Adolescent Mental Health Care Research Articles

Addressing barriers to mental healthcare access for adolescents living in slums: A qualitative multi-stakeholder study in Odisha, India

BackgroundThe burden of mental health problems is a leading issue in India, particularly among adolescents. According to the National Mental Health survey, 2016, the prevalence of mental health problems among the age group of 13–17 years is 7.3 % and the case is the same for both genders. It has also been stated that the prevalence rate is higher among urban adolescents compared to rural ones. Adolescent mental healthcare is a neglected area in Indian society as a result it influences mental healthcare access in India. The present study, therefore, aims to provide an amalgamated overview of the adolescent mental healthcare policies and programs in India and also to find out the challenges and barriers faced by the stakeholders with respect to delivery and access to adolescent mental healthcare. MethodsTo identify the challenges in the implementation of the policies, the thematic framework analysis was used to address the issues pertaining to the delivery and access to mental healthcare. The study involved the stakeholders including healthcare providers (n = 8): non-governmental organizations (NGOs), government stakeholders and adolescents (beneficiaries or service users) (n = 25) and their parents (n = 6). ResultsThe results indicated that there was a gap with respect to awareness and knowledge about mental health and healthcare-related access and delivery among the selected stakeholders. Stigmatization and social distance behaviors were the major prevailing factors among the adolescent participants which influenced their care-seeking behavior and decision-making approach. From program and policy point of view, the key challenges affecting the successful implementation of mental health policies and programs were the lack of collaboration among the stakeholders, funding and logical constraints, scarcity of staff at the facility level, and lack of skills and knowledge among the staff. ConclusionAn integrated and multisectoral approach in adolescent mental healthcare policies and programmes is the need of the time to address the key challenges to mental healthcare access and delivery. Focused intervention is required to reduce the stigma and social distance behaviour among adolescent beneficiaries.

Social Determinants of Mental Health Considerations for Counseling Children and Adolescents

ABSTRACT Childhood is a crucial period for developing a strong social and emotional foundation critical for mental well-being. Given that the childhood developmental period is vital for mental health, it is essential to address social determinants that can disrupt development and have lasting adverse effects on psychological and physical health. Therefore, professional counselors specializing in children and adolescent mental health care can benefit from understanding and utilizing the social determinants of mental health (SDOMH) framework in practice. This article details the SDOMH framework and considerations for SDOMH-informed treatments for professional counselors working in settings with children and adolescents.

Krevjande situasjonar i psykisk helsevern for born og unge – behandlarar si erfaring med og haldning til målretta trening og virtuell røyndom

Objective: Explore experiences of and attitudes towards deliberate practice and virtual reality (VR) among therapists in child and adolescent psychiatry, and what clinical situations are perceived as particularly relevant for practice. Methods: 59 therapists completed an anonymous online survey. Results: Participants had limited experience with deliberate practice and VR, but were generally very positive to trying this framework to develop therapeutic skills. Situations where caregivers were angry were perceived as the most challenging, while situations where clients were quiet and passive were the most frequent. The perceived challenge of different situations varied widely among participants. Implications: The results are used to reflect upon development of therapeutic skills among licensed therapists in general, and within mental health care in particular. Keywords: therapist development, deliberate practice, VR, difficult clinical situations, child and adolescent mental health care

Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial.

Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs' mental health delivery grows. Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 (low) to 4 (high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Our findings suggest that SPs' attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools' support for implementation may scaffold more intensive implementation efforts in schools down the road.

The Status of Integrating Children and Adolescents’ Mental Health Care Services into Primary Health Care in South Africa: Scoping Review

Background: Many children and adolescents who need mental health care services in South Africa find it difficult to access these services. The PHC approach is the foremost strategy adopted by the South African government to improve access to health care services in the country. Therefore, the integration of children and adolescents mental health care services into primary health care should greatly improve access. Objective: The objective of this review is to describe and interrogate the status of integrating children and adolescents’ mental health care services into primary health care in SA. Methods: The scoping literature review was conducted following the framework of identifying the research question, identifying relevant studies, selecting studies, charting data, and finally collating, summarising, and synthesising the results. The databases used are APA, PsychINFO, Medline, Cabinet Discover, and Africa-Wide Informatio. Thematic analysis was used to qualitatively analyse the findings of the studies reviewed. Results: Six studies were selected for inclusion in this research. The analysis yielded three themes : challenges to integrating child and adolescent mental health care, services into primary health care, the need for health care systems to enable integration of child and adolescent mental health services into primary health care, and the lack of child and adolescent mental health care services. Conclusion: The integration of child and adolescent mental health care services into primary health care in South Africa is far from realisation. Recommendations are made for practice, education, and research.

Downstream effects of high patient volume pressure on PHPs: A child psychiatry trainee's perspective

Rhode Island boasts some of the most robust access to specialized child and adolescent mental health care across the country, with one of the highlights being the unique access to various levels of care. Child and adolescent psychiatry applicants from across the country are attracted to the breadth of program variety. In particular, Rhode Island uniquely possesses a significant number of specialized partial hospitalization programs (PHP) for children and teens, some of which are nationally recognized and appeal to patients and families throughout the United States.

Adolescent Self-Efficacy in Relation to Illness Perception and Treatment Compliance: An Inpatient Study

Non-compliance with psychotropic treatment appears to be a growing problem among adolescent mental healthcare users. Treatment is frequently initiated during hospitalisation periods; however, at discharge a change in the primary administrator of the treatment poses a risk that the discharged patient may become non-compliant. In this study, we investigate factors influencing psychotropic treatment compliance of adolescent inpatients admitted to a psychiatric facility. A quantitative, non-experimental, cross-sectional, survey-type research design was employed. Approximately 170 participants were selected through a non-probability convenience sampling method. The data were gathered using self-reporting measures, namely the Drug Attitude Inventory, the Brief Illness Perception Questionnaire and the Decision Self-Efficacy Scale. The data were analysed using a Pearson product–moment correlation coefficient and a moderated hierarchical regression analysis. The results indicated a significant relationship between illness perception and self-efficacy where self-efficacy was identified as a moderator between illness perception and treatment compliance of male adolescent inpatients. The findings of the study and the gender differences which surfaced may contribute to a better understanding of the intricate processes related to treatment compliance in adolescents. These findings may help to direct intervention aimed at promoting treatment compliance.

Patterns of service provision in child and adolescent mental health care in Australia.

Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.

Stemming the tide of mental health problems in young people: Challenges and potential solutions.

One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with individuals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.

Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice.

Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65-78%, and the specificity was 57-78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.

COMMENT: Age and autonomy: An ethical dilemma in community mental health.

Mental illnesses are proven to have their onset in the mid-teens, making early mental healthcare interventions necessary among adolescents. While school-based mental health awareness programmes have gained prominence in recent years, adolescents identify issues around confidentiality, privacy and the need for parental consent impinging on their autonomy, as barriers to accessing mental healthcare, for their perceived needs. We aim to discuss the various ethical dilemmas faced by community mental health providers in using age as a sole marker for determining autonomy for adolescents, focusing on the potential impact of these challenges on adolescent mental healthcare and wellbeing.

Parent, carer and professional views of specialist child and adolescent mental health care during the COVID-19 pandemic

Purpose The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children’s services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers’ accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children’s birth families there were more mixed and negative impressions. Originality/value Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised.

Co-payment and adolescents' use of psychologist treatment: Spill over effects on mental health care and on suicide attempts.

The literature around co-payment shows evidence of increasing consumption following reduced co-payment. We apply difference-in-difference methods to assess the effect of abolishing the co-payment on psychologist treatment of anxiety and depression in 18 to 21-year olds. We apply nationwide individual level data with individuals close to this age interval as control group. The population amounts to approximately 1.2 million individuals and a total of 51 million patient months of observations. We show that after removing co-payment, the use of psychologist treatment almost doubles. We find that this increase involves moderately positive spill over effects on outpatient psychiatric care and on prescriptions of antidepressants. In the heterogeneity analysis we find evidence of higher effects on adolescents from families with lower income, indicating that reduced co-payments may increase equality in access. We also see that effects are higher for individuals listed with general practitioners (GPs) with a reluctant referral style; indicating that these GPs' behavior is affected by patient co-payment rates. Interestingly, we find evidence of significant reductions in suicide attempts - primarily among high-income women and low-income men. This indicates that better access to mental health care for adolescents may have a positive impact on their mental health and well-being.

What Do Adolescents and Their Parents Need From Mental Health Integration in Primary Care? A Qualitative Exploration of Design Insights

The design of integrated adolescent mental health care should address needs and preferences of patients and parents/guardians. We conducted interviews and focus groups with adolescents aged 13-17 years who received care at Kaiser Permanente Washington in 2020 and interviews with parents of such adolescents. We sought to (1) understand the challenges of primary care-based mental health and substance use screening and care for adolescents and (2) identify program design solutions. Sessions were audio-recorded, transcribed, and coded. Thematic analysis was applied to identify key challenges and design solutions. Emerging themes from interviews (n=41) and focus groups (n=10) were summarized in five overarching design principles: Engagement, Privacy, Communication, Choice, and Ease. Each design principle was expanded for operationalization within a new health system program. Health systems serving adolescents in primary care may consider application of these design principles to the development of mental health integration programs.

A transdisciplinary public health model for child and adolescent mental healthcare in low- and middle-income countries.

The Ministry of Women and Child Development, Government of India, provides financial support to the SAMVAD initiative.

Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations

Transition in mental health care is the process ensuring continuity of care of a young patient arriving at the CAMHS (Child and Adolescent Mental Health Service) age boundary within mental health services. Transition refers to a transfer to an adult mental health service (AMHS), to private care or other mental health community services. A transition plan can also lead to a managed end of specialized care with involvement of a general practitioner or social services. For young people with a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or ASD (Autism Spectrum Disorder), two disorders that persist into adulthood, an optimal transition would ensure continuity of care or facilitate access to specialized care in the case of a discharge. Transition typically occurs during adolescence, a known sensitive period when young people may experience major changes at several levels: physiological, psychological and social. Any barrier in the transition process resulting in discontinuity of care may worsen the symptoms of ADHD or ASD and can ultimately adversely affect the global mental health of young people with such neurodevelopmental disorders. The objectives of this narrative review are: 1/to identify the barriers in the transition process in mental health services often faced by young people with these two disorders; 2/to highlight specific recommendations for strengthening the CAMHS-AMHS interface that have been proposed by various countries in Europe.

The Effectiveness and Cost-effectiveness of Well Parent Japan for Japanese Mothers of Children With ADHD: Protocol for a Randomized Controlled Trial.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents.ObjectiveThis pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services.MethodsMothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention.ResultsStudy funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic.ConclusionsThis is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan.Trial RegistrationInternational Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270International Registered Report Identifier (IRRID)DERR1-10.2196/32693

The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment.

A variety of information sources are used in the best-evidence diagnostic procedure in child and adolescent mental healthcare, including evaluation by referrers and structured assessment questionnaires for parents. However, the incremental value of these information sources is still poorly examined. To quantify the added and unique predictive value of referral letters, screening, multi-informant assessment and clinicians' remote evaluations in predicting mental health disorders. Routine medical record data on 1259 referred children and adolescents were retrospectively extracted. Their referral letters, responses to the Strengths and Difficulties Questionnaire (SDQ), results on closed-ended questions from the Development and Well-Being Assessment (DAWBA) and its clinician-rated version were linked to classifications made after face-to-face intake in psychiatry. Following multiple imputations of missing data, logistic regression analyses were performed with the above four nodes of assessment as predictors and the five childhood disorders common in mental healthcare (anxiety, depression, autism spectrum disorders, attention-deficit hyperactivity disorder, behavioural disorders) as outcomes. Likelihood ratio tests and diagnostic odds ratios were computed. Each assessment tool significantly predicted the classified outcome. Successive addition of the assessment instruments improved the prediction models, with the exception of behavioural disorder prediction by the clinician-rated DAWBA. With the exception of the SDQ for depressive and behavioural disorders, all instruments showed unique predictive value. Structured acquisition and integrated use of diverse sources of information supports evidence-based diagnosis in clinical practice. The clinical value of structured assessment at the primary-secondary care interface should now be quantified in prospective studies.

Transitioning adolescent mental health care services: The steps to care model.

A crisis exists regarding the number of children and adolescents who require psychiatric/mental health treatment. According to the 2018-2019 National Survey of Children's Health, 24.4% of children, age 3-17 years, experienced one or more reported mental, emotional, developmental, or behavioral (MEDB) problems. Transitioning from child/adolescent mental health services (CAMHS) to adult mental health services (AMHS) requires a model of care that includes flexible policies and treatment options to accommodate individual developmental needs. Comprehensive and integrated psychiatric/mental health services are needed to improve the well-being of children and adolescents. The Steps to Care Model (STCM) provides a transition plan for adolescents into adult psychiatric/mental health services. The STCM consists of six overlapping segments: development of social and human capital, strategies for the promotion of mental health awareness and care, a shared electronic information system, comprehensive mental health care services in community-based settings, implementing education for all providers, and planned transitional services for youth.

Mandatory Check for COPMI in Adult Mental Healthcare Services in the Netherlands-A Quantitative and Qualitative Evaluation.

BackgroundChildren of parents with a mental disorder and/or addiction (COPMI) are at increased risk of developing a mental disorder. In spite of preventive interventions that can decrease the risk of problem development, COPMI are not automatically offered help. In 2013, a mandatory COPMI check was implemented in the Netherlands, requiring every mental health care professional to check whether their adult patients have children and to assess these children's safety and needs. Earlier research has shown that a gap between these regulations and the actual integration in clinical practice is not uncommon.MethodIn the current study, we evaluated the implementation of the mandatory COPMI check in the Netherlands, using quantitative as well as qualitative data from a large mental healthcare organization in the Netherlands that offers both Child and Adolescent Mental Health and Adult Mental Healthcare.ResultsFiles from 14,469 patients were analyzed quantitatively and a sample of 150 files was further analyzed in depth. Findings were refined through 4 focus groups with adult mental healthcare professionals. It was found that while there are examples of the tool leading to interventions for COPMI, the tool is often not used, and when used tends to direct the focus away from COPMI needs and organizing help toward the more narrow and problematic focus on safety and reporting to child abuse authorities.ConclusionThe potential of the COPMI check is currently not fully realized. Strategies to improve its effectiveness in clinical practice are needed to improve access to interventions for COPMI.