Child Mental Health Professionals Research Articles

What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?

Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might approach them. There are very few evidence-based interventions that guide clinical assessment or practice. Digital Health Interventions (DHIs) have the potential to be an effective option where children and young people's services are challenged, including accessibility and anonymity. The aim of this study was to explore mental health practitioners' views of how DHIs may play a role in supporting young people who have experienced OCSA, and the role they can play in healthcare delivery. In-depth qualitative interviews and one focus group were conducted with 25 child mental health professionals across two sites (Manchester and Edinburgh). Data was analyzed using reflexive thematic analysis. Three overarching themes and 9 sub-themes were identified: (1) feeling a little bit lost; (2) seeing potential problems; and (3) knowing what works. Practitioners expressed interest in a DHI to support this client group and saw it as a way of managing waiting lists and complementing existing therapies. They felt that many young people would see this as a preferred medium to in-person therapy, would be empowering, and offers new ways of learning how to stay safe online. However, there were concerns about how much time would be needed by staff to deliver a DHI, anxieties about safety issues in relation to content and data protection, some of which may be unique to this population of young people, and concerns about the absence of a therapeutic relationship with vulnerable children. Our findings indicated that practitioners were uncertain about working with children subjected to OCSA but were receptive to the possibility of using a DHI to support their practice and to reduce waiting lists. Concerns were expressed about the time needed for staff training and support as well as concerns over patient safety and the lack of evidence about the effectiveness of an unsupported DHI.

Exploring the content of self-help toolkits as an intervention for non-suicidal self-injury in young people in England.

Non-suicidal self-harm has been increasing in young people over the last decade leading to several self-help interventions being developed. Self-help toolkits are given a variety of names, such as 'hope box' and 'self-soothe kit', but all seek to provide young people with the tools to manage thoughts to self-harm by bringing together a collection of personal items, distress tolerance activities and help-seeking prompts. They represent a low-cost, low-burden and accessible intervention. This study explored what child and adolescent mental health professionals working with young people are currently recommending as the content of these self-help toolkits. A questionnaire was sent to child and adolescent mental health services and residential units across England and received 251 responses from professionals. Sixty-six per cent described self-help tool kits as being effective or very effective for helping young people manage self-harm urges. The content was categorized into sensory items (subcategorized by sense), distraction activities, relaxation and mindfulness activities, seeking positives and coping strategies, with the caveat that all toolkits should be individualized. The results of this study help to inform the future manualization of the use of self-help toolkits in clinical practice as a self-harm intervention for children and young people.

Balancing the law with children's rights to participation and decision-making: Practice guidelines for mandatory reporting processes in child sexual abuse.

In India, legal response to a sexual offence, namely, punishment of the perpetrator,relies nearly entirely on mandatory reporting provisions in child sexual abuse law.Mandatory reporting forms an important first step in the medico-legal processes of CSAwork, because it leads onto other legal interventions in CSA cases. However, social, stigma, perceived harassment, rampant gender stereotypes, the unwillingness of, family, disbelief of the victim, and threats by the perpetrator are a few of the many, barriers to mandatory reporting in the Indian context. One particularly insufficiently, addressed critical barrier in the global and Indian literature on CSA and law stems from the reluctance of children to allow child protection and mental health professionals to report to relevant authorities. There are few guidelines or practical strategies available,on how to engage children in mandatory reporting processes. This article uses a childcentric lens to propose the need to balance children's rights to participation and decision-making with the mandatory reporting law. It proposes a conceptual frameworkthat acknowledges the imperatives and challenges of the mandatory reporting law and its implementation, whilst also recognizing children's barriers to abuse disclosures andtheir rights to make decisions and provide consent on reporting issues. It culminates in a guideline for child mental health and protection service providers, offering step-bystep support on navigating the challenges and dilemmas of mandatory reporting through suggested scripts that engage children to enable more effective reporting ofCSA to child protection systems and relevant legal authorities.

Healing with Storybooks: Using Bibliotherapy to Help Children Cope with Death

Abstract Bibliotherapy refers to a dynamic process that occurs when mindful reading of books helps the reader to gain potential insight into their life experiences, overcome negative emotions, and enhance adaptive coping. The key to effective therapeutic reading involves selecting developmentally appropriate books with portrayed characters, situations, and emotional experiences with whom the child can identify. Children’s literature can be used as a pedagogical and clinical tool to teach values, facilitate emotional growth, and promote healthy development. The present case report demonstrates that parent-directed bibliotherapy has the potential to reduce childhood fears and help young children come to terms with loss in a nonthreatening and engaging way. The easy accessibility and low cost make bibliotherapy the treatment of choice in low- and middle-income countries where there is a need for alternative options for the delivery of services due to the scarce availability of trained child mental health professionals.

DC:0–5™ Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Promotion in Russia

The purpose of the report is to inform the community of Russian pediatric mental health professionals about the international DC:05 Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: its purpose, target age, structure and content of diagnostic axes, as well as about the steps already taken domestically to promote the Classification in Russia. We show that the diagnostic Classification is the brainchild of leading foreign experts in the mental health of children and that it is based on an analysis and extrapolation of a large body of clinical data from around the world and covers a wide range of mental disorders experienced by children during their first five years of life. The interdisciplinary focus of DC:05 is emphasized, as well as the presence in it of a crosswalk to the DSM-5 and ICD-10 systems, and the possibility to supplement these classifications taking into account the age specificity of disorders. It was made note that this diagnostic classification is almost unknown among Russian specialists. The report briefly touches on the results of the research activities of the interdisciplinary research group of the Scientific Center for Mental Health (Moscow) carried out in the period between 2002 and 2017 and aimed at analyzing the diagnostic approaches proposed in the Classification and testing them on Russian sample populations. The release of the Russian version of DC:05 in 2022 by the non-profit organization Caritas Social School (St. Petersburg), with the official consent of the DC:05 developer and in cooperation with the Faculty of Psychology of St. Petersburg State University, and an accompanying DC:05 introduction course developed by this team for Russian child mental health professionals were announced.

“She was willing to send me there”: Intrafamilial child sexual abuse, exploitation and trafficking of boys

BackgroundBoys subject to intrafamilial child sexual exploitation and abuse (CSEA) - in particular, cases which begin as incest and later evolve into child trafficking for sexual exploitation - face many barriers in disclosing their exploitation, often leaving victims and survivors feeling isolated from society and dismissed or mishandled by service providers such as law enforcement officers, child protection specialists, medical staff and mental health professionals. ObjectiveThis study explores the unique characteristics of intrafamilial CSEA through the sex trafficking of boys, and the barriers to disclosure and recovery experienced by male victims and survivors. Participants and settingTen adult male survivors of intrafamilial child trafficking for sexual exploitation were interviewed multiple times to gain a deeper understanding of intrafamilial CSEA and how it compares and contrasts with non-familial CSEA. Participants in this study primarily came from North America. MethodologyMultiple semi-structured online interviews were conducted with these 10 adult male survivors because they experienced 1) intrafamilial CSEA and 2) being trafficked by their families to be sexually exploited by non-familial perpetrators. The participants were then asked to compare and contrast intrafamilial and non-familial CSEA. The research team employed a descriptive phenomenological approach and interview transcripts were coded, analyzed, and compared to identify patterns of non-verbal CSEA indicators and thematic narratives. The study also explored the internal and external barriers to disclosure reported by participants. Trauma-informed, person-centered practices were used throughout the entirety of the study to minimize harm to participants. The research team employed a co-productive approach using participants' initial interviews and feedback to formulate new questions for later rounds of interviews and by having the participants confirm the accuracy of their respective quotes and case summaries. Results and discussionThis study highlights several CSEA modalities, such as “boy-swap” events and local/national/transnational trafficking rings engaged in CSEA of boys. It also discusses how survivors' experiences differed between intrafamilial and non-familial CSEA and trafficking, and how familial settings may facilitate concealment of CSEA. Participants described various modus operandi used by abusers, traffickers, and buyers of all genders. While all 10 intrafamilial CSEA cases included male perpetrators, female perpetrators were also present in nine of them. In addition, participants identified various psychological and physiological CSEA and trafficking indicators that evidenced their victimization during their childhood years. All 10 survivors reported long-term health consequences into adulthood and scored highly on Adverse Childhood Experiences (ACEs) questionnaires. Recommendations and conclusionFindings underscore the importance of trauma-informed practices for identifying, liberating, and rehabilitating victims and survivors. Participants reported receiving more effective assistance from service providers that exhibited trauma-informed practices. Traditional gender stereotypes may hinder the ability of service providers to recognize and provide support to boys victimized and trafficked by their families for CSEA. Consequently, service providers may stand to benefit from training on 1) trauma-informed, person-centered practices and 2) conscious and unconscious biases, particularly those related to gender. Survivors in recovery require expanded support services, such as the provision of safe housing, online/in-person support communities, and professional/life skill training. Co-productive research methods that integrate the views and experiences of CSEA and trafficking survivors are also recommended.

3.4 Psychopharmacological Treatment of Sleep Disorders

The objectives are to: 1) provide an update on the relative pros and cons of current prescription pharmacologic options available for the treatment of pediatric insomnia; 2) review the data supporting safety and efficacy of over-the-counter (OTC) medications, particularly melatonin; and 3) present an outline to assist child and adolescent mental health professionals in developing a practical and rational approach to using sedative hypnotic drugs in clinical practice, including patient and medication selection and potential pitfalls in management.

Fluoxetine misuse by snorting in a teenager: a case report

Introduction Self-harm and substance use disorders (SUD) are leading causes of Years of Life Lost (YLLs) among young people aged 10-24 years as per the Global Burden of Disease (GBD) Study 2019. The co-occurrence of these conditions can complicate the clinical picture and often poses a challenge to child and adolescent mental health professionals. Moreover, substance use by adolescents, due to the probable physical, legal and psychiatric complications, has the potential to progress into full-blown SUD in adolescence or adulthood. Case Report We present the case of a 15-year-old female with a history of multiple serious suicidal attempts and drug use disorders who misused fluoxetine as part of maladaptive coping. Selective serotonin reuptake inhibitors (SSRIs) are not known to be commonly abused drugs, let alone sniffed or snorted. To the best of our knowledge, this is the first reported case of an adolescent snorting the drug fluoxetine (SSRI). Conclusion This case highlights three main aspects for child and adolescent mental health professionals. First, the importance of screening for recreational drugs misuse in general, including fluoxetine, in a comprehensive assessment of a young person with coexisting substance misuse issues or its history. Second, ‘comorbidity is the rule rather than the exception’ in adolescents with SUDs. Third, the possible benefit of quetiapine in managing emotional dysregulation in a high-risk adolescent with traits of an emerging borderline personality disorder.

Eco-crisis and mental health of children and young people: Do child mental health professionals have a role?

Child mental health professionals have an extremely important role to play in their distinct roles as clinicians, therapists, researchers, policy makers, advocates, preventative public health professionals and service developers pertaining to eco-crisis in the child and adolescent populations. This article provides examples of how this can be done.

Integrated Family Approach in Mental Health Care by Professionals From Adult and Child Mental Health Services: A Qualitative Study.

ObjectiveA multiple case-study in which each case was evaluated by adult and child mental health professionals who used an integrated family approach in their treatments. In this approach, treatment focuses on the mental disorders of the parents as well as on the development of the young child and family relationships. This study evaluated the experiences of professionals from adult and child mental health services using this approach. The aim of the study is identifying key elements of this approach, processes involved in treatment, and barriers to its success, with the aim of contributing to the development of practice based integrated mental health care for the whole family.BackgroundParental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parent and child from being caught up in the intergenerational transmission of psychopathology, an integrated family approach in mental health care is needed. Methods: A qualitative case study design using a grounded theory approach. Data were collected through 19 group interviews of professionals (N = 37) from adult and infant mental health teams who worked together in the treatment of a family.ResultsProfessionals from the two services were comfortable coping with complexity and felt supported to perform their treatments by staying in touch with each other in multi-disciplinary consultations. They indicated that by attuning the treatment components to each other and tailoring them to the capabilities of the family, their treatments had more impact. A flexible attitude of all involved professionals and commitment to the interest of all family members was essential.ConclusionAccording to professionals, treatment with an integrated family approach in mental health care is of value for families by addressing the distinct roles, positions and relationships, by implementing a flexible complementary treatment plan, and by empowering professionals by multi-disciplinary consultations.

Debate: Child and adolescent mental health professionals have a responsibility to diagnose Personality Disorder.

In the United Kingdom, mental health professionals have been historically reluctant to diagnose Personality Disorder in young people over many decades, and there is little evidence that much has changed. However, there are consequences to this reluctance. Personality Disorders in young people are absent from national prevalence studies and research is sparse, as a lack of diagnosed patients makes it hard to recruit for studies. Consequently, national policy-makers lack an awareness of the scale of the problem and the focus on service provision to address it. Deliberate misdiagnosis of Personality Disorder due to professionals' unwillingness to use the diagnosis is not only unethical but can also cause harm as it stops young people from receiving the evidence-based interventions and support that they require. Young people and families often experience reassurance and relief when they receive an accurate diagnosis. Professionals need to reconsider whether their reluctance to diagnose is in their patients' best interests.

Debate: How can child and adolescent mental health professionals show leadership in the face of the ecological and climate crisis?

The authors discuss the failure of political leadership in the face of the climate and ecological crisis, particularly in the Australian context.This failure exacerbates the climate distress of young people. The work of Psychology for a Safe Climate offers clinical leadership with its support model and Climate Aware Practitioner Network. It is argued that child and adolescent mental health professionals need to show leadership both as clinicians and advocates.

WHEN A VIDEO GAME BECOMES THE TREATMENT: HARNESSING DIGITAL AND SCREEN TECHNOLOGY AS THERAPEUTIC MODALITIES IN CHILD AND ADOLESCENT PSYCHIATRY

Objectives: American teens consume approximately 7 hours of screen time daily, with use extending into social, recreational, and academic spheres of life. Youth also appear increasingly invested in using digital media to address health issues, with 64% reporting the use of a mobile app for health-related purposes. As their patients become more reliant on the use of screens, it is incumbent on child and adolescent mental health professionals to understand evolving digital technologies and their potential role in mental health treatment. The presentation’s overall objectives are both to review the most salient examples of mobile health (mHealth) technologies useful in the clinical encounter and to guide participants through how to make informed recommendations surrounding the use of mHealth technology. Methods: Specifically, this presentation explores the use of video games in psychotherapeutic treatment, including case studies to exemplify this practice, as well as the use of varying mHealth technologies (eg, digital phenotyping, electronic diary cards). Programs will review each technology’s potential risks and benefits. The presentation will also use a mixed didactic and interactive approach to guide participants through specific treatment decisions regarding incorporation of these technologies into the treatment setting (including through use of an online decision-making tool). Results: Psychiatrists have begun exploring clinical use of novel mHealth technologies. However, through its emphasis on remote forms of mental health care, the COVID-19 pandemic has forced more expedient clinical adoption of these novel technologies. Overall, treatments that incorporate video gaming, behavioral health apps, and apps that collect survey and phone sensor data appear feasible and acceptable to young patients;however, recommendation of a particular technology relies on cautious, calculated decision making. Conclusions: The patients of child and adolescent psychiatrists are rapidly adapting to new digital technologies, increasingly incorporating them into their lives, including their health. Adoption of mHealth technology has the potential to improve quality and facilitate obtainment of important clinical information. Mental health professionals should become proficient in both using and discussing mHealth technologies with their patients. TREAT, COMP, TVM

Sexual Behavior In preschool, school and preadolescents children A Sample from Outpatient’s Clinic of Pediatric Hospital

Abstract Background Studies have suggested that Sexual behaviors are common in children. More than 50% of children will engage in some type of sexual behavior before their 13th birthday. Sexual behaviors in children range from normal and developmentally appropriate to abusive and violent. In retrospective study of 339 child welfare and mental health professionals in which participants were asked about their own experiences before 13 years of age, 73% recalled engaging in sexual behaviors with other children, 34% recalled showing their genitals to another child, 16% recalled simulating intercourse with another child, and 5% recalled inserting an object in the vagina or rectum of another child Aim of the Work To observe the developmental course of describe normative sexual behaviors in 2- to 12-years-old Egyptian children and to assess the relative frequencies of different types of sexual behaviors in general outpatient clinic of pediatric hospital of Ain Shams University hospitals. Patients and Methods This is a Cross sectional analytical started on October 2018. Study conducted in pediatric hospital Ain Shams University hospitals. This present study aimed at analyzing the data of 500 children aged from 2 to 12 years old. Thirsty four refused to participate on sexual behaviour questions. Results A total of 500 questionnaires were done by parents of child vising clinic of pediatric hospital of Ain Shams university, 35 refused to participate in sexual behaviour questionnaire. It was divided in three groups. Preschool aged children from 2-6 years 254 child (50.8%), school aged children from 6-9 years 106 child (18.82%) & preadolescents from 10 to 12 years 140 child (24.014%). The study Included both 252 males and 248 females. The most sexual behaviours detected among children “sometimes” were touching genitals at home 111(22.2%), child asks about sexual acts 86 child (17.2%) & saying sexual words 80 (16%) and mostly repeated children was flirt with strangers 11(2.2%) & asking about sex more than other children 10 (2%). Conclusion In general, sexual behaviors in children two to five years of age are of a greater variety and are more common compared with the behaviors in children older than five years. once the child becomes aware of social rules regarding sexual behaviors in public, those behaviors become more covert. There is a need for further national studies in different settings, to help create a better understanding of what constitutes both normative and deviant sexual behaviour in children.

Sleep-Related Breathing Problem Trajectories Across Early Childhood and Academic Achievement-Related Performance at Age Eight.

Background: Childhood sleep disordered breathing (SDB) has been linked to poorer academic performance; however, research has not investigated the extent improvement in SDB may alter outcomes across key academic skills. This study aimed to investigate if children's early SDB status could predict later academic outcomes, and if an improvement in SDB status across the early childhood years would coincide with better, later performance in key academic skills related to reading, numeracy, and listening comprehension.Methods: Eighty five case children with an SDB symptom score >25 (maximum 77) were matched to 85 control children (score <12) at recruitment (age 3). SDB severity (symptom history and clinical assessment) was evaluated at ages 3, 4, 6, and 8 years and performance on individually-administered academic skills assessed at age 8 (91% retention from age 3). Case children were categorized into “improved” or “not-improved” groups based on SDB trajectories over the 5 years. Contributions of SDB status and trajectory group to academic performance were determined using regression analysis adjusted for demographic variables.Results: History of SDB from age 3 predicted significantly poorer performance on some key academic skills (oral reading and listening skills) at age 8. Children whose SDB improved (45%) performed better in oral reading fluency than those whose SDB did not improve, but difficulties with specific tasks involving oral language (listening retell) remained when compared to controls.Conclusion: Findings support links between early SDB and worse academic outcomes and suggest key academic areas of concern around oral language. Findings highlight the need for child mental health professionals to be aware of children's sleep problems, particularly SDB (past and present), when assessing potential barriers to children's achievement, to assist with appropriate and timely referrals for evaluation of children's sleep difficulties and collaborative evaluation of response to intervention for sleep difficulties.

Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study

BackgroundLow and middle-income countries (LMICs) lack trained child mental health professionals. While teachers’ child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions of serving as lay counselors and their mental health attitudes and knowledge.MethodsIn 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ perceptions of serving as lay counselor and mental health attitudes and knowledge.ResultsQualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention.ConclusionsTraining, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an “education as mental health therapy” system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes.Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27..

Viral time capsule: a global photo-elicitation study of child and adolescent mental health professionals during COVID-19

ObjectiveTo examine, through photo-elicitation, the personal and professional impact of the COVID-19 pandemic on mental health professionals working with children and adolescents around the globe.MethodsWe invited the submission of images collected about the pandemic between May and August 2020. We encouraged participants to yoke personal reflections or voice memos to their images. Using snowball sampling, we began with two invitations, including one to the graduates of a mentorship program continuously hosted since 2004 by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). We analyzed de-identified images and anonymized transcripts through iterative coding using thematic analysis informed by rich picture analysis and aided by NVivo software.ResultsWe collected submissions from child and adolescent mental health professionals (n = 134) working in 54 countries spread across the five continents. We identified four overarching domains with component themes that revealed both the commonality and the uniqueness of the pandemic experience around the globe: (1) Place (adjusting to emptiness and stillness; shifting timeframes; blending of spaces); (2) Person (disruption to life rhythms; emotional toll; positives of the pandemic); (3) Profession (changing practices; outreach efforts; guild pride—and guilt); and (4) Purpose (from pandemic to syndemic; from lamenting to embracing; planning toward a better tomorrow).ConclusionsPhoto-elicitation provided a disarming and efficient means to learn about individual, regional, and global similarities and differences regarding the professionals charged with addressing the mental health needs of children and adolescents around the globe. These findings may help inform practice changes in post-pandemic times.

A survey of evidence-based practice, training, supervision and clinician confidence relating to post-traumatic stress disorder (PTSD) therapies in UK child and adolescent mental health professionals

ABSTRACT Background: Post-Traumatic Stress Disorder (PTSD) in children and adolescents has received increasing recognition in recent decades. Despite development of treatments and improved dissemination efforts, research has identified a number of barriers to implementing these approaches. Objective: This study sought to understand what interventions mental health professionals working with children and adolescents utilised to treat PTSD, their training and supervision, their confidence in assessing and treating PTSD, and how these factors relate to clinicians characteristics (e.g. age, gender, professional background). Method: The study comprised an internet-delivered survey of clinicians working in child and adolescent mental health services in the UK (N = 716). Results: Many clinicians (>40%) had not received training in working with PTSD, with considerable variation between professional background. Lack of training and supervision was associated with reduced clinician confidence in treating children with PTSD (possible range 0–10; training M = 7.54, SD = 1.65, no training M = 5.49, SD = 2.29; supervision M = 7.53, SD = 1.63, no supervision M = 5.98, SD = 2.35). Evidence-based therapies for PTSD such as Trauma-Focused Cognitive-Behavioural Therapy and Eye Movement Desensitisation and Reprocessing were only endorsed modestly by clinicians (58.4% and 37.5%, respectively). Regression analyses identified that lack of training and supervision were significant barriers to the use of evidence-based interventions. Other predictors of clinician confidence and use of evidence-based interventions included profession and years of experience. Participants almost universally wanted more training in working with PTSD. Conclusions: Evidence-based treatments are not currently universally delivered by mental health professionals in the UK, with certain professions particularly lacking training and confidence with this condition. Training around trauma and PTSD may be an ongoing need to boost and maintain confidence in working with PTSD in youth.

Narrative Matters: Mental health recovery - considerations when working with youth.

Youth mental health and well-being is of increasing concern to practitioners and policy-makers. Youth experiencing mental health problems face many barriers in accessing care and often have different needs to those of adults experiencing mental health problems. In order to adequately respond to the needs of young people aged 12-25, it is necessary to understand, from their perspective, their diverse needs and their different realities, using a global health approach and through participation in the development of mental health services and care. There are documented difficulties in implementing a recovery-oriented practice approach that have led to misapplications, misunderstandings and critiques. That said, there is little research or discussion on mental health recovery by and for young people and young adults. To help child and adolescent mental health practitioners better assess the pertinence of the mental health recovery model in their practice, a focus on the emergence of the model can be helpful in order to adapt the current conceptions of mental health recovery for work with youth. Child and adolescent mental health professionals might want to consider the following three suggestions - consider developmental processes, focus on hope and create strong community ties.

Clinicians' use of and attitudes towards technology to provide and support interventions in child and adolescent mental health services.

Technology can increase child and adolescent mental health service (CAMHS) capacity by supporting and delivering interventions, yet it has not been widely adopted by CAMHS child mental health professionals. Uptake can either be facilitated or obstructed by child mental health professionals' attitudes, which remain largely unknown. One hundred fifty-four CAMHS child mental health professionals completed a questionnaire about their use of, and attitudes towards, using technology with children and adolescents. Child mental health professionals perceived themselves as generally competent at using technology, especially younger child mental health professionals, and perceived it to be helpful in their clinical work. A number of benefits of its use were identified such as accessibility, convenience and appeal, and it was primarily perceived as a preventative/psychoeducational tool rather than a replacement for face-to-face therapy. Older technologies (helplines and websites) were most frequently used, whereas newer technologies (computer games) were rarely used. Child mental health professionals were unsure what resources were available and whether technology is safe, private or reliable. Despite positive attitudes towards technology, newer technologies were rarely used by child mental health professionals. An overall lack of knowledge about resources along with concerns about safety and reliability may account for the slow uptake of technology within CAMHS. These issues need addressing to maximise implementation, perhaps through training or workshops.