Child Psychiatric Care Research Articles

La révélation d’un inceste entre frère et sœur dans le cadre d’une prise en charge pédopsychiatrique : étude qualitative auprès d’adolescentes et leurs parents

ObjectiveIncest among siblings is a topic that is not often discussed despite its frequency. The objective of this study is to explore the subjective experience of the disclosure of brother/sister incest by the adolescent victim and their parents in the context of child psychiatric care. MethodThis is a qualitative study based on semi-structured interviews with three adolescent victims who were under child psychiatric care and who had revealed the brother/sister incest to their caregivers for the first time, as well as with two mothers of adolescent victims. The analysis of the data was conducted using the interpretative phenomenological analysis method. ResultsThe results include eleven themes grouped into three meta-themes: (1) pre-disclosure: a state of unease that leads to the initiation of care; (2) the experience of disclosure to a health professional; (3) post-disclosure and its consequences. The different themes highlight the specificities of the experience of the disclosure of incest during the teenage years and the consequences for the parent–child relationship and also for the victim's relationship to the family depending on the adolescent's perspective, parental support, and the medical and legal support. ConclusionThe vulnerability of the adolescent population in a context of disclosure of intrafamilial sexual abuse between brothers and sisters makes it essential that we conceive of care in a specific way and take into account family and transcultural approaches. This study allows us to identify research perspectives in the field of child psychiatry as well as to formulate concrete clinical proposals, in particular a multidisciplinary support protocol on three different levels: individual, parental and familial.

Treatment Effects of Introducing the Neurosequential Model of Therapeutics in a Norwegian Residential Treatment Facility for Children Aged 7-13.

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7-13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child's unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy.

Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff

BackgroundLegislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care.MethodsDuring 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context.ResultsThe legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators’ understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy.ConclusionsThe study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.

Suicide and sudden violent death among young people: Two sides of the same coin?

The aim of the present study was to compare risk factors for death by suicide and sudden violent death (SVD) among young people aged 10-25 years. Two target samples, 63 consecutive cases of youth suicide and 62 cases of SVD, were compared on potential risk factors differentiating the two groups from 104 controls. Data on psychiatric diagnoses, psychosocial factors, adverse childhood experiences, stressful life events, and coping strategies were collected in psychological autopsy interviews. Distinguishing for the suicide group was lower frequency of living in a steady relationship, adult psychiatric care, depression, autism spectrum disorder, being sexually assaulted, higher frequency of recent stressful life events, and lowest levels of adaptive coping. Distinguishing for the SVD group was a predominance of males, lower elementary school results, abuse of psychoactive drugs, being investigated or sentenced for criminal acts, conduct disorder or antisocial personality disorder. Common risk factors for both kinds of premature unnatural death included lower educational level, absence of work or studies, different forms of addiction, child and adolescent psychiatric care, borderline personality disorder, adverse childhood experiences, and less adaptive coping. Accordingly, there is a common ground of vulnerabilities, early adversities, and recent strains in life for both forms of premature death, but also substantial differences between these contrasting lethal developments. Prevention of both suicide and SVD should focus on adverse childhood experiences, learning difficulties, meaningful occupation, more adaptive coping, addiction, and treatment of borderline personality disorder. Suicide prevention should comprise promotion of adaptive stress management skills, depression prevention and treatment, and paying attention to young people with autism. SVD prevention should involve early response to learning difficulties, abuse of psychoactive drugs and delinquent behavior, and treatment of conduct disorder and antisocial personality disorder.

Managing Type 1 Diabetes in an Inpatient Child Psychiatric Care Setting.

Individuals with diabetes are at increased risk for psychological, behavioral, and social problems. Comorbid mental illness and diabetes present a unique set of challenges for people with diabetes and their health care providers, particularly in an inpatient setting. Psychiatric symptoms before admission may affect type 1 diabetes management, and mental status and behavior can affect individuals' ability to cooperate with treatment while they are inpatients. This article describes a clinical protocol to manage type 1 diabetes and maximize patient safety in an acute inpatient child psychiatric unit.

Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care.

With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.

Developing Consensus: A Look at the Up-to-Date Research, Guidelines, and Principles for the Integration of Pharmacogenetics (PGx) in Child and Adolescent Psychiatric Care

Developing Consensus: A Look at the Up-to-Date Research, Guidelines, and Principles for the Integration of Pharmacogenetics (PGx) in Child and Adolescent Psychiatric Care

4.2 Postpandemic Availability of Outpatient Child Psychiatric Care: A Simulated Patient Study Across Three US Cities

4.2 Postpandemic Availability of Outpatient Child Psychiatric Care: A Simulated Patient Study Across Three US Cities

Survey Reveals Stark Difficulty in Obtaining Appointments for Child Psychiatric Care

Survey Reveals Stark Difficulty in Obtaining Appointments for Child Psychiatric Care

Availability of Outpatient Child Psychiatric Care During COVID-19: A Simulated-Patient Study in Three U.S. Cities.

In this study, the authors sought to ascertain the availability of outpatient child psychiatric appointments in three U.S. cities. Using a simulated-patient methodology, investigators called 322 psychiatrists who were listed in a major insurer's database for three U.S. cities, and they attempted to make appointments for a child with three payment types: Blue Cross-Blue Shield, Medicaid, and self-pay. Initial appointments were available 11% of the time, and it was most difficult to obtain an appointment under Medicaid coverage. Nineteen percent of phone numbers were wrong, and 25% of psychiatrists were not accepting new patients. These results are concerning given the current mental health crisis among youths and suggest the need for more psychiatrists, higher reimbursement rates for psychiatric services, and continued efforts to increase access to care. This study also highlights the need for insurance companies to maintain accurate information in their databases.

Athree-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic

The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing aseries of articles in aspecial issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape. First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other. On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, asignificant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.

Inpatient care in child and adolescent psychiatry-Who gets treatment?

This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022. In June 2022, the authors surveyed the current status of child and adolescent psychiatric primary care in Austria. Both systemised beds and day hospital beds as well as the number of specialists and assistant doctors were taken into account. Abed index of 0.05 beds/1000 inhabitants (as of 6/2022) was calculated, which is below the guideline for beds needed and does not correspond with the need depicted for sufficient provision of care ("Österreichischer Strukturplan Gesundheit"). Moreover, in June 2022, 40beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria. Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for alimited period of time until 31.05.2027, it is hardly possible to guarantee sufficient mental health care according to the increased demand for child and adolescent psychiatry, especially in times of the pandemic. Measures need to be urgently taken to improve child and adolescent psychiatric treatment options. In order to ensure adequate care for the increasing number of mentally ill children and adolescents (a)the number of beds must be increased, (b)structural deficits have to improve, and (c)innovative treatment options in the sense of inpatient-equivalent treatment (home treatment) has to be considered.

Day care clinics central and/or distributed. Astandard element of child and adolescent psychiatric care

Day-care clinics as specialized care units of child and adolescent psychiatric care in Austria represent an important component for person-orientated treatment offers. In addition to numerous advantages, they also put higher demands on the young patients and their relatives. The Austrian structure for day-care settings is recorded in the Austrian structure plan for health. Therefore, particular attention is paid to structural quality criteria, which are based on the Austrian concept of performance-oriented hospital financing. Ahigh demand and need for readiness for transdisciplinary, multimodal treatment concepts and forms is discussed. It becomes ovious that there is aneed for large spatial resource requirements. The establishment of several day clinic groups at one location and spatial requirements cannot be found in the concept of performance-oriented hospital financing. To ensure and evaluate the quality of treatment, recommendations are made on apatient-related and team- or organization-related level. The workgroup "day-care-clinic" of the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy recommends atreatment structure characterized by transdisciplinarity and participation. Further, it regionalized and local access and the integration of the day clinic into the community is necessary. Networking with other care structures and using social-psychiatric networks is essential. Regional characteristics should be taken into account and specialized, topic-specific day clinic groups should be increasingly included in further planning and concepts.

Care, provision of care and models of care in child and adolescent psychiatry in Austria

HintergrundDie Situation der Kinder- und Jugendpsychiatrischen Versorgung hat sich seit 2007, seit der Schaffung des Sonderfaches KJP+P, sukzessive verbessert. Die Arbeitsgruppe Versorgung der ÖGKJP gibt in diesem Heft einen Überblick über die KJP-Versorgungssituation in Österreich. In dieser Einführung geht es um die Darstellung der rechtlichen Vorgaben und deren Umsetzung. Es bestehen nach wie vor massive Defizite der KJP-Versorgung.Im Österreichischen Strukturplan Gesundheit (ÖSG) ist das momentan gültige Versorgungskonzept festgeschrieben und umfasst die ambulante, teilstationäre und stationäre Versorgung. Für die ambulante und stationäre Versorgung existieren Messzahlen, für die teilstationäre Versorgung nicht.Das Fachgebiet KJP hat verschiedene Besonderheiten: die Multimodalität, die Multiprofessionalität, die Altersgruppen der Betroffenen, pro Alter unterschiedliche und unterschiedlich ausgeprägte Erkrankungen, die Beschränkung auf eine bestimmte Altersgruppe (< 19 Jahre) und – das verbindet es mit dem Fach Psychiatrie – eine hohe Prävalenz der Erkrankungen sowie die Integration der Psychotherapeutischen Medizin in den Facharzt.SchlussfolgerungenDie aus diesen Besonderheiten sich ergebenden Konsequenzen – altersdifferenzierte Angebote, fachübergreifende Kooperation etc. – haben bisher keinen Eingang in die strukturellen und finanziellen Berechnungen gefunden. Anhand der den Begriff Versorgung beschreibenden Begriffe: „care“, „provision“ und „supply“ wird ein Modell vorgestellt, das bei der Planung von Gesundheitsmaßnahmen in diesem Bereich als Denkansatz herangezogen werden könnte. Da psychisch kranke Kinder und Jugendliche sich in allen Teilen der Gesellschaft finden, wird die Einrichtung einer zentral verantwortlichen und ressortübergreifenden Stelle für Mental Health gefordert.

Expérience subjective du rapport aux soins pédopsychiatriques chez des adolescents franco-algériens : une perspective individuelle, et historique

IntroductionAlgerian-French adolescents, whether they are aware of it or not, carry an unfinished past, the consequences of History. Those can have an impact on their self-projection into the future, as well as in the clinic itself. The aim of this study is to explore the subjective experience of child psychiatric care for Algerian-French adolescents, from an individual and historical perspective. MethodsThe study was qualitative, phenomenological, and inductive. Adolescents with Algerian ancestry were recruited from two child psychiatry services. Semi-structured interviews were transcribed and analyzed through the Interpretative Phenomenological Analysis. ResultsThe seven adolescents included in the study expressed an internal experience of shame and guilt concerning mental disorders and evoked parental reluctance to hospitalize their children and their fear of deprivation of their rights. The taboo of psychiatric illness, which was occasionally mentioned, is part of an Algerian cultural identity, while religion was rather seen as a support in the troubles and the construction of the identity-related experience. DiscussionThe results underline the importance of History in the intrapsychic experience and the fragility these adolescents presented in their relationship to child psychiatry. The hypotheses are that there could be a collective traumatic transmission of the episodes of imprisonment of Algerians by the French, and that the partial absence of psychiatric care in their imagination could be linked to a defensive rejection of care structures in the colonial period. ConclusionsAll of this has allowed us to highlight the need for a greater awareness of the medical environment in order to help these adolescents to appropriate and transcend the violence inherent to their history.

La consultation unique en pédopsychiatrie pour les enfants d’âge préscolaire : intérêts et limites d’un modèle de réponse à des demandes exponentielles

IntroductionIn child psychiatry, the classic model of care, which is the therapeutic consultations, implies a continuity of care by the same therapist from the first session. The strong emotional charge which emerges from this first consultation favours the therapeutic alliance. This model requires staff resources which are often no longer available in our care systems. Depending on the area, children have to wait several months to several years to get a first appointment with a specialist. A Geneva outpatient child psychiatric unit for preschool children has experimented a different approach in which families are first seen by an experienced child psychiatrist for a single consultation (SC) with the following objectives: to reduce the waiting time before the first appointment, to relieve parental anxiety, to give initial advice and to refer families to care with another therapist if needed, either within the same unit or to another structure. ObjectivesIn this article, we examine, through an observational study, the relevance of this model, its acceptance by families and therapists, as well as its advantages and limitations. MethodsAn observational study was conducted between March 2019 and February 2020 among 79 families who benefited from this model. The data were collected in an outpatient child psychiatry unit for preschool children, the Guidance infantile, which is part of the Geneva University Hospitals. Exclusion criteria were: no French speaking, the presence of a legal third party during the session (minor protection service, lawyer), or a known clinical contraindication to a change of therapist. Four questionnaires were distributed along the study. The first and second were respectively completed by the family and the therapist immediately after the SC. The third was filled out by the family by telephone two months after the SC and the fourth was completed by the second therapist in charge of the therapy after the SC, if therapy took place in the same unit. ResultsAt the end of the 79 SCs, 41 indications for continuation of care in the Guidance were made, 26 of them also including a parallel referral to an outpatient care structure. 24 patients were referred only to outpatient care, and for 14 patients no further care was indicated or desired by the parents. The SCs lasted between 60 and 90minutes. Regarding their concern about their child, 65% of families noticed a reduction of anxiety immediately after the SC and 51% two months after the SC. 75% answered that the SC helped them to better tolerate the wait before the rest of the treatment. However, this waiting time was still perceived as too long by 22% of families. Most parents (51% after the SC and also after 2 months) perceived the change of therapist as “not problematic at all”. When the patient was redirected toward a junior therapist inside the same care unit, the written report and oral transmissions facilitated the follow-up. All of the second therapists considered that the change of clinician had no negative impact on the establishment of a therapeutic alliance. On the contrary, 63% of them noted that the SC had favored the alliance. ConclusionsGood clinical practice requires the development of therapeutic models that take into account their quality, effectiveness and cost effectiveness. The lack of child psychiatrists, together with the increase in needs, pushes us to think about new modes of care which take into account the particularity of child psychiatric care in which the therapeutic alliance constitutes a major stake. The results of this observational study show the relevance and acceptability of this model in a population of families seeking psychiatric help for preschool children. The families noted fare more advantages than inconveniences with this new practice. The majority of them appreciated the rapid management of care, which was more important to them than the continuity of care by the same therapist. The clinicians, who were mainly doubtful about this model, gave a positive evaluation, in particular by realizing that the therapeutic alliance was not negatively impacted by the change of therapist. However, this model should be applied with some flexibility by allowing a second session when clinically useful to improve the evaluation or the referral and by allowing the SC's therapist to continue the assessment and the treatment with families who are at risk of disruption of care if there is a change of therapist or an additional waiting period.

Changes in child and adolescent psychiatric care with respect to autism spectrum disorders

The evaluation unit for pervasive developmental disorders and autism - diagnostic center of Seine-et-Marne "United" has been open for eleven years within the child and adolescent psychiatry department. At the beginning, it welcomed patients as a first intention, or not, at a time when the diagnosis verbalized to the families was not self-evident. It has gradually taken on the role of an evaluation center for complex situations, pushed in this by the political authorities who are trying to structure (to change) the life course of people with autism. The Canadian "SACCADE" model opens up avenues of reflection on the understanding of autism, thus reexamining the place of the caregiver in child psychiatry.

Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. Asurvey of the demand situation

Ein steigender kinder- und jugendpsychiatrischer Versorgungsbedarf ist in den letzten Jahren deutlich zu beobachten. Die vorliegende Studie befasst sich mit 20 Kinder- und Jugendhilfeeinrichtungen im Industrieviertel (Niederösterreich) und dem kinder- und jugendpsychiatrischen Behandlungsbedarfs der 439 dort fremduntergebrachten Kinder und Jugendlichen. Es zeigen sich bei 270 (62 %) der Kinder und Jugendlichen psychiatrische Auffälligkeiten und bei 220 (50,1 %) ein oder mehrere psychiatrische Diagnosen. Davon sind 200 Kinder und Jugendlichen bereits in einer kinder- und jugendpsychiatrischen Behandlung. Bei elf Einrichtungen besteht ein Behandlungsbedarf von 80–100 % der fremduntergebrachten Kinder und Jugendlichen. Es ergibt sich daraus ein hochbelastetes Helfer:innensystem und eine große Versorgungsnotwendigkeit in den Einrichtungen. Eine intensivere Vernetzung und Zusammenarbeit der involvierten Institutionen bzw. Helfer:innensysteme und einer Weiterentwicklung des Kinder- und Jugendpsychiatrischen Angebots wäre wünschenswert, um den steigenden psychiatrischen Behandlungsbedarf bei Kindern und Jugendlichen adäquat begegnen zu können.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s40211-022-00419-y) enthalten.

Tevredenheidsvragenlijsten bij residentiële geestelijke gezondheidszorg voor minderjarigen: systematische review

Satisfaction questionnaires for residential care in child psychiatry: a systematic review Background. The measurement of patient satisfaction in child psychiatry is used for evaluation, quality projects and scientific research. It is recommended to use instruments with sufficient validity and reliability. Methodology. The goal of this systematic review is to make an overview of the questionnaires that are currently used in residential child psychiatric care, and to evaluate the quality of those instruments. A search was performed in the databases Medline and Cochrane Library. Studies with patients aged below 18 years or their parents, who have used residential psychiatric care, were included. The studies were published in peer-reviewed magazines in Dutch, French or English. The quality of the instruments was evaluated based upon their psychometric properties (using the COSMIN (‘Consensus-based Standards for the Selection of Health Measurement Instruments’) criteria) and descriptive features were compared. Results. In 50 relevant articles, 44 questionnaires were found. For 31 questionnaires, psychometric properties were mentioned. Validity was determined more frequently than reliability (30 versus 2 questionnaires). Conclusion. Questionnaires YSS (Youth Services Survey) and YSSF (Youth Services Survey for Families) are recommended to use because of their good content validity and internal consistency.

Substance-related disorders and transition psychiatry

Addictive disorders are typically manifested during adolescence and have a high transmission rate into adulthood. When adulthood is reached the responsibility by the child and adolescent psychiatric care system ends and patients transition to adult psychiatry. Alack of supportive concepts and approaches to this transition can have detrimental effects on the long-term health of affected individuals. Addiction treatment requirements of young adults transitioning between the systems of care are presented. Developmental psychopathological concepts are presented and treatment recommendations are provided. The scientific literature on development-related approaches to addiction treatment was evaluated. Care conditions relevant to transitional psychiatry are discussed and a description of needs is carried out. Adolescents and young adults are very frequently affected by addictive disorders. The need for disorder-specific and age-specific transition-related concepts and services for these patients is high. During the transition from child and adolescent psychiatry to the psychiatric care system for adults, patients with substance-related disorders require treatment-related educational and age-appropriate psychosocial support services that address the high comorbidity and developmental delays. Age-specific and disorder-specific treatment services should be broadly expanded and the interfaces to youth welfare, addiction counseling and adult psychiatry should be better coordinated.