Child And Adolescent Mental Health Services Services Research Articles

A national research survey of childhood autism assessment services in the UK: empirical evidence of diagnostic practice, challenges and improvement opportunities

BackgroundThe UK National Health Service (NHS) Long Term Plan aims to reduce waiting times for childhood autism diagnostic assessment and improve parent and child satisfaction. This empirical research investigated current...

Clinicians’ perceptions of the mental health needs of young people in alternative provision educational settings: An exploratory qualitative analysis

ABSTRACT It is estimated that 1 in 2 young people who are educated in Alternative Provision (AP) educational settings have social, emotional and mental health difficulties. However, the extent to which the mental health needs of these young people are currently being met by Child and Adolescent Mental Health Services (CAMHS) is less clear. In this qualitative study, semi-structured interviews were conducted with 15 CAMHS practitioners who had worked with young people educated in AP settings to explore secondary health care service engagement. We analysed the data using thematic analysis. Findings suggest that young people educated in AP settings have complex mental health needs for which they are currently not receiving adequate support, due to shortcomings within AP schools and numerous external barriers to care. Implications for clinicians and service commissioners include a need for further integration between CAMHS and education services, and better quality support across AP settings.

Working with trauma; finding new ports of entry1

ABSTRACT This paper describes how, in the wake of a spate of fatal knife crime in one London borough, the council, Clinical Commissioning Group (CCG) and Child and Adolescent Mental Health Service (CAMHS) got together to think about how to improve outcomes for their young people. Starting with schools and pupil referral units, the CAMHS and educational psychology service were commissioned to work with whole staff groups, from senior leadership to lunchtime monitors and playground staff, to embed trauma informed policy and practice. The aim was to spread understanding about complex developmental trauma; what it is, how it affects the behaviour and experience of children and families, and how to work with it. Given how widespread trauma is, the objective was also to think about what might need to change in the environment and ethos of the borough’s schools as a result. Following the project’s initial success, its scope and remit were expanded to support services on a policy level, while also working with their staff to think about the impact of trauma, and how best to support children and families who have been affected by it. As well as teaching about trauma, the project is primarily an experiential one. This paper explores the impact on staff who were involved in the project; what came out of it for them personally in terms of changes to their thinking and outlook, and what they saw as the changes for the children and families they worked with.

Youth Metacognitive Therapy (YoMeta): protocol for a single-blind randomised feasibility trial of a transdiagnostic intervention versus treatment as usual in 11–16-year-olds with common mental health problems

BackgroundMental health disorders in children and young people (CYP) are increasing but the provision of current evidence-based treatment for common mental health problems is limited. Treatment effects vary widely with no clear superiority of a single treatment approach. Further evaluation of contemporary and effective treatments in CYP is needed. Metacognitive therapy (MCT) has shown enhanced efficacy over ‘gold standard’ approaches in adult mental health, but so far has not been evaluated in a randomised trial of CYP. As such, we aim to assess the acceptability and feasibility of group-MCT for CYP with common mental health problems in comparison to usual treatment within Child and Adolescent Mental Health Services (CAMHS).MethodYoMeta is a multicentre, two-arm, single-blind randomised feasibility trial comparing group-MCT to usual care in CYP with common mental health problems in CAMHS. CYP (target sample n = 100) with a common mental health problem will be recruited across at least three CAMHS services in the UK. Participants in the intervention arm will receive up to eight sessions of group-MCT delivered by a CAMHS mental health practitioner. The control arm will receive usual care in CAMHS which includes individual or group-based therapy. Feasibility will be assessed by the success of recruitment, retention, and data quality. Acceptability of the intervention will be assessed by the number of sessions attended and through qualitative interviews aimed at exploring CYP acceptability and understanding of the intervention. Symptoms of psychological distress will be assessed using the Revised Children Anxiety and Depression Scale (RCADS) at 20 weeks. We will also assess psychological well-being, symptoms of depression, metacognitive beliefs, quality of life, and measures to support economic evaluation (health status and health and social care use). Qualitative interviews will be conducted to understand practitioner’s views on training and delivery of group-MCT.DiscussionThe trial is designed to evaluate the acceptability and feasibility of group-MCT for CYP with common mental health problems. Group-MCT may aid in improving access to treatment, reduce waiting times, and improve outcomes for CYP with common mental health disorders. The study will provide important information and data to evaluate future research potential and confirm sample size estimation for a definitive large-scale RCT to test the effectiveness and cost-effectiveness of group-MCT in CYP.Trial registrationNCT05260060; ISCTRN18335255

Inequalities in children’s mental health prescribing and referrals for specialist mental health services.

Objective1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children’s mental health prescribing and referrals to specialist outpatient services. ApproachWe linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral. We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection. ResultsPrescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas. Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls’ referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas. ConclusionsBoth mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.

Debate: "The-Diagnosis-That-Must-Not-Be-Named" - Professionals' fear of BPD is failing their patients.

Borderline personality disorder (BPD) in Child and Adolescent Mental Health Services (CAMHS) seems to be the "Voldemort Diagnosis" - it must not be named! We believe this is misguided and dangerous. Failure to inform patients and carers of the potential for this diagnosis disempowers them. Everyone has a right to research and understand their own condition. The absence of honest diagnoses leaves young people feeling "mad and bad" and losing trust in professionals' ability to help them. Complex Post Traumatic Stress Disorder is not a suitable substitute diagnosis (at least not for our daughters). Failure to identify BPD symptoms in young people means CAMHS services are not investing in the treatments needed by these young people - often leading to the kind of inpatient stays that Guidelines from the National Institute for Health and Care Excellence (NICE) warn against - and to further deterioration.

Community paediatricians’ experience of joint working with child and adolescent mental health services: findings from a British national survey

ObjectivesChildren and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and...

Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

ObjectivePrevious work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD)....

The role of mental health symptomology and quality of life in predicting referrals to special child and adolescent mental health services

BackgroundChildren and adolescents’ mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life).MethodThe study examined longitudinal association between a young person’s self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral.ResultsPupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0–1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9–0.98).ConclusionChildren and young people’s perception of their quality of life should be considered at the stages of a clinical needs assessment.

An audit of Individual Care Plan (ICP) in Dublin North City and County (DNCC) child and adolescent mental health service (CAMHS)

AimsThe objectives/aims of the Audit include: 1.To standardize and implement ICP for service users attending DNCC CAMHS team in accordance with the established policy.2.To achieve greater involvement of service users/parents in ICP.3.To standardize and improve treatment of care involving all members of one team.BackgroundEvery patient should have a care plan. Each care plan has a set of needs and goals. These are agreed between the service user and key worker and are assessed and measured frequently. Consultation with each service user/parents, as far as practicable is important. Specification of treatment and care required in accordance with best practice should be recorded. Identification of the necessary resources should be recorded and discussed with service user and key worker. Records kept in one composite set of documentation, and a signed copy should be made available to the service user/parents.MethodFirst Cycle commenced 15th October 2019. 166 files were selected from CAMHS team. Data were collected from clinical records from time of admission into CAMHS service to the time of audit. The audit report was prepared on the 6th December 2019, and intervention discussed at the multidisciplinary team meeting and wider DNCC CAMHS academic meeting. Second Cycle 23rd March 2020. 30 files randomly selected and audited. Data were collected by Dr Uchechukwu Egbuta, Mr Cillian Howley, Dr Anitha Selvarajoo, under supervision of Dr Muhammad Iqbal and Dr Diana Meskauskaite.Method of data input/analysis is IBM SPSS.ResultFor each ICP, the following were looked at: Files with ICP, Identifiable key worker, Formulation, Goals, Action plan, Copy of ICP to young person/parents, Next Review Date, Projected discharge date.Overall compliance shows 62% in first cycle, and 68% in second cycle after intervention.There was a 6% quality improvement of ICPs in terms of overall compliance in applying the various components of ICP.ConclusionEach service user should have an individual care plan. Each individual care plan should be measured regularly. To develop a therapeutic individual care plan, a formulation of the case from history taking is essential looking at the bio-psychosocial model and should be service user focused. Care plans are part of clinical governance, therefore continuous re-audit every three months was recommended. The follow-up audit will be carried out by the multidisciplinary team members.

Representation of #CAMHS on social media platform TikTok

AimsThe video-based free social media app, TikTok, has grown in popularity during the COVID-19 pandemic, with half of British children using Tik Tok regularly. With more than 2 billion downloads, it was the most downloaded app of 2020. Child and Adolescent Mental Health Services (CAMHS) is currently found on TikTok via the hashtag #CAMHS. The aim of this study was to explore how CAMHS is represented on TikTok through reviewing the hashtags associated with CAMHS and exploring the themes of videos with the #CAMHS hashtag.MethodThe Tik Tok app was downloaded and a search for the hashtags which featured the word #CAMHS was undertaken. A thematic analysis of the top 100 most popular uploaded videos featuring the #CAMHS was conducted. The number of likes, views and shares of the videos featuring each theme was recorded.ResultVideos with the hashtag #CAMHS had 203.9 million views, followed by: #camhsmeme(s) totalling 43.1 million views, #camhsjokes with 21.4 million views and #camhskids, 12.5 million views. The top 100 most popular videos represented 24% of total viewed videos with the hashtag #CAMHS.The most popular recurrent themes associated with the hashtag #CAMHS in our sample were: raising awareness of mental health symptoms and management (40% of videos), reference to self-harm (27% of videos) and negative perception of CAMHS (27% of videos).Raising awareness of mental health symptoms and management had the most likes (3,694,700) and views (17,435,900). This was followed by videos with themes of reference to self-harm (3,006,300 likes and 14,382,700 views). The most shared themes were: reference to suicide (shared 56,763 times) and videos which portrayed a theme of negative perception of CAMHS (40,628 shares). Videos with themes of a negative perception of CAMHS also garnered 1,762,500 likes and 8,666,900 views.ConclusionCAMHS is actively represented on TikTok through freely accessible unregulated videos. Videos with themes of raising awareness of mental health symptoms and management can potentially allow young people to share their experiences. Nonetheless, popular hashtags such as #CAMHSmemes and #CAMHSjokes, as well as videos featuring themes of negative perception of CAMHS, could potentially undermine the reputation of CAMHS to existing and future service users. The content of these videos should be taken seriously by CAMHS clinicians as it can potentially provide an insight into service users’ experiences of CAMHS on a scale that has not been observed before. Presently these videos are not screened or modulated by the NHS CAMHS service.

Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS).

There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 (n = 1074) and April to September 2019 (n = 1172). Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

Innovations in Practice: A randomised controlled feasibility trial of Behavioural Activation as a treatment for young people with depression.

Behavioural Activation (BA) treatment effectively reduces symptoms of depression in adults and is more cost-effective than more complex therapies. Two recent systematic reviews of BA for depression in young people highlighted the need for more studies in this area. In order to evaluate the acceptability of BA treatment for adolescents with depression and the feasibility of conducting a trial of this intervention in Child and Adolescent Mental Health Services (CAMHS), 22 patients from across three sites were randomised to BA or usual CAMHS care. Existing CAMHS staff were trained to deliver the manualised intervention via a brief course. Following treatment, young people and their parents/carers were asked to complete a feedback survey. Symptoms and functioning were assessed at 3- and 6-month follow-up. The trial was registered with the ISRCTN Registry (ref: ISRCTN52147450; https://www.isrctn.com/). Recruitment targets were achieved through screening large numbers of CAMHS service users. Intervention adherence by the participating adolescents was high (median number of completed BA sessions was seven out of a total of eight). There were tentative suggestions of improvements following treatment; a large change in a positive direction for the BA group, but not for usual care, was observed by visual comparisons of mean scores on measures of depression, self-esteem and functioning. No adverse events were reported. The findings suggest that BA in this setting is acceptable and warrants evaluation via a fully powered randomised controlled trial.

Knowledge and confidence of clinicians in Irish CAMHS when working with transgender youth; and the factors clinicians report will assist them in this work.

The Health Service Executive (HSE) Quality Improvement Division (2016) report states that young people who identify as transgender are one of the highest risk groups for suicidal ideation, self-harm, and completed suicides and may require significant input in Irish Child and Adolescent Mental Health Services (CAMHS). This research represents the first exploration of CAMHS staff's capacity within an Irish mental health service to support transgender youth by considering their knowledge about and confidence in working with these youth. A multi-method design was used to evaluate the knowledge and confidence levels of CAMHS clinicians in supporting transgender youth and to identify what factors would enable them to conduct this work. A questionnaire and a survey about supporting transgender youth were distributed to all clinicians in five Irish-based CAMHS services (N = 71), using an online platform. Additionally, semi-structured interviews were conducted with six clinicians. Quantitative, content, and thematic analyses were performed. CAMHS staff reported limited knowledge and experience about supporting transgender youth. Findings indicated that both of these factors undermined their confidence in supporting these youths. Clinicians expressed a need for additional clinical education delivered through expert consultation, presentations, and learning from 'experts by experience'. CAMHS clinicians need and want further clinical education about supporting transgender youth and their families. Recommendations are made for enhancing the knowledge, confidence, and competence of CAMHS clinicians using methods identified as acceptable by clinicians, in order to best support these youths.

Impact of transforming mental health services for young people in England on patient access, resource use and health: a quasi-experimental study

ObjectiveTo evaluate the impact of child and adolescent mental health services (CAMHS) transformation in South East England on patient access, resource utilisation and health outcomes.DesignIn an observational study, we use...

WARRN – a formulation-based risk assessment procedure for Child and Adolescent Mental Health Services (CAMHS): the view of clinicians

PurposeWales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services which has been adopted across most Child and Adolescent Mental Health Services (CAMHS) across Wales. The paper aims to discuss this issue.Design/methodology/approachAn online survey was disseminated to National Health Service clinicians in CAMHS to evaluate their perceptions of the use and effectiveness of WARRN. Data from 88 clinicians were analysed with both quantitative and qualitative methods.FindingsClinicians reported increased clinical skills, increased confidence in their assessment and management of risk and in safety planning, the increased safety of service users and the general public, and a belief that WARRN had saved lives. The qualitative data showed that clinicians thought a common risk evaluation instrument across Wales and different agencies had created a common language and understanding that improved communication.Practical implicationsWARRN appears well accepted in CAMHS services with the view that it is having a very positive effect on service user well-being and safety and could be implemented in other services.Originality/valueThis is the first report of a formulation-based approach to the management of serious problem behaviours in CAMHS services.

Creation of an out of hours child and Adolescent Mental Health emergency service

Both Wexford and Waterford Counties are badly suffering from the lack of Child and Adolescent Mental Health Services (CAMHS). This is directly connected to the lack of CAMHS consultants to lead these services. Accessing the existing CAMHS services, especially in emergency, is particularly difficult as the waiting lists are ever growing, and therefore delaying the possibility of an early first appointment. An emergency “out of hours” child psychiatric service has been developed, in order to provide help when the CAMHS services are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in Accident and Emergency (A&E) or hospitalised on a Ward (Paediatric, psychiatric or other) and also sometimes “off-site”, it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training), and therefore needs an efficient triage procedure. The triage tool that was chosen is the Irish Child Triage System (ICTS) that was launched in Ireland by the RCSI in 2016. It operates in Wexford General Hospital (WGH) and in University Hospital Waterford (UHW). Between February and August 2018, every intervention provided by the Consultant Psychiatrist responsible for this “emergency out of hours” service was recorded; this includes interventions on both sites (WGH and UHW), In A&E but also on the Wards (Pediatric, Psychiatric, Medical and Surgical), both face to face consultations with the Consultant but also phone supervisions provided by the Consultant to the Doctor in psychiatric training on call for Psychiatry (UHW). The purpose of this article is to review the first figures of attendance of this new service provided and to discuss its profitability. Within 7 months, a total of 675 interventions was provided by the Consultant Psychiatrist on call for this new out of hours CAMHS service. Keywords: Child and Adolescent Psychiatry- Emergency Department– Out of hours - Ireland- Triage- out of hours- Irish Children Triage System (ICTS)

Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a...

Referral rates of depression and anxiety to a Child and Adolescent Mental Health Service (CAMHS) at Sidra Medicine: Comparisons of outpatient CAMHS, inpatient CAMHS and psychiatric liaison services

Referral rates of depression and anxiety to a Child and Adolescent Mental Health Service (CAMHS) at Sidra Medicine: Comparisons of outpatient CAMHS, inpatient CAMHS and psychiatric liaison services

Participation in developing youth mental health services: “Cinderella service” to service re-design

PurposeWhilst there are pockets of excellence in the provision of Child and Adolescent Mental Health Services (CAMHS), many services fail to meet young people’s needs. Considering this, the purpose of this paper is to ascertain perceptions of CAMHS provision in a rural county of the UK to inform re-design of youth mental health services.Design/methodology/approachThe study comprised of two phases: phase one involved analysis of questionnaire data of youth views of CAMHS. Phase two involved analysis of the “Have Your Say” event data which explored perceptions of CAMHS and future service re-design. Data were thematically analysed.FindingsKnowledge of the existence and purpose of CAMHS was variable. Participants wanted accessible information about services, rights, confidentiality and for this to be provided in multiple media. Young people wanted staff who were easy to talk to, genuine, understanding and who valued their insights. Participants wanted to be offered choice about appointments, location and timing. An ideal mental health service was described as a “one-stop-shop” of co-locality and multi-agency collaboration. Young people clearly expressed a desire to influence the design and delivery of the radical service re-design and to be embedded in its development.Practical implicationsThe results highlighted multiple problems with CAMHS provision and provided a clear justification for the re-design of services.Originality/valueThis was a novel approach demonstrating the importance, utility and power of effective participatory practices for informing the re-design of services.