CAMH Services Research Articles

Training CAMHS Professionals in Developing Countries: An Indian Case Study.

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.

Joined up CAMH services

Joined up CAMH services

Eight Months to Eight Weeks: Reducing Waiting Times in a Child and Adolescent Mental Health Service

Introduction Many child and adolescent mental health services (CAMHS) struggle with increasing demands, long waiting lists and keeping waiting times for first appointments to within government guidelines. An audit of 7,000 successive new referrals to CAMHS found that the average number of attendances was 4.52 and only 11% of families were still in treatment at six months. Eighty-five per cent of families attended six sessions or fewer and 32% were only seen once (Hoare et al, 1996). Clinicians may believe that families and children need long-term treatment, yet we know from our experience and the literature that most will not engage in long-term interventions. Dropout rates increase as the waiting time for an initial appointment increases, and 30 weeks appears a crucial cut-off after which most families give up. Providing brief, focused interventions is one approach and some CAMH services have found offering as few as three sessions to be helpful. Seeing families relatively quickly, yet perhaps not sooner than a month, may be ideal (Foreman & Hanna, 2000). Combining the two strategies results in a potential model for providing brief, focused interventions over three to eight sessions within a period of four to 30 weeks of referral. There is a growing literature on the use of brief interventions for managing child and adolescent mental health problems. Stallard and Sayers (1998) describe an opt-in, brief three-session problemsolving, empowerment approach developed in their CAMHS. Average initial HoNOSCA scores were 9.23 (range: three to 25). The majority of families were satisfied with the service they received and both they and their clinicians indicated an improvement in symptoms at the end of contact. Goldberg and Campbell (1997) also describe a three-session approach developed in their community adolescent service. They use techniques from solution-focused therapy, brief motivational interviewing, interventive interviewing and cognitive behavioural strategies in a collaborative model of working with families. Both they and Weltner (1982), who also uses a three-session model, report that the method produces change and is seen as helpful by families. Spoth et al (2000) describe a seven-session intervention for parents and young adolescents that was successful in reducing aggressive and hostile behaviours. Partridge et al (1999) developed a brief, focused family therapy service and reported that 48% of families were seen on one occasion, 26% on two occasions, 15% on three occasions and 11% on four or more occasions. Of the 30 families whose treatment was completed, only two were re-referred within a year of discharge. Allison et al (2000) reported that brief therapy resulted in significant improvement in the majority of the children seen in their service but

Research Leading to Action: A Study of Accessibility of a CAMH Service to Ethnic Minority Families.

This article describes an action research project aimed at examining the accessibility of a child and adolescent mental health service to its ethnic minority populations. A Child and Adolescent Mental Health Service was involved in a process of inquiry, deciding first to compare rate of referral and treatment outcomes for the four largest ethnic groups amongst the client population. Following discussion of findings throughout the service, groups of Bangladeshi service users and professionals were interviewed about low rates of referral amongst this community. By highlighting the different referral rates and profiles of different ethnic groups, the study elicited an increasingly shared commitment across the service to addressing issues of accessibility to ethnic minority communities. The study is presented as one possible model of response to the challenge to all public services made by Macpherson (1999), to examine the 'appropriateness' of the service offered to different ethnic populations.

Healthcare Professionals to Child and Adolescent Mental Health Clinicians: Developing a Generic Profession

anarkshire Child and Adolescent Mental Health Service (CAMHS) is a multidisciplinary community-based service in the central belt of Scotland for the children, young people and their families who live within the health board boundaries, a total population of 560,000. The CAMH service is delivered by four community-based teams each serving a defined geographical district. The current CAMH service has a staff complement of 29.6 WTE and a budget of £1,370,000, which represents 3.2% of the overall mental health budget. Child and adolescent mental health clinicians currently make up 15 WTE of the CAMHS staff group. This article describes how the service has continued to develop in spite of the significant national shortages of specialist child mental health professionals in all disciplines. It particularly focuses on the emergence of this new generic professional group whose professional backgrounds include specialist nursing, occupational therapy and social work. The child and adolescent mental health clinician structure offers: ■ an integrated career pathway for CAMHS professionals ■ retention as clinicians with increasing seniority, rather than a progression within a professional discipline which can only offer managerial positions ■ a framework of uniform pay, terms and L conditions which values and rewards the disparate professional training, qualifications and experience of senior clinicians ■ continuing professional development to consolidate changing specialist roles in order to meet more complex service demands.

Attitudes To and Knowledge of CAMHS: Differences Between Pakistani and White British Mothers.

Research suggests that there are differences in the problems that are referred to Child and Adolescent Mental Health Services (CAMHS) by White British and Asian families as well as differences in how these services are accessed. There is a need for more information about how different ethnic communities perceive and access CAMH services. White British or Pakistani mothers of children between 0-20 years at an urban health centre were invited to complete a study-specific questionnaire written in English (with verbal translation provided when needed). Data were collected on awareness and experience of, and willingness to use CAMH services; severity of problems before referral is considered and additional factors that influence service use. In comparison to White British mothers, Pakistani mothers were found to be less likely to consider a referral for problems judged as mild or moderate. There was no difference for severe problems. Qualitative factors that would enhance the use of CAMH services by Pakistani mothers include the availability of culture and gender matched therapists, and better access to translation facilities. The study highlights service needs and expectations of mothers of Pakistani origin, and emphasises the need for relevant, inclusive and culturally sensitive services.

Low uptake of CAMHS services

Low uptake of CAMHS services

Child and adolescent mental health services: rhetoric and reality.

Jane Davies and colleagues compare the reality of CAMHS services for children in South Wales with the recommended levels of service in recent policy documents

Needs Assessment of Children and Adolescents

Needs assessment is a frequently used term by all agencies involved in the welfare of children and adolescents, and is a key method in health service planning (Stevens & Raftery, 1994). However, there is often a lack of clarity about the meaning of the phrase ‘needs assessment’ (Cohen & Eastman, 1997). In addition, for CAMHS services there are few established research or clinical instruments to assess the needs of individuals. This review sets out first to describe some key concepts and issues and, second, to describe the development of a needs assessment instrument for adolescents with complex and multiple problems, and how such an instrument can be used in clinical and research settings.

Needs Assessment of Children and Adolescents

Needs assessment is a frequently used term by all agencies involved in the welfare of children and adolescents, and is a key method in health service planning (Stevens & Raftery, 1994). However, there is often a lack of clarity about the meaning of the phrase ‘needs assessment’ (Cohen & Eastman, 1997). In addition, for CAMHS services there are few established research or clinical instruments to assess the needs of individuals. This review sets out first to describe some key concepts and issues and, second, to describe the development of a needs assessment instrument for adolescents with complex and multiple problems, and how such an instrument can be used in clinical and research settings.