Child & Adolescent Mental Health Services Research Articles

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

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

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.

Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial

BackgroundSelf-harm in adolescents is common and repetition frequent. Evidence for effective interventions to reduce self-harm is limited. Long term follow-up of existing studies is rare. MethodsExtended follow up, from 18 to at least 36-months, of the SHIFT trial: a pragmatic, multi-centre, individually-randomised, controlled trial involving young people (11–17) who had self-harmed at least twice and presented to Child & Adolescent Mental Health Services (CAMHS). SHIFT evaluated manualised family therapy (FT) versus treatment as usual (TAU) in reducing repetition of self-harm leading to hospital attendance 18 months post-randomisation.We obtained ONS mortality data, adult mental health data, and further details of hospital attendance from routine Hospital Episode Statistics (HES) data plus researcher follow-up. We assessed longer-term differences in outcome using multivariable Cox Proportional Hazards regression analysis, and assessed all-cause mortality and morbidity relating to hospital attendances for reasons other than self-harm. Study registrationISRCTN 59793150 OutcomesThe original sample of 832 were randomised between April 2010 and December 2013. Extended follow-up continued until February 2017 for a median 55·4 months (range 0–82·5 months), providing post 18-month data for 804 (96·6%) participants, of whom 785 (94·4%) had a minimum of 36-months follow-up.There was no evidence of a between-group difference in the primary outcome during the extended follow-up period (Hazard Ratio (HR) 1·03; 95% CI: 0·83, 1·28; p-value=0·78), consistent with our findings in the original trial with 18 months follow-up (HR 1·14, 95% CI 0·87, 1·49; p-value 0·33). There was a reduced rate of self-harm in older participants aged 15–17 (HR 0·7, 95% CI 0·56, 0·88), as compared with those aged 11–14; and significantly increased rates of self-harm in participants whose index episode combined self-injury and poisoning (HR 1·8, 95% CI 1·2, 2·7). Two deaths were reported during the extended follow up period. InterpretationFor adolescents referred to CAMHS after self-harm, having self-harmed at least once before, trial FT confers no benefits over TAU in reducing subsequent hospitalisation for self-harm over 18 months or 36 months. FundingNIHR HTA Reference: 07/33/01

Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project.

The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24months. 112 adolescents (aged 13-18years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12months and 13% over 24months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.

Innovations in Practice: Dialectical behaviour therapy for adolescents: multisite implementation and evaluation of a 16-week programme in a public community mental health setting.

Dialectical behaviour therapy for adolescents (DBT-A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. This study describes the implementation and effectiveness of 16-week DBT-A across multiple sites in publicly funded child/adolescent mental health services (CAMHS) in Ireland. The Consolidated Framework for Implementation Research was used to guide this national implementation. Fifty-four clinicians from seven CAMHS teams completed DBT training and delivered the 16-week DBT-A programme. Eighty-four adolescents with emotional and behavioural dysregulation participated in the intervention and outcome measures were administered at preintervention, postintervention and 16-week follow-up. Significant reductions on all outcome measures were observed for DBT-A participants including presence and frequency of self-harm, suicidal ideation and depression. Reductions in the number of acute inpatient admissions, bed days and emergency department visits were also reported. DBT-A can be successfully implemented in CAMHS settings and yield positive outcomes for adolescents with emotional and behavioural dysregulation.

Developmental Coordination Disorder Plus Oculomotor and Visuospatial Impairment as Neurodevelopmental Heralds of Psychosis Proneness.

Aiming at preventing transitions to more severe psychopathology and boosted by the availability of operational criteria to identify help-seeking subjects at increased risk for psychosis, research into the early prodromal phases of psychosis is attracting a growing clinical interest. Furthermore, the focus of early detection is gradually shifting from prodromal syndromes to the premorbid period. Although mainly driven by clinical-pragatic aims, such a shift is coherent with the neurodevelopmental hypothesis of schizophrenia that might offer a unifying, developmentally informed conceptual framework for early detection. Psychotic experiences, indeed, while overtly manifested in adolescence/early-adulthood, are often antedated by subtle expressions of biological vulnerability already presenting in the early years of life and indexing a putatively altered neurodevelopmental process. Concretely, unspecific premorbid symptoms that may be present since infancy and childhood may lead to early clinical consultancy in child-adolescent mental health services, which could be considered the primary clinical setting to implement early detection. We herewith present a clinical vignette of a child with severe Developmental Coordination Disorder presenting an Attenuated Psychosis Syndrome. The vignette illustrates the intertwining between possible early neurodevelopmental disorders and clinical psychosis proneness in childhood.

Implementation of British tool for the evaluation of outpatient child-adolescent mental health services (CAMHS) in Attica-Greece

Introduction The development of child-adolescent mental health services (CAMHS) is a necessity for each country. Based on evidence-based findings the provision of specific quality in regard to mental health services, maximizes the patients' health outcomes and satisfaction. Objectives A British tool adapted in the Greek context accesses the services against the British standards. For the current study, we used the part of the tool referred to the areas of: – referral and access; – assessment & planning; – care & intervention. Aims Promotion of evaluation and quality assurance of Greek CAMHS. Methods Due to the fact that Greek services are based on the British model, we chose the British self-review questionnaire of Quality Network for Community CAMHS (QNCC). The tool was translated, adapted and posted to services. Twelve out of twenty outpatient CAMHS of Attica (includes Athens) responded. Data collected was computed in SPSS taking a highest and a lowest score of the standards. Results Based on a scale of not the standards, the standards, and meeting the standards, ten out of twelve services moderately met the British Standards on all three areas examined. It should be noted that the assessment and care section was found to have a higher quality of replies among services reaching the 75%–100% of meeting the standards for two services. Conclusions Greek CAMHS show a satisfactory function in Attica prefecture, taking into consideration the extremely difficult political/financial circumstances. Strengths and weaknesses between different domains were also identified.

How to improve the mental health care of children and adolescents in Brazil: Actions needed in the public sector

Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life. Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources. The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system. Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.

Adolescents who self-harm: Professional staff knowledge, attitudes and training needs

This study aimed to investigate professional staff attitudes and knowledge about adolescents who engage in self-harming behaviour and to identify training needs. Previous research has suggested that medical and health care staff perceptions may reinforce the stigma associated with such behaviour and therefore jeopardise the effectiveness of interventions. To date, no available research exists on the views of school teachers. Participants recruited for the study were 120 qualified professionals working within an Accident and Emergency Department (A&E), Child & Adolescent Mental Health Services (CAMHS) and a Secondary School, based within the West Midlands, United Kingdom. Results demonstrated statistically significant differences between the groups. CAMHS staff were more knowledgeable and felt more effective than either A&E staff or teachers, whereas A&E staff expressed more negative attitudes. 95% of all staff reported that they would benefit from further training. These findings are discussed in relation to practice issues.

The complexities of maximising recruitment to complex intervention trials in child and adolescent mental health services

Objectives The HTA-funded SHIFT Trial (Self-Harm Intervention: Family Therapy) aims to recruit 832 young people following self-harm, along with their primary care givers. Recruitment is scheduled to take place over 3 years, across three ‘Hubs’ in the UK – Greater Manchester, London and Yorkshire – each involving approximately 15 Child & Adolescent Mental Health Services (CAMHS). Due to the complexities of set-up and the involvement of many clinicians in largely research-naive services, recruitment has been slower than anticipated. The TMG thus agreed an intensive strategy to enhance the existing recruitment plan.

Commentary on the Child-Adolescent Mental Health Services (CAMHS) Conference—Nashville, TN, September 2009

Commentary on the Child-Adolescent Mental Health Services (CAMHS) Conference—Nashville, TN, September 2009