Child And Adolescent Mental Health Services Research Articles

Dismissive attitudes and affirmative journeys: Parental perspectives on the mental health support of gender diverse children

Transgender/gender diverse (TGD) children experience poorer mental health and social outcomes than those who do not identify as TGD (Smith et al., 2014; Geist et al., 2019), including increased risk for depression and suicidal ideation (Haas et al., 2011; VanBergen & Love, 2022). Research has linked these poor outcomes to the micro-aggressions and dismissive attitudes of their families, communities and wider society (Brooks, 2000; Ryan et al., 2010). This service evaluation used Interpretive Phenomenological Analysis (IPA) with a small number of purposively sampled parents (n = 5) to explore experiences of their children’s involvement with CAMHS (Child and Adolescent Mental Health Services). The aim was to add to the understanding we have of the needs of TGD client groups and to inform service provision. This study supports the wider research base linking affirmative attitudes to more positive mental health outcomes, and adds additional nuance to our understandings of parental attitudes. Parents are not typically polarised in ‘affirmative’ or ‘dismissive’ positions, but rather engaged in journeys of personal growth and development, generally becoming more affirmative over time. These parents also described significant additional support needs with social deprivation, family breakdown and the impact of developmental difference highlighted. Recommendations for intervention are made.

Effectiveness of internet-delivered cognitive behavioural therapy for anxiety and obsessive-compulsive disorders within routine clinical care in rural Sweden

Few studies have evaluated the implementation of ICBT in regular child and adolescent mental health services (CAMHS). This study aimed to explore the acceptability, feasibility, and effectiveness of ICBT for children and adolescents with anxiety disorders and obsessive-compulsive disorder (OCD) within a rural CAMHS. The study also explored outcome predictors and long-term outcomes.Eighty-three participants were consecutively recruited from a non-specialized CAMHS in Region Jämtland Härjedalen in northern Sweden. Therapist-guided ICBT was offered during 12 weeks to children aged 8–17 with an anxiety disorder or OCD. Acceptability and feasibility measures included treatment adherence, treatment satisfaction, and adverse events. The primary outcome measure was the Clinical Global Impression–Severity. Secondary measures of effectiveness included clinician-, self-, and parent-ratings of symptom severity and functional impairment. Assessments were completed at baseline, post-treatment, and three-month follow-up (primary endpoint). A two-year follow up was conducted using medical records. Potential predictors included both patient characteristics and treatment variables.Results indicated that ICBT was both acceptable and feasible according to study measures. Statistically significant improvements were found from baseline to the three-month follow-up on clinician rated severity (B [SE] = −0.92 [0.09]; p < .001), as well as on all secondary measures. Forty-three percent of participants no longer fulfilled criteria for their principal disorder at the three-month follow-up. No serious adverse events were reported. Clinical improvement was highest among children with higher functioning at baseline (B [SE] = −0.05 [0.02]; p < .05). Forty-six percent of participants had been in contact with CAMHS during the two-year follow-up period, mainly for reasons other than their initial diagnosis. Findings suggest that ICBT could be an acceptable and feasible treatment option for young people with anxiety disorders and OCD in rural non-specialized CAMHS settings. Further studies are needed to confirm treatment effectiveness in this setting. Trial registration: NCT02926365.

Art therapy is associated with a reduction in restrictive practices on an inpatient child and adolescent mental health unit

Background The elimination of restrictive practices, such as seclusion and restraint, is a major aim of mental health services globally. The role of art therapy, a predominantly non-verbal mode of creative expression, is under-explored in this context. This research aimed to determine whether art therapy service provision was associated with a reduction in restrictive practices on an acute inpatient child and adolescent mental health services (CAMHS) unit. Methods The rate (events per 1,000 occupied bed days), frequency (percent of admitted care episodes with incident), duration, and number of incidents of restrictive practices occurring between July 2015 and December 2021 were analysed relative to art therapy service provision. The rate, frequency and number of incidents of intramuscular injected (IM) sedation, oral PRN (as-needed medication) use, and absconding incidents occurring in conjunction with an episode of seclusion or restraint were also analysed. Results The rate, frequency, duration, and total number of incidents of seclusion, the frequency and total number of incidents of physical restraint, and the rate, frequency and total number of incidents of IM sedation showed a statistically significant reduction during phases of art therapy service provision. Conclusions Art therapy service provision is associated with a reduction in restrictive practices in inpatient CAMHS.

Turning 18 in mental health services: a multicountryqualitative study of service user experiences and views.

Worldwide, the division between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) has frequently resulted in fragmented care with an unprepared, non-gradual transition. To improve continuity of care and other service transition experiences, service user input is essential. However, such previous qualitative studies are from a decade ago or focused on one mental disorder or country. The aim of the present study was to learn from service users' transition experiences and suggested improvements. Semi-structured interviews were held with young people aged 18-24 and/or parents/caregivers in the United Kingdom, Ireland, the Netherlands and Croatia. Inclusion was based on the experience of specialist mental health care before and after turning 18. Thematic analysis of transcribed and translated interview transcripts was performed using ATLAS.ti 9. Main themes of service user experiences included abrupt changes in responsibilities, various barriers and a lack of preparation, communication and ongoing care. Young people expressed a great need for continuity of care. Their suggestions to improve transitional care included early and adequate preparation, joint working, improved communication from and between services, overlapping services, staying at CAMHS for longer and designated youth mental health teams. Young people who experienced care before and after turning 18 suggested either altering the age limits of services or ensuring early preparation and communication regarding the transition and finding AHMS. This communication should include general changes when turning 18. Further considerations include increasing collaboration and overlap between CAMHS and AMHS.

Evaluation of intensive community care services for young people with psychiatric emergencies: study protocol for a multi-centre parallel-group, single-blinded randomized controlled trial with an internal pilot phase

BackgroundOver 3000 young people under the age of 18 are admitted to Tier 4 Child and Adolescent Mental Health Services (CAMHS) inpatient units across the UK each year. The average length of hospital stay for young people across all psychiatric units in the UK is 120 days. Research is needed to identify the most effective and efficient ways to care for young people (YP) with psychiatric emergencies. This study aims to evaluate the clinical effectiveness and cost-effectiveness of intensive community care service (ICCS) compared to treatment as usual (TAU) for young people with psychiatric emergencies.MethodsThis is a multicentre two-arm randomized controlled trial (RCT) with an internal pilot phase. Young people aged 12 to < 18 considered for admission at participating NHS organizations across the UK will be randomized 1:1 to either TAU or ICCS. The primary outcome is the time to return to or start education, employment, or training (EET) at 6 months post-randomization. Secondary outcomes will include evaluations of mental health and overall well-being and patient satisfaction. Service use and costs and cost-effectiveness will also be explored. Intention-to-treat analysis will be adopted. The trial is expected to be completed within 42 months, with an internal pilot phase in the first 12 months to assess the recruitment feasibility. A process evaluation using visual semi-structured interviews will be conducted with 42 young people and 42 healthcare workers.DiscussionThis trial is the first well-powered randomized controlled trial evaluating the clinical and cost-effectiveness of ICCS compared to TAU for young people with psychiatric emergencies in Great Britain.Trial registrationISRCTN ISRCTN42999542, Registration on April 29, 2020

Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study

AbstractAdolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 – 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.

The Mental Wellbeing of Child and Adolescent Mental Health Service (CAMHS) Workers in England: A Cross-Sectional Descriptive Study Reporting Levels of Burnout, Wellbeing and Job Satisfaction.

In the UK, there has been a notable increase in referrals to specialist children's mental health services. This, coupled with shortages of qualified staff, has raised concerns about the escalating occupational stress experienced by staff in this sector. In this brief report, we present cross-sectional quantitative data from 97 staff members working in one Child and Adolescent Mental Health Service (CAMHS) in the UK during spring 2023, reporting on their wellbeing, job satisfaction, and burnout. Our findings reveal that over a third of CAMHS staff experienced moderate or high levels of work-related burnout; 39% reported moderate or high levels of personal burnout, but levels of client-related burnout were much lower (13%). Both work- and client-related burnout showed a robust negative relationship with job satisfaction, with higher burnout predicting lower levels of job satisfaction. Only a small proportion of respondents reported high levels of wellbeing, with about a quarter experiencing levels of wellbeing that can be considered indicative of mild or clinical depressive symptoms. Whilst these results are from a small sample in one area of the UK, they present an important snapshot of CAMHS staff wellbeing and are discussed in the context of similar trends reported in the wider NHS sector.

Combining mindfulness and cognitive training in children with attention deficit hyperactivity disorder: study protocol of a pilot randomized controlled trial (the NeuroMind study).

Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated.Clinical trial registration:ClinicalTrials.gov, identifier, NCT05937347. https://clinicaltrials.gov/study/NCT05937347?locStr=Spain&country=Spain&cond=ADHD&intr=Mindfulness&rank=1.

Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis.

Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.

Lost in between-the transition process from a child and adolescent eating disorder service to adult mental health services in the German health care system.

In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3years. Thirty-two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. Only approximately one-third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process.

A scoping review of physical activity interventions in youth attending child and adolescent mental health services.

There has been an international effort to improve physical health in general and in those with mental illness. Physical activity (PA) may be beneficial as an adjunctive treatment for mental health disorders and to improve physical well-being. The objective of this scoping review is to understand the extent and type of evidence in relation to PA interventions offered in child and adolescent mental health services (CAMHS). Eligibility was determined using the Population, Concept, Context framework. Studies were included if the participants were under 18years old, attending CAMHS and where PA interventions were offered. PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO and SportDiscus were searched without language or date restrictions. Titles and abstracts, followed by full texts, were screened by two independent reviewers. Two reviewers carried out data extraction, and discrepancies in any of these processes were resolved in consultation with a third reviewer. After 2213 non-duplicate titles and abstracts were screened, 2090 were excluded and 123 full texts were screened. Seventeen studies met inclusion criteria. Included studies demonstrated PA interventions to be effective in reducing depressive symptoms and improving psychosocial functioning. While no study reported significant changes in anthropometric measurements, 2 studies demonstrated increased aerobic fitness. Evidence that PA interventions are being offered in CAMHS worldwide is limited. Included studies demonstrate potential benefits in depressive symptoms, psychosocial functioning, self-esteem and aerobic fitness in youth attending CAMHS. Future research should identify effective ways to incorporate exercise interventions in CAMHS and evaluate long-term benefits.

Challenges in Interpreting Norwegian Child and Adolescent Mental Health Records.

The Electronic Health Record system BUPdata served Norwegian Child and Adolescent Mental Health Services (CAMHS) for over 35 years and is still an important source of information for understanding clinical practice. Secondary usage of clinical data enables learning and service quality improvement. We present some insights from explorative data analysis for interpreting the records of patients referred for hyperkinetic disorders. The major challenges were data preparation, pre-analysis, imputation, and validation. We summarize the main characteristics, spot anomalies, and detect errors. The results include observations about the patient referral diversity based on 12 different variables. We modeled the activities in an individual episode of care, described our clinical observations among data, and discussed the challenges of data analysis.

Validation of the Arabic strengths and difficulties questionnaire in Qatar

BackgroundThe Strengths and Difficulties Questionnaire (SDQ) is a screening questionnaire to identify children and youth’s emotional symptoms, conduct problems, hyperactivity, peer issues, and prosocial behaviors. The objective of this study was to validate the SDQ-Arabic against trained clinicians’ diagnoses for the first time in a Gulf Cooperation Council (GCC) country by examining its ability to discriminate between clinically referred and community youth samples, and to differentiate between major categories of diagnoses within a clinically referred youth sample.ResultsWe recruited two samples of 13–17-year-old Arabic-speaking youth and their parents in Qatar: a clinically-referred sample from a child and adolescent mental health services (CAMHS) outpatient clinic and a stratified, representative school sample. Survey data, including the SDQ-Arabic, were collected as well as the clinical diagnoses given by the youths’ clinicians for the clinically referred sample.Using both areas under the curve and traditional analyses of variance, the SDQ-Arabic differentiated between the clinically referred and community samples of Arabic-speaking youth. In addition, the SDQ-Arabic differentiated between the main diagnoses in the clinically referred sample.ConclusionThe current study extends the validity of the SDQ-Arabic. The SDQ-Arabic, which had previously been validated in Arabic-speaking Levantine countries in the region, continues to demonstrate strong predictive value in a GCC sample. Implications for mental health screening are discussed.

Mapping and identifying service models for community-based services for children with intellectual disabilities and behaviours that challenge in England

BackgroundOne in five children with an intellectual disability in the UK display behaviours that challenge. Despite associated impacts on the children themselves, their families, and services, little research has been published about how best to design, organise, and deliver health and care services to these children. The purpose of this study was to describe how services are structured and organised (“service models”) in England for community-based health and care services for children with intellectual disability who display behaviours that challenge.MethodsSurvey data about services were collected from 161 eligible community-based services in England. Staff from 60 of these services were also interviewed. A combination of latent class and descriptive analysis, coupled with consultation with family carers and professionals was used to identify and describe groupings of similar services (i.e., “service models”).ResultsThe latent class analysis, completed as a first step in the process, supported a distinction between specialist services and non-specialist services for children who display behaviours that challenge. Planned descriptive analyses incorporating additional study variables were undertaken to further refine the service models.Five service models were identified: Child and Adolescent Mental Health Services (CAMHS) (n = 69 services), Intellectual Disability CAMHS (n = 28 services), Children and Young People Disability services (n = 25 services), Specialist services for children who display behaviours that challenge (n = 27 services), and broader age range services for children and/or adolescents and adults (n= 12 services).ConclusionsOur analysis led to a typology of five service models for community health and care services for children with intellectual disabilities and behaviours that challenge in England. Identification of a typology of service models is a first step in building evidence about the best provision of services for children with intellectual disabilities who display behaviours that challenge. The methods used in the current study may be useful in research developing service typologies in other specialist fields of health and care.Study registrationTrial Registration: Current Controlled Trials ISRCTN88920546, Date assigned 05/07/2022.

Transitioning to adult mental health services for young people with ADHD: an Italian-based survey on practices for pediatric and adult services

BackgroundSupporting young ADHD patients in transition to adult services is essential. Yet, the low percentages of successful referrals and the issues reported by patients and clinicians stress the need for further attention to transitioning practices. The present study assessed the transitioning process of Attention-Deficit/Hyperactivity Disorder (ADHD) patients in Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Italian territory. We asked child and adult psychiatrists to report the current state of services and their observations on limitations and possible future matters that must be addressed.MethodSeventy-seven centers (42 CAMHS, 35 AMHS) filled in a web-based survey in which they reported the number of ADHD patients, how many transitioning patients they had within the past year, and how they structured transition.ResultsA fragmented picture emerged from the survey. Lack of resources, training, and communication between services hinder the transition process, and many adult patients remain under CAMHS’ care. While some services have a protocol, there is no structured guidance that can help improve integration and continuity of treatment.ConclusionThe observed situation reflects a need for improvement and standard guidelines to enable a successful transition process, considering clinicians' and patients’ necessities.

Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence.

Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16-19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90-1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

Short Research Article: Opening a new CAMHS day hospital - does it affect inpatient admissions and does it help at all?

Day hospitals in child and adolescent mental health services are held to be helpful entities in the psychiatric care of young people. However, limited research has been done to look into how day hospitals and similar settings affect referrals, inpatient stays and in which cohort of patients do they show the most impact. This study's primary aims were to examine the impact of a new Child and Adolescent Mental Health Service (CAMHS) day hospital on referrals and admissions to the associated CAMHS in-patient unit. A secondary aim of this study was to examine the demographics and clinical outcomes of the young people attending the day hospital. Information was gathered using retrospective reviews of clinical files and databases. There was a reduction in admissions and in the total bed days from the study area following the opening of the day hospital. There was an improvement in clinical outcomes for young people attending the day hospital. Day hospital in child and adolescent mental health services can prove to be a useful modality to provide support to young people with a moderate to severe mental illness leading to reduced inpatient admissions and improving lengths of inpatient stay. It also improves clinical outcomes for cohorts of young people where inpatient stay is not warranted but higher levels of support is needed.

‘Understanding our family’: Co-producing empowering &amp; non-blaming stories with families in a CAMHS inpatient unit

The influence and importance of a family on children and young people’s mental health and wellbeing has been well documented (Kana’Iaupuni et al., 2005). Therefore, when children and young people encounter mental health services it is vital that a family focused perspective is prioritised (Gross &amp; Goldin, 2008). However, efforts to consider and explore family dynamics in the context of children’s lives have often been blaming and overly expert (Dallos, 2019). There have been some attempts to move away from individualistic understandings of children’s distress to more family functional formulations (Dallos, et al., 2020). Nonetheless, there remains very little literature and evidence around involving families in co-producing psychological formulations in a non-blaming, transparent and empowering way, but in particular this scarcity is evident in inpatient child and adolescent mental health services (CAMHS). The present paper will outline a co-produced family focused formulation called ‘Understanding Our Family’ developed for inpatient CAMHS settings by the authors. ‘Understanding Our Family’ is informed by the Power Threat Meaning Framework (Johnstone, et al., 2018) to provide an alternative understanding to what brings families into contact with inpatient settings and to offer a de-stigmatising and empowering narrative to families subject to multiple stressors and complex systems. The present article discusses and critically interrogates the challenges and opportunities of developing, implementing, and embedding this approach within a CAMHS inpatient setting in the North of England.

Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

BackgroundYoung people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little...

A postgraduate training programme in child and adolescent mental health in a lower-middle-income country: a partnership model from Nigeria.

This paper describes a postgraduate training programme in child and adolescent mental health (CAMH) in Nigeria. It explains the background, curriculum development, teaching, evaluation and outcomes. By its 10th year the programme had trained 166 CAMH professionals from 14 African countries. Many of the graduates are running clinical CAMH services in their countries, mostly pioneered by them. They are also conducting CAMH training, including as faculty on the programme, and some are in international CAMH leadership roles. Key success elements of the programme that can be replicated in other low- and middle-income countries include international partnership, adopting a train-the-trainer approach, using a curriculum that covers clinical aspects of CAMH while also developing leadership and research skills, use of free-access training resources, and access to seed funding.