Adolescent Mental Health Clinic Research Articles

Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling.

This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12-month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community-based primary care, need to be explored to improve timely management.

Foster Parents’ Experiences with Child-Oriented Family Therapy: A Qualitative Study

Child-oriented family therapy places great emphasis on involving children directly in the course of therapy. The research question for this study was as follows: what are foster parents’ experiences from participating in child-oriented family therapy? To answer this question, we conducted four semi-structured qualitative interviews with foster parents who were connected to a child and adolescent mental health clinic. With the use of interpretative phenomenological analysis, four main findings were identified: (1) The therapist’s competence and way of being have significance; (2) Therapy helps in getting to know the inner life of the child; (3) The everyday life of the family is worked with through the sandbox; and (4) Understanding the child’s perspectives helps foster parents to relate in new ways with the child. The study showed that child-oriented family therapy provides arenas and facilitates dialogical processes in which the child is heard. The foster parents found that child-oriented family therapy had its starting point in real challenges the family faced every day. The concrete work in child-oriented family therapy led the foster parents to experience better collaboration between family members.

Practitioner Review: Mental health problems of refugee children and adolescents and their management.

Since 2010, the numbers of refugees have increased and around half are under 18years of age. It is known that experience of organised violence, displacement and resettlement increases the risk for psychiatric disorders and psychosocial impairment. This review integrates recent research into the risk and protective factors for psychopathology with service and treatment issues. We draw on and critically evaluate key systematic reviews in the selected areas, innovative robust studies and relevant government reports. Many refugee children show resilience and function well, even in the face of substantial adversities. The most robust findings for psychopathology are that PTSD, and posttraumatic and depressive symptoms are found at higher prevalence in those who have been exposed to war experiences. Their severity may decrease over time with resettlement, but PTSD in the most exposed may show higher continuity. More severe psychiatric disorders including psychosis may also occur. Service delivery needs to take into account socioeconomic and cultural influences but, given the high level of unmet need even in high-income countries, stepped care delivery is required. The evaluation of psychological interventions, often delivered in group settings, suggests that they can be effective for many distressed children; however, for the more impaired, a greater range of disorder-specific therapies will be required. Child and adolescent mental health clinicians and service providers need to be aware of the specific needs of this population and systems for service delivery. There are significant knowledge gaps in understanding risk and vulnerability, service delivery and treatment effectiveness.

Achieving Service Change Through the Implementation of a Trauma-Informed Care Training Program Within a Mental Health Service.

As evidence continues to accumulate for the association between childhood trauma and long-term adverse outcomes, Trauma-Informed Care (TIC) approaches are emerging as fundamental to contemporary mental health services. To evaluate a workshop designed to influence mental health practitioners in TIC principles and practices. Nursing, medical and allied health professionals completed pre and post measures of confidence, awareness and attitudes towards TIC practice. The workshop was rated as highly relevant and useful to clinician's practice. Participants' self-reported confidence, awareness and attitudes towards TIC significantly increased (p < .001) and the perceived number of barriers to working within a TIC framework significantly decreased (p < .05). Child and Adolescent Mental Health clinicians routinely screened for trauma and 80% had received training in a traumaspecific intervention at follow-up. This brief training provides an important foundation for the development of trauma-informed, evidence-based mental health services.

Association between irritability and depressive symptoms in children and adolescents

IntroductionIrritability is the most frequently reported symptom in child and adolescent depression. The association of both has been linked with high rates of chronicity, comorbility and impairment.ObjectivesTo study the association between irritability and depressive symptoms in children and adolescents.MethodsWe have studied 857 participants recruited from the only child and adolescent mental health clinic in a catchment area of 122,968 people under 18 (2004–2010). A sample of 857 participants (112 controls and 745 patients) was included to carry out a cross-sectional study. Irritability was measured by a Visual Analog Scale (VAS irritability)–scored from 0 to 10–, and depressive symptoms by the Children's Depression Inventory (CDI). The participants were categorized into controls and patients, and according to their irritability (≤ 4 [I], 5 [II] and ≥ 6 [III]). The mean of CDI score was calculated for each of the groups, adjusted by sex and age, and analyzed by ANCOVA.ResultsThe following means were obtained from the controls: 13,71 (group I), 9,82 (group II) and 17,45 (group III). Regarding to the patients: 13,92 (group I), 11,54 (group II) and 15,64 (group III). A quadratic association (P &lt; 0.0015) was found between VAS irritability score and CDI score.ConclusionsThere is not a linear association between irritability and depressive symptoms in children and adolescent. High rates of depressive symptoms were associated both with high and low rates of irritability. Several questions remain unexplained about the status of irritability in psychiatry, as Stringaris group has been pointed out.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Who seeks child and adolescent mental health care in Kenya? A descriptive clinic profile at a tertiary referral facility

BackgroundThe presence of psychiatric morbidity in the child and adolescent age group is demonstrable in various studies conducted in various settings in Kenya. This study set out to determine the psychiatric morbidity and socio-demographic profile of patients who eventually present for care at a tertiary specialist child and adolescent mental health clinic in Kenya. Knowledge of the patterns of presentation of disorders is crucial for planning of service scale up as well as serving as a useful training guide.MethodsThis was a cross sectional descriptive study of 166 patients and their guardians presenting to the child and adolescent mental health clinics at a tertiary referral hospital in Nairobi, Kenya. Data was collected using a researcher designed socio-demographic questionnaire and the Kiddie-schedule for affective disorders and schizophrenia-present and lifetime (KSADS-PL 2009 Working Draft) and analysed using Statistical Package for Social Scientists.ResultsThere were more males (56%) than females in this study and the participant’s mean age was 13.6 years. Substance abuse disorders were the most prevalent presentation (30.1%) followed by depressive disorders (13.9%), with most referrals to the clinic coming from medical practitioners and teachers. The mean time to accessing care at the clinic after the onset of symptoms was 16.6 months, with the longest time taken to specialist care being 183 months.ConclusionsThe findings from this study will go a long way to support the establishment of programs that improve timely child and adolescent mental health service delivery. The involvement of various stakeholders such as the education sector and the community is key in the development of these programs.

Study of user experience of an objective test (QbTest) to aid ADHD assessment and medication management: a multi-methods approach

BackgroundThe diagnosis and monitoring of Attention deficit hyperactivity disorder (ADHD) typically relies on subjective reports and observations. Objective continuous performance tests (CPTs) have been incorporated into some services to support clinical decision making. However, the feasibility and acceptability of adding such a test into routine practice is unknown. The study aimed to investigate the feasibility and acceptability of adding an objective computerised test to the routine assessment and monitoring of attention deficit hyperactivity disorder (ADHD).MethodsSemi-structured interviews were conducted with clinicians (n = 10) and families (parents/young people, n = 20) who participated in a randomised controlled trial. Additionally, the same clinicians (n = 10) and families (n = 76) completed a survey assessing their experience of the QbTest. The study took place in child and adolescent mental health and community paediatric clinics across the UK. Interview transcripts were thematically analysed.ResultsInterviewed clinicians and families valued the QbTest for providing an objective, valid assessment of symptoms. The QbTest was noted to facilitate communication between clinicians, families and schools. However, whereas clinicians were more unanimous on the usefulness of the QbTest, survey findings showed that, although the majority of families found the test useful, less than half felt the QbTest helped them understand the clinician’s decision making around diagnosis and medication. The QbTest was seen as a potentially valuable tool to use early in the assessment process to streamline the care pathway. Although clinicians were conscious of the additional costs, these could be offset by reductions in time to diagnosis and the delivery of the test by a Healthcare Assistant.ConclusionsThe findings indicate the QbTest is an acceptable and feasible tool to implement in routine clinical settings. Clinicians should be mindful to discuss the QbTest results with families to enable their understanding and engagement with the process. Further findings from definitive trials are required to understand the cost/benefit; however, the findings from this study support the feasibility and acceptability of integrating QbTest in the ADHD care pathway.Trial registrationThe findings form the implementation component of the Assessing QbTest Utility in ADHD (AQUA) Trial which is registered with the ISRCTN registry (ISRCTN11727351, retrospectively registered 04 July 2016) and clinicaltrials.gov (NCT02209116, registered 04 August 2014).

Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children's Behavior Problems. A Randomized Controlled Study.

ObjectiveThe aim of the present investigation was to compare the effectiveness of Parent-Child Interaction Therapy (PCIT) with treatment as usual (TAU) in young children who were referred to regular child and adolescent mental health clinics for behavior problems.MethodEighty-one Norwegian families with two- to seven-year-old children (52 boys) who had scored ≥ 120 on the Eyberg Child Behavior Inventory (ECBI) were randomly assigned to receive either PCIT or TAU. The families were assessed 6 and 18 months after beginning treatment. Parenting skills were measured using the Dyadic Parent-Child Interaction Coding System (DPICS), and child behavior problems were measured using the ECBI and the Child Behavior Checklist (CBCL).ResultsLinear growth curve analyses revealed that the behavior problems of children receiving PCIT improved more compared with children receiving TAU according to mother reports (ECBI d = .64, CBCL d = .61, both p < .05) but not according to father report. Parents also improved with regard to Do and Don’t skills (d = 2.58, d = 1.46, respectively, both p ≤ .001). At the 6-month assessment, which often occurred before treatment was finished, children who had received PCIT had lower father-rated ECBI and mother-rated CBCL-scores (p = .06) compared with those who had received TAU. At the 18-month follow-up, the children who had received PCIT showed fewer behavior problems compared with TAU according to mother (d = .37) and father (d = .56) reports on the ECBI and mother reports on the CBCL regarding externalizing problems (d = .39). Parents receiving PCIT developed more favorable Do Skills (6-month d = 1.81; 18-month d = 1.91) and Don’t Skills (6-month d = 1.46; 18-month d = 1.42) according to observer ratings on the DPICS compared with those receiving TAU.ConclusionChildren receiving PCIT in regular clinical practice exhibited a greater reduction in behavior problems compared with children receiving TAU, and their parents' parenting skills improved to a greater degree compared with those receiving TAU.Trial RegistrationClinicalTrials.gov NTC01085305

Parent-reported symptoms, impairment, helpfulness of treatment, and unmet service needs in a follow-up of outpatient children with attention-deficit/hyperactivity disorder

Background: Limited information exists regarding the associations between impairment, symptoms, helpfulness of treatments, and service needs after initial treatment of children with attention-deficit/hyperactivity disorder (ADHD). Aims: The aims of this study were to examine persistence rates and associations between parent-reported symptoms, impairment, helpfulness of treatments, and service needs in a retrospective follow-up study of children with ADHD.Methods: Parents of 214 children with a mean age of 12.6 years (SD = 2.1) who were diagnosed with ADHD at five child and adolescent mental health clinics (CAMHS) completed questionnaires 1–10 years (mean = 3.7 years, SD = 2.2) after baseline assessment. The response rate was 43.4%. A community comparison group (n = 110) was recruited from the same area.Results: Approximately two-thirds (60.3%) of the sample fulfilled the DSM-IV symptom criteria of ADHD at follow-up, 84.3% were functionally impaired, and most children (84.7%) were on medication. Inattentive and emotional symptoms were the strongest predictors of impairment across impairment areas. Perceived helpfulness of different treatments varied from 71.8–88.7%, and no significant difference was found between the ADHD sub-groups regarding reported helpfulness. ‘Adjustment of the school situation’ was the most frequent service need, and approximately half of the parents reported needs for care co-ordination. Children fulfilling the symptom criteria of the ADHD Combined sub-group were most impaired and had most service needs.Conclusions: At follow-up, children were highly symptomatic and impaired, despite a high rate of persistent medication treatment. The findings underline the need for more tailored treatment and co-ordinated care over time.

A comparison of clinician and caregiver assessment of functioning in patients attending a child and adolescent mental health clinic in Nigeria

Objective. To compare clinician and caregiver assessments of functioning and impairment among children attending a specialist mental health facility. Methods. Caregivers of patients attending the Harvey Road Child and Adolescent Centre ( N =155) were consecutively recruited over a 1-month period. The caregivers were requested to fill in a sociodemographic questionnaire, the Columbia Impairment Scale (CIS), the 12- item version of the General Health Questionnaire (GHQ-12) and the Zarit Burden Interview. Scoring on the Children’s Global Assessment Scale (CGAS) was done by clinicians. Results. The mean (standard deviation (SD)) age of patients and caregivers was 12.3 (4.9) years and 41.5 (8.9), respectively. Mean (SD) scores on the CGAS and CIS were 55.3 (22.8) and 16.4 (14.3), respectively, while mean scores on the Zarit Burden Interview and the GHQ were 27.9 (17.2) and 2.5 (2.6), respectively. Poorer clinician-rated functioning was associated with lower educational level of the child, a main diagnosis other than seizure disorder, longer duration of illness, and presence of comorbidity. Worse caregiver rating of impairment was equally associated with lower child education, and main diagnosis other than seizure disorder. Both CGAS and CIS scores showed significant correlation with Zarit and GHQ scores. Finally, a significant correlation was found between CGAS and CIS scores ( r =−0.388, p <0.001). Conclusion. Children attending specialist neuropsychiatric services have functional impairment which may be associated with lower child education, and which is linked with increased caregiver burden and psychiatric morbidity.

A telephone interview version of the middle childhood HOME Observation Measurement of the Environment.

The Home Observation Measurement of the Environment (HOME) is a 59-item observation and interview tool used to measure how suitable a child's home is for a child of his or her developmental age and has been used extensively in research. The HOME is usually performed in the child's home, which has cost implications. We wished to develop a telephone version of the HOME. We developed a 54-item telephone interview version of the HOME and used it to measure the home environment in 77 children aged 6-10 years inclusive attending a child and adolescent mental health clinic, followed by a home visit and HOME assessment. The results of the telephone home assessment were then compared with the results of the original HOME. Our sample had a mean HOME score of 47.6, standard deviation (SD) = 5.5 and a mean telephone home score of 42.6, SD = 5.1. No difference was found in comparison of the subscale mean scores of the HOME with the telephone home assessment. The agreement of 54 items in common between the HOME and telephone home assessment ranged from 73% agreement to 100% agreement. Forty-three of 50 items had moderate to almost perfect agreement using kappa analysis (kappa = 0.41-0.99); three had 100% agreement. The telephone version of the HOME compares favourably with the HOME.

Clinical and psycho-social profile of child and adolescent mental health care users and services at an urban child mental health clinic in South Africa

National and international child and adolescent mental healthcare policy and action advocate that the health and well being of children should be increasingly given greater attention. The purpose of this study was to describe the demographic, socio economic and clinical profile of the users at the child and adolescent mental health clinic of the Rahima Moosa Mother and Child Hospital (RMMCH). A descriptive, retrospective clinical audit from users' clinical files was performed over a one-year period from January to December 2007. Descriptive statistical analyses of demographic and socio-economic variables were made and these variables were compared with the presenting clinical problems. Odds ratios were calculated for variables that showed a statistically significant association (p-value less than 0.05). A total of 303 users attended this clinic. Statistical comparisons between demographic data and disorders revealed that being male increased the likelihood of presenting with AHDH and disruptive behaviour disorders; being female increased the likelihood of being sexually abused. Race showed a significant association with parent-child relationship difficulties. Regarding socio-economic variables, the identity of the caregiver of the child influenced the risk of disruptive behaviour disorders, sexual abuse, neglect and academic problems. Where the child was placed was a risk factor for disruptive behaviour disorders, sexual abuse, neglect and academic problems. Whether the mother of a user was alive or deceased, was found to be related to ADHD and disruptive behaviour and whether the father of a user was alive or deceased, was found to be related to sexual abuse and academic problems. The education level of the caregiver showed a significant association with sexual abuse, neglect and academic problems; the marital status of the parent (widowed mother) showed a significant association with bereavement. Household income was associated with sexual abuse, neglect and academic problems. This study demonstrated the impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve the socio-economic status of communities. There is a need to improve psychiatric services for the population served by this hospital, including more clinics in its catchment area, as well as child psychiatry training posts and extended social work services.

The Brief Assessment Checklists (BAC-C, BAC-A): Mental health screening measures for school-aged children and adolescents in foster, kinship, residential and adoptive care

Abstract More than half of children and young people in foster, kinship, and residential care, as well as those subsequently adopted from care, have mental health difficulties that require clinical formulation and intervention. While an increasing number of alternate care jurisdictions are instituting universal mental health screening, existing measures may not adequately screen for a range of attachment- and trauma-related mental health difficulties observed among these populations. The Brief Assessment Checklist for Children (BAC-C), and the Brief Assessment Checklist for Adolescents (BAC-A) are 20-item caregiver-report psychiatric rating scales designed to: 1. screen for and monitor clinically-meaningful mental health difficulties experienced by children and adolescents in various types of care; and 2. be safely administered and interpreted by health and social care professionals other than child and adolescent mental health clinicians. The BAC-C/A were also designed to be used as brief casework monitoring tools by foster care and adoption agencies, and for treatment monitoring in CAMHS. The BAC-C and BAC-A were derived from the Assessment Checklist for Children (ACC, 120 items) and Assessment Checklist for Adolescents (ACA, 105 items) respectively. Internal consistency of BAC-C (N = 347) and BAC-A (N = 230) scores were 0.89 and 0.87 respectively. The BAC-C/A were highly accurate in screening for clinical range ACC and ACA scores (area under the curve (AUC) ranging from 0.96 to 0.99), as well as for CBCL clinical range scores (AUCs: BAC-C = 0.89 to 0.92; BAC-A = 0.93 to 0.94). They were moderately accurate in screening for children that caregivers reported had been referred to mental health services (AUCs: BAC-C = 0.74; BAC-A = 0.79). Initial BAC-C/A psychometric properties compare favourably with that of existing screening instruments, including the Strengths and Difficulties Questionnaire and the Brief Problem Monitor (CBCL short form).

3008 – Effectiveness of cognitive-behavioral anxiety treatments for children and adolescents

There is substantial evidence that cognitive behavioral therapy (CBT) works for child anxiety disorders, but this evidence-base mainly rests on efficacy trials with rigorous scientific control conducted in University-clinics. Are results transferable to ordinary clinics? To a large extent, the answer seems to be yes. This presentation will review the state-of-the-art of effectiveness trials for child anxiety disorders. Additionally, data will be presented from a large ongoing randomized controlled trial (RCT) for child anxiety disorders conducted in community child and adolescent mental health clinics in Norway. This is the child part of the Assessment and Treatment - Anxiety in Children and Adults (ATACA) trial, PI's Heiervang and Havik. Children aged 8 to 15 years (N = 182) with a primary diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder were included and randomized to group CBT (GCBT), individual CBT (ICBT) or a waitlist condition (WLC). The treatment program was Barrett's Friends for life manual. CBT outperformed WLC, with no major difference between GCBT and ICBT. Although overall symptom reduction was comparable to previous effectiveness trials, the full remission rates were somewhat lower than in previous trials. The possible reasons behind this will be discussed, and there will be an emphasis on how process factors such as pretreatment motivation, perceived treatment credibility, and the therapeutic alliance, which were all assessed in the RCT, may play a part to influence treatment results.

Experience of child and adolescent mental health clinicians working within an at‐risk mental state for psychosis service: a qualitative study

To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an 'at-risk mental state' (ARMS) for psychosis. A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a 'last resort', requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi-agency working practices. Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).

Clinical Concepts in Messaging Strategies to Parents of Depressed and Suicidal Adolescents

Firearms have been noted as a risk factor in youth suicide, but this has not necessarily translated effectively into the clinical setting. There is little information from the mental health field on firearm counseling interventions with parents of adolescents. The intent of this study was to uncover adolescent mental health clinicians' endorsements of specific messaging strategies on firearm access and safety counseling geared toward parents of depressed and suicidal adolescents. A total of 24 clinicians from a rural area took part in a focus group study. As part of the focus group, mental health counselors looked at six short paragraphs that phrased counseling parents on suicide and firearms. They were asked to identify three sentences across these paragraphs that they felt would be useful with parents of depressed or suicidal adolescents in counseling. Results found 66 responses that resulted in the recognition of 16 common statements across participants. The frequency of statements was examined, qualitatively analyzed and grouped according to messaging concept. The results indicated that the sentences the counselors identified fit into five concepts: Risk, Empathy, Impulsivity, Lethal Means Restriction Counseling, and Parental Responsibility. The present study provides insight into message strategies identified as helpful in engaging parents in discussions of firearms when the risk of adolescent suicide is present.

A randomized controlled trial of preschool‐based joint attention intervention for children with autism

Deficits in joint attention (JA) and joint engagement (JE) represent a core problem in young children with autism as these affect language and social development. Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective. However, there is little knowledge about the success of the intervention when done in preschools. Assess the effects of a preschool-based JA-intervention. 61 children (48 males) with autistic disorder (29-60 months) were randomized to either 8 weeks of JA-intervention, in addition to their preschool programs (n = 34), or to preschool programs only (n = 27). The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics (CAMHC). Changes in JA and JE were measured by blinded independent testers using Early Social Communication Scale (ESCS) and video taped preschool teacher-child and mother-child play at baseline and post-intervention. Clinicaltrials.gov: NCT00378157. Intention-to-treat analysis showed significant difference between the intervention and the control group, with the intervention group yielding more JA initiation during interaction with the preschool teachers. The effect generalized to significantly longer duration of JE with the mothers. This is the first randomized study to show positive and generalized effects of preschool-based JA-intervention.

Attitudes and knowledge of child and adolescent mental health clinicians in relation to the psychosis risk syndrome

To evaluate the knowledge and attitudes of clinicians in a Child and Adolescent Mental Health Service in relation to the 'At-Risk Mental State' concept in psychosis. A questionnaire was constructed and administered to child and adolescent mental health clinicians working in North East England. Sixty-seven per cent (n=121) of eligible clinicians responded. Almost all the participants believed that young people 'At-Risk' needed support. However, only around half felt confident in identifying this patient group. Approximately a third felt that antipsychotic medication may be useful. Some interprofessional differences were noted in relation to both knowledge and attitudes. Further training would be required for most health workers in this sample to feel confident in identifying the syndrome. These findings require replication in other service settings and may have implications for the implementation of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic category relating to the At-Risk Mental State.

A preliminary evaluation: Demographic and clinical profiles and changes in functioning in children receiving psychosocial rehabilitation

The present study is the first to examine the demographic and clinical profiles at intake of children, ages 4 to 18 years, who received Child Psychosocial Rehabilitation (CSPR), a relatively new community-based treatment model for children with emotional disturbance. In addition, the relationship between the relative change in psychosocial, emotional, and behavioral functioning as measured by CAFAS (Hodges, 1989, 1994, 2000) and PECFAS (1994, 2000) scores and the children's age, gender, ethnicity, current living arrangement, internalizing and externalizing behaviors, and severity of impairment at intake were evaluated. Fifty-three children received CPSR for a minimum of six months from a for-profit outpatient child and adolescent mental health clinic located in southwestern Idaho. Significant improvement in the children's overall functioning was found after six months of treatment. Middle or high school age children demonstrated significantly more impairment at intake compared with their younger counterparts. No significant differences in overall functioning were revealed considering the characteristic of gender, living arrangement and clinical profiles at intake.

An Examination of Treatment Completers and Non-Completers at a Child and Adolescent Community Mental Health Clinic

This study examined sociodemographic and clinical characteristics of treatment completers (N = 114) and non-completers (N = 136) at a child and adolescent community mental health clinic. Results indicated that children who completed treatment significantly differ from those who prematurely drop out of treatment. Non-completers presented with considerably more impairment in functioning and psychiatric symptoms, and their caregiver reported experiencing significantly more parenting stress and depressive symptoms. Results suggest that mental health treatment is not readily provided to the most difficult to reach and most at-risk youth and their families.