Adolescent Health Services Research Articles

The Impact of Introducing Midwives and also Mentoring on the Quality of Sexual, Reproductive, Maternal, Newborn, and Adolescent Health Services in Low- and Middle-Income Countries: An Integrative Review Protocol.

Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what midwives need to realize their full potential. There are gaps in the definition of a midwife and an understanding of effective means to support the implementation of midwifery care. Mentorship has been found to support systems and healthcare providers to improve care availability and quality. We describe the methodology of an integrative review that aims to generate evidence of the impact of introducing midwives and also on-site facility mentoring to better understand facilitators and barriers to implementation of the quality and availability of SRMNAH services in low- and middle-income countries (LMICs). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to carry out the integrative review. Four electronic bibliographic databases, PubMed MEDLINE, EMBASE, Scopus, and CINAHL, will be used to identify eligible studies. All types of qualitative or quantitative studies will be considered. Eligible studies will be screened according to Population, Intervention, Comparison, and Outcome (PICO) inclusion criteria, and data will be extracted against a predetermined format. The aspects of health system strengthening in providing improved SRMNCH care will be examined in this review to generate evidence on how midwives and mentorship can improve routine care and health outcomes using the World Health Organization's Six Building Blocks approach. The quality of the articles will be thematically analyzed in four areas: coherence and integrity, appropriateness for answering the question, relevance and focus, and overall assessment using the Gough weight-of-evidence framework. The literature review will consider assessing both upstream health systems regulators and downstream effectors for implementing midwifery interventions. Within this building block framework, this research will report on the outcomes and experiences of introducing midwives and the effectiveness of mentoring midwives and other staff in midwives' roles in improving care quality and health outcomes.

Attitudes of Children, Adolescents, and Their Parents Toward Digital Health Interventions: Scoping Review

The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population's developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. This study aimed to establish an inventory of children's, adolescents', and their parents' attitudes toward DHIs. A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: "child and adolescent mental health service users," "digital health interventions," and "attitudes." Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. The results of this study provide a better understanding of the factors influencing children's and adolescents' attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care.

Graphic Paper: The impact of digital communication on adolescent to adult mental health service transitions.

Inaccessible services and poor communication are barriers to successful transitions between adolescent and adult mental health services, for which digital communications (DC) offer a possible solution. To investigate the role of DC, including smartphone apps, email and text, given the known barriers and facilitators of mental health service transitions reported in the literature. Use of Neale's (2016) iterative categorisation technique to undertake a secondary analysis of qualitative data collected for the Long-term conditions Young people Networked Communication (LYNC) study. DC were used successfully by young people and staff in ways that ameliorated known barriers to service transitions. They engendered responsibility in young people, promoted service access and contributed to client safety, particularly in times of crisis. DC risks included over-familiarity between young people and staff, and the possibility that messages could go unread. DC have the potential to facilitate trust and familiarity during and after transition to adult mental health services. They can strengthen young people's perceptions of adult services as supportive, empowering and available. DC can be used for frequent 'check-ins' and remote digital support for social and personal problems. They provide an additional safety net for at-risk individuals, but require careful boundary setting.

STUDY ON KNOWLEDGE ABOUT RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK) AMONG ADOLESCENTS ATTENDING HEALTH CENTRE IN DELHI.

Background: Adolescents are susceptible to several preventable and treatable health problems like nutritional disorders, substance abuse, mental health concerns, early and unintended pregnancy, unsafe sex, injuries and violence. To ensure holistic development of the adolescent population, the Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram (RKSK) programme. This study aimed to assess the knowledge regarding Rashtriya Kishor Swasthya Karyakram (RKSK) among adolescents attending the health centre in Delhi. Methods: Acrosssectional study conducted among 100 adolescents belonging to age group of 10-19 years, who were attending the urban and rural health training centres in Delhi. Data was collected with the help of the predesigned and pretested questionnaire. Data was collected regarding socio-demographic details and knowledge regarding different adolescent health services provided under the programme. Results: Out of 100 adolescents, 18.0 % participants had adequate knowledge about RKSK. Knowledge about IFA supplementation, transmission and prevention of Sexually Transmitted Infection and common mental health problems was 52.0%,36.0% and 24.0% respectively. Knowledge regarding adverse effects and consequences of tobacco, alcohol and drug abuse and risk factors for non-communicable diseases was 46.0% and 42.0% respectively. 12.0% participants had awareness about Adolescent Friendly Health Clinics and 8.0% had registered themselves at these clinics. 44.0% participants had knowledge about Adolescent Health Days. 71.4% of adolescent girls had awareness regarding good menstrual hygiene. Conclusions: The knowledge regarding RKSK programme is low amongst the adolescents Awareness need to be spread regarding the various services provided under the programme through social media, local newspapers and television channels so that more number of adolescents avail these services

Factors Associated with Accessibility and Utilization of Adolescent Health Services in Chingola, Zambia

The purpose of this paper was to explore the factors associated with accessibility and utilization of adolescent health services in Chingola, Zambia. The study was done among secondary school students in their junior and senior grades. Data were collected from four focus group discussions and four key informants’ interviews. Data management analysis principles illuminating verbatim quotations are used to illustrate findings. The study findings indicate that lack of information and stigmatization were some of the factors identified to be the barriers to adolescents’ health. The paper further outlines the proposed solutions which include establishing and strengthening the linkage between the schools and health facilities adolescent health services and creating awareness among the adolescents. Further, the paper gives the future direction that clinics and health centres should take advantage of technology and use electronic means to increase awareness of available reproductive health services for adolescents and that they should have door to door programs for the community aimed at sensitizing adolescents on reproductive health. In conclusion, it is indicated that improving the utilization of adolescent health services is a global dream. This dream can be realized only if the efforts are made to reach the adolescent population. Keywords: Accessibility, Adolescent Health Services, Stigmatization, Utilization.

Remote and Digitally Delivered Mental Health Support for Care-Experienced Young People: Some Practice-Based Reflections in Response to Cummings (2023)

In a recent contribution to this journal, Cummings (2023) reports findings from a preliminary qualitative study of practitioner viewpoints regarding digitally delivered mental health support to care-experienced young people. Cummings’ study highlights the need to engage with professional experiences of using digital methods with this group, both during and outside of the COVID-19 pandemic. A response to - and commentary on – Cummings’ contribution is provided, to advance discussion of issues identified by the research. We reflect on our experience as practitioners and researchers working in and alongside specialist child and adolescent mental health service teams serving care-experienced children and young people. We focus on workspaces in remote working, therapeutic technique in online and telephone-based care, and virtues and challenges of remote care delivery.

Role of the COVID-19 Pandemic on Sexual Behaviors and Receipt of Sexual and Reproductive Health Services Among U.S. High School Students - Youth Risk Behavior Survey, United States, 2019-2021.

Disproportionate rates of sexually transmitted diseases (STDs), including HIV, and unintended pregnancy among adolescents persist and might have been affected by the COVID-19 pandemic. This study uses 2019 and 2021 data from the nationally representative Youth Risk Behavior Surveys to characterize changes in sexual behaviors and receipt of sexual and reproductive health services among U.S. high school students before and during the pandemic. Outcomes included HIV testing (lifetime), STD testing (past 12 months), condom use (last sexual intercourse), and primary contraceptive method used to prevent pregnancy (last sexual intercourse). Except for HIV testing, all analyses were limited to currently sexually active students. Weighted prevalence and 95% CIs of outcomes for 2019 and 2021 were calculated for each year by demographics (sex [female or male], age, and race and ethnicity) and sex of sexual contacts (opposite sex only, both sexes, same sex only). For each year, pairwise t-tests with Taylor series linearization were used to identify demographic differences among outcomes. Across years, change in prevalence of outcomes was assessed by using absolute and relative measures of association overall and by demographics. During 2019-2021, the prevalence of HIV testing decreased by 3.68 percentage points, from 9.4% to 5.8%. Among sexually active students, prevalence of STD testing decreased by 5.07 percentage points, from 20.4% to 15.3%. Among sexually active students reporting opposite sex or both sexes sexual contact, intrauterine device or implant use at last sexual intercourse increased by 4.11 percentage points, from 4.8% to 8.9%, and no contraceptive method use increased by 2.74 percentage points, from 10.7% to 13.4%. Because of disruptions throughout the pandemic, results underscore the importance of improving access to a range of health services for adolescents and improving STD/HIV and unintended pregnancy prevention.

Evaluating an emotion coaching programme for parents of young adolescents attending Child Adolescent Mental Health Services (CAMHS) in New Zealand: protocol for a multi-site feasibility trial including co-design with service users

BackgroundEarly adolescence is a time of increased vulnerability for the development of common mental health conditions such as anxiety and depression (internalising outcomes). Current treatments such as cognitive-behavioural therapy and antidepressant medication are focused on the individual and have small effect sizes, particularly in real-world clinical settings such as the public Child Adolescent Mental Health Services (CAMHS). Parents are an important and under-utilised resource in treating these conditions in young adolescents. Teaching parents how to respond to their young person’s emotions can improve emotion regulation and reduce internalising outcomes. One emotion-focused programme for parents of this age group is Tuning in to Teens (TINT). This is a structured, manualised skills group for parents only focused on teaching skills to coach young people through their emotional experiences. This study aims to investigate the impact of TINT in the clinical setting of publicly funded CAMHS in New Zealand.MethodsThe trial will evaluate the feasibility of a two-arm multi-site randomised control trial (RCT). Participants will be 10–14-year-olds referred to CAMHS in Wellington, New Zealand, with anxiety or depression, and their parents or guardians. Arm 1 will be parents attending and implementing TINT (in addition to the usual care received at CAMHS). Arm 2 will be usual care only. TINT groups will be facilitated by CAMHS clinicians who have been trained in the programme and will be delivered over 8 weekly sessions. Prior to the RCT, a co-design methodology will be used with service users to inform outcome measures used in the trial. A group of service users meeting the RCT criteria will be recruited to take part in workshops to help determine their priority outcomes. Measures based on the results of workshops will be included in the outcome measures. The primary feasibility outcomes will be the recruitment and retention of participants, acceptability of the intervention for service users and clinicians and acceptability of outcome measures.DiscussionThere is a need to improve outcomes for the treatment of adolescent anxiety and depression. TINT is a programme with the potential to enhance outcomes for those accessing mental health services by providing targeted support to parents of adolescents. This trial will inform whether a full RCT is feasible to evaluate TINT. Including service users in the design will increase its relevance of an evaluation in this setting.Trial registrationThe Australian New Zealand Clinical Trials Registry (ACTRN): ACTRN12622000483752. Registered on 28 March 2022.

Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic.

Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.

The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service.

Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.

Development of preconceptions health modules in adolescents based on information and communication technology

Background: Preconception health is a behavioral and social health intervention for women and couples before conception occurs. Intervention starts from adolescence to improved health and readiness in pregnancy. This research is aimed at the development of preconception health modules for adolescents based on Information and Communication Technology (ICT). Method: Qualitative study of exploration conducted on adolescents in the working area of Sidemen Health Center data collection was conducted in August 2020 against 4 informants consisting of 2 adolescents, 1 head of Public Health Center, and 1 obstetrician specialist. Data is collected by in-depth interview methods online. The data of the results of the study is analyzed thematically. Result: The results of the interview obtained 4 (four) themes that are preconception health problems in adolescents, the content of the material of modules, methods of dissemination of information and the place of preconception health services. The teen had never heard of preconception health. Suitable materials presented in the preconception health module in adolescents are the introduction of reproductive devices, menstrual cycles, pregnancy cycles, premarital screening preparations, and preconception health interventions. Preconception health services are provided in private health services, hospitals and public health centers. Nevertheless, preconception health services in adolescents have not been optimally provided. Precisely the media chosen in the dissemination of knowledge about preconception health is face-to-face, lectures, video and book. Conclusion: Based on this, it can be concluded that this module is expected to improve the teen's knowledge of preconception health.

The impact of the COVID-19 pandemic on physical activity and anxiety levels of young mental health patients and their parents

Abstract: Introduction: One restriction measure during the COVID-19 pandemic period was the closure of sport-related facilities, generating substantial anxiety. This study analyzed longitudinal changes in anxiety and physical activity (PA) levels in young people (YP) attending a community child and adolescent mental health service, and their parents/caregivers from 2020 to 2022. Method: This quantitatively driven convergent mixed-methods cohort study utilized validated scoring tools (GAD-7/GLTEQ) as the core quantitative component, and open-ended questions as the supplementary qualitative component. The quantitative and qualitative data were statistically analyzed, and both results were integrated. Questionnaires were distributed in August–October 2020 (Phase 1: At the peak of restriction period), August–October 2021 (Phase 2: During gradual removal of restrictions) and August–October 2022 (Phase 3: When all restrictions were removed). Results: Parent/caregiver’s anxiety levels significantly reduced from Phase 1 to Phase 3. Results revealed non-significant improvements in YP’s PA levels from Phase 1 to Phase 3. PA levels in YP were significantly higher than those of parents/caregivers throughout all Phases. A significant negative correlation was revealed between PA and anxiety levels in parents/caregivers throughout all Phases. The fear of getting infected, lifting of restrictive measures, vaccination benefits, and pandemic-induced social/financial struggles were common themes generated from the qualitative comments. Conclusion: The authors recommend PA promotional campaigns and incentives during such restrictive periods, helping the population’s mental well-being. The high attrition rates in this study may decrease its generalizability. However, the results generated from this innovative study may serve as a platform for future research carried out during traumatic periods.

Correlation of Warm Handoffs Versus Electronic Referrals and Engagement With Mental Health Services Co-located in a Pediatric Primary Care Clinic

ObjectiveTo analyze the correlation of referral mechanism—warm handoff or electronic referral and attendance at behavioral health appointments in an outpatient pediatric primary care setting. MethodsA retrospective cohort study was conducted in an inner-city pediatric primary care clinic from January 2019 to December 2019. Adolescent patients who screened positive for depression or anxiety were referred to a Licensed Master Social Worker (LMSW) either via a warm handoff (WH group, n = 148) or an electronic referral (EF group, n = 180). The EF group was contacted by the LMSW via telephone to schedule an appointment. Multiple logistic regression was used to analyze the correlation of type of referral, age, gender, race/ethnicity, primary language, and time between referral and first contact with attendance at three appointments. ResultsThe WH group was more likely to engage with mental health services compared to the EF group (odds ratio = 3.301, 95% confidence interval = 1.850–5.902, p = .002) while age, gender, race/ethnicity, and primary language had no correlation. Within the EF group, those who were contacted by the LMSW within 3 days (1–3 days group) were more likely to attend appointments (odds ratio = 2.680, 95% confidence interval = 0.414–8.219, p = .040). There was no difference in attendance in the WH group and the 1–3 days group (p = .913) DiscussionA warm handoff between primary care providers and behavioral health clinicians is significantly correlated with engagement with behavioral health services for adolescents who screen positive for depression or anxiety. Contact with the family within 3 days of referral is significantly correlated with engagement compared to a longer duration between referral and family contact.

A pilot evaluation of the role of a children's wellbeing practitioner (CWP) in a child and adolescent mental health service (CAMHS).

In 2017, the Children and Young People's Improving Access to Psychological Therapies (CYP-IAPT) project was extended to deliver low-intensity Cognitive Behavioural Therapy (CBT), delivered by Children's Wellbeing Practitioners (CWPs), but to date evaluation is sparse. To evaluate low-intensity interventions delivered by trainee CWPs for the treatment of anxiety and depression in a child and adolescent mental health service (CAMHS). The evaluation adopted a quantitative, within-subjects, cross-sectional design. The outcome measures of 98 service users aged 8-17years were included in the evaluation. Service users were children and young people accessing CAMHS in the North East of England. Outcome measures included the Revised Children's Anxiety and Depression Scale (RCADS-47) and Goal Based Outcomes (GBOs). Descriptive data relating to the types of interventions used and outcomes following CWP involvement were also explored. Analysis of pre and post intervention data highlighted significant reduction in symptomatology across all RCADS subscales and composite total scales, and significant goal progress as measures by GBO's. Effect sizes ranged from moderate to large (d = 0.75 - 0.90) across all subscales of the RCADS. Large effect sizes were found for depression, total anxiety and total RCADS scores (d = 0.86, d = 1.12, d = 1.14), and GBOs (d = -1.33). Findings support the potential value of low intensity CBT interventions delivered by CWPs in reducing anxiety and depression in this population. Recommendations for the development of the CWP role and CWP services are discussed.

Utilisation of adolescent reproductive and sexual health services in a rural area of West Bengal: A mixed-method study.

Despite policy actions and strategic efforts for improving the reproductive and sexual health of adolescents by promoting the uptake of adolescent reproductive and sexual health (ARSH) services, the utilisation rate remains significantly low, especially in rural areas of India. This study aimed to assess the utilisation of these services by adolescents in rural West Bengal and its associated determinants. This mixed-method study was conducted from May to September 2021 in the Gosaba rural block of South 24 Parganas, West Bengal. Quantitative data were collected from 326 adolescents using a pre-tested structured questionnaire. Qualitative data were collected via four focus group discussions among 30 adolescents and key-informant interviews among six healthcare workers. Quantitative data were analysed using SPSS, while qualitative data were analysed thematically. Ninety-six (29.4%) adolescents had utilised ARSH services at least once during adolescence. The factors associated with non-utilisation of ARSH services were younger age, female sex, increasing reproductive health stigma and decreasing parent-adolescent communication related to sexual health. Qualitative exploration revealed that unawareness regarding services, perceived lack of privacy and confidentiality at healthcare facilities and disruption of services post-emergence of the COVID-19 pandemic were some major barriers to ARSH service utilisation. A multi-component strategy, including promotion of adolescent-friendly health clinics, community support interventions associated with motivation and counselling of parents regarding the importance of adolescent reproductive health, is needed to improve the utilisation of ARSH services. Necessary steps to correct the deficiencies at the facility level should also be prioritised.

An Assessment of Community Pharmacists' Competence and Involvement in Adolescent Sexuality Education and Reproductive Health Services.

Background: Provision of sexuality education and reproductive health (SERH) services for the adolescent population has been inadequate. Increasing access to adolescent SERH through the community pharmacy is a viable option in bridging this gap. Objective: The study objectives were to assess community pharmacists' involvement, self -reported competence, confidence and comfort level regarding provision of adolescent SERH services and explore barriers to service delivery. Method: A pre-tested questionnaire was distributed to 200 community pharmacists by simple random sampling. Self-reported competency and confidence were measured on a Likert scale ranging from 1-5, midpoint 3. Continuous data was expressed as mean and standard deviation while categorical data was expressed as frequencies and percentages. Results: Community pharmacist' self-reported competence, confidence and comfort levels were high, 4.09 ± 0.14; 3.2±0.75; 4.17± 0.18 respectively on a Scale of 1-5. Majority of the pharmacists, 130 (81.3%) claimed to have had formal training in sexuality education and nearly three quarters, 105 (65.6%) had recently updated their knowledge. Although product availability was adequate, 118 (73.6%), availability of educational materials was low, 37 (23%). Schools were the most frequent place where pharmacists had distributed sexuality education materials 96 (60%). Lack of time and religious objection were the major barriers to service delivery 99(61.9%); 63(39.4%) respectively. Conclusion: Pharmacist' self-reported comfort, competency and confidence levels in delivering adolescent SERH services were high. The major barriers to service delivery were lack of time and religious objection. These findings suggest that community pharmacists have a potentially major impact on improving access to adolescent SERH service. Therefore, the option of delivering SERH services through pharmacies is worth exploring in order to improve access and service delivery to the adolescent population.

Development and Validation of the Adolescent Sexual and Reproductive Competency Assessment Tool (ASRH-CAT) for Healthcare Providers.

This study aimed to validate a competency assessment tool for adolescent sexual and reproductive health (ASRH) services for healthcare providers (HCP) at primary healthcare (PHC) facilities that require a specific set of competency skills to address ASRH problems. The tool development process used the nine steps of scale development and validation. Fifty-four items were yielded through the expert panel discussion. Two hundred and forty respondents were recruited for an online questionnaire using non-probability sampling. The item content validity index (I-CVI) and exploratory factor analysis (EFA) were used for construct validity. Fourteen items were removed based on the I-CVI (scores < 0.8) and two items were removed in the EFA (factor loadings < 0.4). The reliability analysis, according to the latent factor, yielded a good item-total correlation (ITC) and a good internal consistency value, with Cronbach's alpha values of 0.905-0.949. The final ASRH competency assessment tool (ASRH_CAT) contains 40 items and is reliable and suitable for use in studies related to the ASRH competency assessment of HCPs at the PHC level.

Children subjected to family violence: A retrospective study of experiences of trauma-focused treatment.

Exposure to adverse childhood experiences is a risk factor for the development of serious psychiatric and somatic illness. Although trauma-focused therapy is effective in reducing symptoms, not all children benefit from it. To improve treatment efficacy, the children's perspective on what they perceive as helpful versus hindering is necessary. This study aimed, retrospectively, to explore how children exposed to family violence experienced treatment at the Child and Adolescent Mental Health Service. Seventeen children and youths were interviewed 4-5years after treatment. The thematic analysis resulted in five themes: confusion, the need to feel heard, fear of consequences, feelings of pain, and identifying oneself as an agent. The results emphasize the importance of the therapeutic relationship, and that trust, genuine interest, and reciprocity are necessary for the child to engage in treatment. However, neither the child's own agency nor external obstacles such as continuous exposure to abuse should be underestimated in terms of the child's engagement.

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

PurposeThis study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. MethodsOur retrospective cohort study analyzed adolescents aged 12–17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. ResultsAmong 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02–1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05–1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39–1.91, p < .01) during the COVID-19 pandemic. DiscussionIndividual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Child and Adolescent Mental Health Services in Australia: A descriptive analysis between 2015-16 and 2019-20.

To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators. Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed. Between 2015-16 and 2019-20, overall CAMHS expenditure increased by an average annual rate of 3.6%. Per capita expenditure increased at a higher rate than for other subspeciality services. CAMHS admissions had a higher cost per patient day, shorter length of stay, higher readmission rate and lower rates of significant improvement. Adolescents aged 12-17 had high community CAMHS utilisation, based on proportion of population coverage and number of service contacts. CAMHS outpatient outcomes were similar to other age-groups. There were high rates of 'Mental disorder not otherwise specified', depression and adjustment/stress-related disorders as principal diagnoses in community CAMHS episodes. CAMHS inpatient admissions had lower rates of significant improvement and higher 14-day readmission rates than other ages. Australia's young population had a high outpatient CAMHS contact rate. Evidence-based modelling of CAMHS providers and outcomes may inform future service improvement.