of using a wider spectrum of yogic tools and discusses their application to the school context, resulting in a positive effect on treating primary dysmenorrhea.

Heroin chic is in? Reflective poem by a core trainee working in child and adolescent mental health services - poem.

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Evaluation of Factors affecting effective use of Condoms in Adolescents of Mayengo Parish, Kamuganguzi Sub County, Kabale District

Unsafe sex was very common among the youth as they got involved into unprotected and unsafe sex practices due to factors like lack of parental support and guidance, breakdown of parent-child communication and cultural factors among others. The purpose of this study was to identify the factors affecting effective use of condoms among adolescents of Mayengo Parish, Kamuganguzi Sub County, Kabale District. The study design was descriptive and simple random sampling procedure was used to select 40 respondents. Data was collected by use of a semi structured interview guide. The findings showed that 40 (100%) were currently involved in a sexual relationship, 37 (92.5%) knew about the safe sex practices, 34 (85%) knew how to effectively use condoms, 35 (87%) agreed that not knowing about effective condom use had made them have live sex, 30 (75%) had ever had unsafe sex, 10 (25%) respondents said youth did not use condoms because they wanted to know how sex without a condom felt, 8 (20%) who wanted to show love to their partners, 24 (60%) sometimes used condoms while having sex, 31 (77.5%) said cross generational sexual relationships were sometimes common in their area, 25 (62.5%) always felt shy to ask for condoms at the shop/hospital, 32 (80%) intended to use protection the next time they had sex, 34 (85%) had never been sensitized about the importance of using condoms. The study concluded that although all the respondents were knowledgeable and had ever heard of safe sex practices and correctly described the effective way of using condoms, all the respondents were sexually involved. The majority of respondents had a very early sexual debut and they have had unprotected/live sex due to various reasons including curiosity and wanting to know how it felt like when having live sex, peer pressure or wanting be like their friends, nonavailability of condoms among many other factors. The majority of respondents had ever had unsafe sex. The key recommendations included adequate nationwide sensitization programs on the dangers of unsafe sex as well as what they could do to ensure safe sex, offering adolescent friendly sexual and reproductive health services, ensuring that protective gears such as condoms were provided free of charge to youth and adequate sensitization about the importance of practicing safe sex practices. Keywords: Unsafe sex, Condom use, Adolescents, Sexual debut, Safe sex.

Wellbeing while waiting evaluating social prescribing in CAMHS: study protocol for a hybrid type II implementation-effectiveness study

BackgroundSocial prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve mental health and wellbeing in adult populations. In the last few years, it has been used in child and youth settings with promising results. Currently, pathways are being developed for social prescribing in Child and Adolescent Mental Health Services (CAMHS) to support children and young people on treatment waiting lists. The Wellbeing While Waiting study will evaluate whether social prescribing benefits the mental health and wellbeing of children and young people.MethodsThis study utilises an observational, hybrid type II implementation-effectiveness design. Up to ten CAMHS who are developing social prescribing pathways as part of a programme run across England with support from the Social Prescribing Youth Network will participate. Outcomes for children and young people receiving social prescribing whilst on CAMHS waiting lists will be compared to a control group recruited prior to the pathway roll-out. Questionnaire data will be collected at baseline, 3 months and 6 months. Primary outcomes for children and young people are mental health symptoms (including anxiety, depression, stress, emotional and behavioural difficulties). Secondary outcomes include: loneliness, resilience, happiness, whether life is worthwhile, life satisfaction, and service use. An implementation strand using questionnaires and interviews will explore the acceptability, feasibility, and suitability of the pathway, potential mechanisms of action and their moderating effects on the outcomes of interest, as well as the perceived impact of social prescribing. Questionnaire data will be analysed mainly using difference-in-differences or controlled interrupted time series analysis. Interview data will be analysed using reflexive thematic analysis.DiscussionThe Wellbeing While Waiting study will provide the first rigorous evidence of the impact of social prescribing for children and young people on waiting lists for mental health treatment. Findings will help inform the prioritisation, commissioning, and running of social prescribing in other CAMHS. To maximise impact, findings will be available on the study website (https://sbbresearch.org) and disseminated via national and international networks.Trial RegistrationN/A.

Analisis Perilaku dan Kebutuhan Remaja dalam Peningkatan Kesehatan Remaja di Kota Makassar

Background: PKPR or adolescents friendly health services is a health service for adolescents and can be accessed by adolescents anywhere in Indonesia. In 2014, South Sulawesi, out of 90% of the program target of each district/city that is capable of implementing PKPR, currently only 62.5%. By the end of 2019, it is targeted that 45% of public health centers throughout Indonesia have organized youth health activities. Objectives: Analyzed the implementation of national standards for PKPR services based on five national standards for adolescents care health services, (1) Human resources in health; (2) Health facilities; (3) Youth; (4) Networks; and (5) Health Management in the health center, Makassar. Method: This type of research is a qualitative descriptive with a cross-sectional study. The interviewed informants were 12 puskesmas officers and 1 staff from the Family Health Division of Health Office. The sampling technique used purposive sampling by making criteria. Results: 11 out of 13 references stated that those implementing the PKPR were health workers. 3 out of 12 references stated that the number of trained health workers for PKPR is still small, because of the double burden of work or programs that must be handled by health workers. 10 out of 13 reference answers stated that adolescents' health service package implemented was still related to nutrition and reproductive health. Conclusion: The evaluation of the implementation of the National Standard for PKPR has been implementing in the health center. The best national standards have been implemented, was first standard (human resources in health) and second standard, health facilities, which can be described by the implementation of services inside and outside the building for educational activities to adolescents. The implementation of PKPR that has not been maximally implemented is standard 3 (youth), standard 4 (network), and standard 5 (health management).

A protocol for a multi-site cohort study to evaluate child and adolescent mental health service transformation in England using the i-THRIVE model.

The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the 'THRIVE' needs-based principles of care. The implementation protocol in which this model, 'i-THRIVE' (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young people's mental health, a cohort study design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 'comparator sites' that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young people's mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive.

Adolescents with developmental traumas in therapy in a child and adolescent mental health service, outpatient unit: experiences of daily living and expectations for therapy - a qualitative study.

Developmental trauma has a profound effect on people's lives. There are few studies of the perceived difficulties and treatment needs of adolescents with developmental trauma. More studies are called for to explore the perspectives and experiences of these patients, especially adolescents. Semi-structured interviews were conducted with eight adolescents with developmental trauma aged 14-18 years in a Child and Adolescent Mental Health Service, Outpatient Unit. The interviews were analyzed using systematic text condensation. A main finding in this study regards the participants' understanding of why they needed therapy: symptom alleviation and coping tools. They expressed a need for talking with a safe and reliable adult who understood their situation. Their stories of daily functioning and bodily sensations align mainly with symptoms described for adolescents with developmental trauma. The study also shows that the participants' experiences of trauma affected their lives to a greater or lesser extent, in the form of ambivalence, avoidance, regulation, and coping strategies. They also described various physical problems, especially insomnia and inner restlessness. Their subjective stories revealed insights into their experiences. Based on the results, we recommend that adolescents with developmental trauma be allowed to express their understandings of their difficulties and their treatment expectations at an early stage of their therapy. An emphasis on patient involvement and the therapeutic relationship can increase their autonomy and control over their own lives and treatment.