Adolescent Mental Health Settings Research Articles

Prevalence and correlates of restrictive interventions in an Irish child and adolescent psychiatric unit: a 4-year retrospective study

BackgroundThere has been a global effort to reduce the use of restrictive interventions (RIs) in healthcare settings. In order to reduce unnecessary RIs, it is essential to understand their use in mental health settings. To date, there have been few studies examining the use of RIs in child and adolescent mental health settings, with no such studies in Ireland.AimsThe purpose of this study is to examine the prevalence and frequency of physical restraints and seclusion and to identify any associated demographic and clinical characteristics.MethodsThis is a 4-year retrospective study of the use of seclusion and physical restraint in an Irish child and adolescent psychiatric inpatient unit from 2018 to 2021. Computer-based data collection sheets and patient records were retrospectively reviewed. Eating disorder and non-eating disorder samples were analysed.ResultsOf 499 hospital admissions from 2018 to 2021, 6% (n = 29) had at least one episode of seclusion and 18% (n = 88) had at least one episode of physical restraint. Age, gender and ethnicity were not significantly associated with rates of RI. Unemployment, prior hospitalization, involuntary legal status and longer length of stay were significantly associated with higher rates of RIs in the non-eating disorder group. Involuntary legal status was associated with higher rates of physical restraint in the eating disorder group. Patients with a diagnosis of eating disorder and psychosis had the highest prevalence of physical restraints and seclusions respectively.ConclusionsIdentifying youth who are at greater risk of requiring RIs may allow early and targeted intervention and prevention.

Determining staff experience of lesbian, gay, bisexual and gender identity presentations in child and adolescent mental health settings.

Determining staff experience of lesbian, gay, bisexual and gender identity presentations in child and adolescent mental health settings.

Competence building in child mental health -A Norway-Cambodia transcultural experience

The prevalence of mental health and neurodevelopmental disorders in young people is high in low- and middle-income countries. Collaboration between institutions from high-income countries and institutions in resource-poor settings may enhance professional competence. This may be a key to bridging the gap between service needs and ability to meet those needs. However, there are challenging issues in transferring knowledge from a Western context to a different cultural and socioeconomic situation. The aim of the present study is to describe significant aspect of a transcultural competence building project in Cambodia in child mental health from the perspective of the staff. A Norwegian expert team developed and implemented a program at Centre for Child and Adolescent Mental Health (Caritas-CCAMH) in collaboration with the staff two weeks per year over a 14-year period. The study has a qualitative approach using thematic analysis of the transcripts from a focus-group interview with 11 staff members at the end of the 14-year period. The multidisciplinary staff described a learning process characterized by collaboration in planning and implementation. Mixing theory and practice in clinical case discussions with a bio-psycho-social perspective was perceived as the cornerstone of the teaching process. A pedagogical strategy that involved constant reflection back and forth enabled the customization of the content and method of capacity building despite the differences in socio-economic conditions and learning styles. This model of continuity, low-investment, and low-intensity capacity-building may enrich the child and adolescent mental health settings in low- and middle-income countries.

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges.

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Motivational interviewing to enhance adolescent mental health treatment engagement: a randomized clinical trial.

The prevalence of anxiety and mood disorders in adolescents is a growing public health concern worldwide. Given the high rates of drop-out and limited resources available in psychiatric settings, the importance of engaging adolescents in evidence-based treatments cannot be understated. The aim of the study was to determine the efficacy of motivational interviewing (MI), as a brief pre-treatment intervention, to enhance treatment engagement in a standard therapy setting (group cognitive behavioral therapy; gCBT) for adolescents with anxiety and mood disorders. Ninety-six adolescents (13-18 years) with a principal diagnosis of an anxiety or mood disorder participated in a trial conducted at two publicly funded outpatient services. Participants were randomly assigned to individual MI for treatment engagement prior to gCBT (MI+gCBT), or to an individually administered active control (befriending) prior to gCBT (befriending+gCBT). Eight pairs of gCBT were run in parallel. Outcome measures were the mean number of gCBT sessions attended, treatment initiation, and ratings of readiness for treatment. Participants randomized to MI as a pretreatment intervention attended significantly more group therapy sessions compared to those in the active control condition. The MI group also demonstrated greater treatment initiation, and ratings of treatment readiness were significantly higher for those randomized to MI. MI, used as a pre-treatment intervention, enhanced group treatment engagement in adolescents diagnosed with anxiety and mood disorders compared to the active control condition. MI is a promising intervention to facilitate engagement in adolescent mental health settings.

Sexual health knowledge and training in a child and adolescent mental health setting

ABSTRACTSexual health is a core component of human well-being. This mixed-methods study (N = 158) assessed mental health clinicians’ sexual health knowledge, attitudes, values, clinical behaviors, and training. Findings pertaining to sexual health knowledge, clinical behaviors, and specific sexual health training are reported. The study found that while many clinicians scored well on the sexual health knowledge scale, most did not discuss sexual health with clients. Additional findings were that the majority of participants believed sexual health should be an important clinical focus, but most did not receive training pertaining to sexual health topics. Reasons for not discussing sexual health will be discussed and implications for training and practice are explored.

Is it Possible to be a Bit Dialogical? Exploring How a Dialogical Perspective Might Contribute to a Psychiatrist's Practice in a Child and Adolescent Mental Health Setting

This article explores the potential relevance of dialogical ideas to psychiatric practice and asks: Is it possible to be a bit dialogical? A practice predicament is offered as a point of reference that is explored in light of the ideas presented. The notion of voice is used to introduce some ideas that inform dialogical approaches to clinical practice. Voice is then considered with respect to a medical setting, through examination of the biopsychosocial model, psychiatry's contract with society, the example of Open Dialogues, and Recovery. The conclusion acknowledges the possibility that tension is experienced between therapeutic ideals and contextual constraints. The original question may assist the clinician in defining a set of values that acknowledges this tension.

Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS)

ObjectiveThe purpose of this study was to examine the acute effectiveness of manualized exposure-based CBT with a family-based treatment, as an initial treatment for pediatric OCD delivered in regular community child and adolescents outpatient clinics. The report summarizes outcome of the first treatment step in the NordLOTS, which was conducted in Denmark, Sweden and Norway. Method269 participants, age 7–17, with OCD, received treatment for 14 weekly sessions. Treatment response was defined as CY-BOCS score of ≤15 at post treatment. Results241 participants (89.6%) completed all 14 weeks of treatment. Treatment response among the completers was 72.6% (95% CI 66.7%–77.9%). Mixed effects model revealed a statistically significant effect of time F(1,479) = 130.434. Mean symptom reduction on the CY-BOCS was 52.9% (SD = 30.9). The estimated within-group effect size between baseline and post treatment was 1.58 (95% CI: 1.37–1.80). ConclusionThis study found that manualized CBT can be applied effectively in community mental health clinics. These findings underscore the feasibility of implementing exposure-based CBT for pediatric OCD in a regular child and adolescent mental health setting. Clinical trials registration informationThis study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).

Working around a contested diagnosis: Borderline personality disorder in adolescence

This discourse analytic study sits at the intersection of everyday communications with young people in mental health settings and the enduring sociological critique of diagnoses in psychiatry. The diagnosis of borderline personality disorder (BPD) is both contested and stigmatized, in mental health and general health settings. Its legitimacy is further contested within the specialist adolescent mental health setting. In this setting, clinicians face a quandary regarding the application of adult diagnostic criteria to an adolescent population, aged less than 18 years. This article presents an analysis of interviews undertaken with Child and Adolescent Mental Health Services (CAMHS) clinicians in two publicly funded Australian services, about their use of the BPD diagnosis. In contrast with notions of primacy of diagnosis or of transparency in communications, doctors, nurses and allied health clinicians resisted and subverted a diagnosis of BPD in their work with adolescents. We delineate specific social and discursive strategies that clinicians displayed and reflected on, including: team rules which discouraged diagnostic disclosure; the lexical strategy of hedging when using the diagnosis; the prohibition and utility of informal 'borderline talk' among clinicians; and reframing the diagnosis with young people. For clinicians, these strategies legitimated their scepticism and enabled them to work with diagnostic uncertainty, in a population identified as vulnerable. For adolescent identities, these strategies served to forestall a BPD trajectory, allowing room for troubled adolescents to move and grow. These findings illuminate how the contest surrounding this diagnosis in principle is expressed in everyday clinical practice.

Implementing Single Session Family Consultation: A Reflective Team Approach

Setting up and implementing a single session family consultation in a specialist child and adolescent mental health setting, which for a long time has been an organisation and culture that has undertaken a traditional detailed child and family assessment and treatment, brings with it challenges. This paper will look at the history of single session consultation within the field of child and family services and, in particular, child and family services in mental health. It will also look at the development and implementation of a single session therapy program, and associated research on the effectiveness of the program, at the Alfred Child and Youth Mental Health Service. Clinical examples will assist in illustrating the program and its model and structures. Lastly, it will review the research data and compare this with other research data in the field.

Antipsychotic prescribing: old wine in new bottles?

Recent research suggests first generation antipsychotic medications may be no less effective or tolerated than second generation antipsychotics. To review prescribing practices in UK adolescent mental health settings. A review of literature and a postal survey (structured questionnaire) of clinicians in UK adolescent mental health settings (80 general and specialised in-patient units) were conducted. Second generation antipsychotics remain the drug of first choice for most UK clinicians (based on a survey response rate of 40%). Guidelines for antipsychotic use in adolescents need updating. Clinicians who qualified in the last 10 years may need specific training and experience in use of first generation antipsychotics.

Factors Associated with Dropout and Diagnosis in Child and Adolescent Mental Health Services

Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors. A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories. Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses. There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.

Diagnosing pervasive developmental disorders in a forensic adolescent mental health setting

Developmental delays in social and communication functioning have been proposed as a possible risk factor for offending behaviour in both young people and adults. These deficits may be particularly common in young people with both offending behaviours and mental health needs. This article describes how an assessment for pervasive developmental disorder (PDD) may be undertaken in a forensic adolescent mental health setting and integrated into the overall needs and risk assessment. Two case histories are summarised to illustrate the advantages and challenges of using this approach as part of the assessment and management of young people. It is likely that a thorough evaluation of social and communication functioning can contribute to developing effective management strategies for patients with offending behaviours and complex needs.

Implementing a Multi-Agency Needs Assessment in a Secure Adolescent Unit.

Process issues in relation to the introduction of standardised needs assessments have traditionally received little attention. Descriptive approach to the theoretical and practical aspects of the development of an assessment process using a structured instrument, the clinical version of the Salford Needs Assessment Schedule for Adolescents (SNASA). The context for this was child and adolescent mental health liaison with a social services secure unit for adolescent boys. The use of a structured process model facilitated the implementation process enormously. Positive outcomes were experienced by participating staff at different levels within agency hierarchies and by the wider professional network. Successful implementation and continuing use of structured assessments and other instruments in multi-agency settings requires attention to process issues. Such attention needs to be concerted and ongoing. Within child and adolescent mental health settings such an approach may be helpful beyond the field of secure adolescent care.

Increasing diagnosis of nicotine dependence in adolescent mental health patients.

The aim of this study was to investigate the routine recording patterns of patients' smoking by clinical staff of an adolescent mental health service over a 3-year period. A systematic examination of the clinical files of all patients who underwent an initial assessment or reassessment at the Youth Specialty Service (Mental Health; YSS) over a 2-month period (1 April-31 May) was carried out in 1996, 1997 and 1998. A range of data were collected including: demographics; diagnoses; amount of total information recorded and history of nicotine dependence. A stable historical record of cigarette smoking in the region of 30-40% across the 3 years sampled was found, but the rate of formal diagnosis of nicotine dependence rose from 3.6% in 1996 to 26.3% in 1998. This rise was in the context of relative stability over this time period of: size of reports and relevant sections (alcohol and drug history, cigarette smoking history); three other key diagnoses, major depression, conduct disorder and alcohol dependence; and demographic data. The rise in rate of diagnosis proceeded specific discussion within the clinical team about nicotine dependence. Adolescent mental health settings are a key venue to address heavy and potentially chronic cigarette smoking, but nicotine dependence has been traditionally a neglected diagnosis in mental health patients. The rate of diagnosis is likely to rise when specific discussion is undertaken within clinical teams.