Children's Mental Health Center Research Articles

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Garden as Canvas: Therapeutic Metaphors in a Children's Garden (Le jardin pour toile : les métaphores thérapeutiques dans un jardin pour enfants)

ABSTRACTThe garden is an inspired place, naturally imbued with metaphors of growth, healing, and renewal. Therapeutic work in the garden can help young clients discover healthy ways to cope with challenging feelings and behaviors such as anxiety and aggression, and learn self-regulation through the senses. Along with supporting literature and clinical examples, this article will present the story of the Children's Therapeutic Garden at a children's mental health center. This garden provides a welcoming, normalized environment for children and families who may otherwise feel stigmatized in a mental health setting.In this article, we share our innovative exploration in expanding the creative media we use to include nature and gardening in our work as art therapists. A variety of spin off topics emerged from our exploration and research, including caring for our environment, outdoor education, nutrition, healthy cooking and eating, and promotion of physical health, which are beyond the scope of this article. Rather we will focus on the innovation of using therapeutic metaphors in our work in the garden while doing art therapy with our clients. We will highlight artful garden interventions that facilitate the cooperative interactions of children and families, building stronger relationships, and improving communication.

Implementation and Evaluation of an Evidence-Based Treatment of Disruptive Behaviour within a Children's Mental Health Program

Abstract: This practice note details the synchronous implementation and developmental evaluation of a novel model of care that integrates an evidence-based treatment of children with disruptive behaviour within a community-based children's mental health centre in Canada. The overall objective of the project was to evaluate the impact and viability of the integrated program. A multidisciplinary team used a “knowledge to action” framework to guide implementation activities and a developmental evaluation approach to support learning and innovation, as well as measure program success. Key insights and lessons learned with regards to building staff capacity and appreciation for evaluation, balancing clinical and evaluation practices, and sustaining evaluation procedures are discussed. Suggestions for future similar efforts within a children's mental health context are provided.

When They Call, Will They Come? A Contextually Responsive Approach for Engaging Multistressed Families in an Urban Child Mental Health Center

Objective: This study examines the effect of an ecological and contextually responsive approach, during initial intake call, on engagement for multistressed families seeking child mental health services in an urban setting. Methods: Using a randomized design, parents were allocated to phone Intake As Usual (IAU) or Enhanced Engagement Phone Intake (EEPI). IAU consisted of a lengthy mandated standardized phone intake interview. EEPI, wrapped around the standard intake, was a flexible approach, attuning to the parent’s concerns, help-seeking experience, and stressors and incorporating problem-solving and motivational interviewing. Results: Controlling for child gender, child age, income, and marital status, parents in the EEPI condition were 3 times more likely to attend their initial face-to-face agency appointment and subsequent treatment services. Conclusions: This study contributes to building the evidence base for early engagement approaches responsive to families’ broader ecological context to ensure that vulnerable children and families access and receive benefits of treatment.

Effects of the child–perpetrator relationship on mental health outcomes of child abuse: It's (not) all relative

The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

Changes in clinical presentation of children with autistic disorder, at an autism clinic in Taiwan from 1987 to 1995

Autistic disorder was originally viewed as a distinct, rare, and severe childhood mental disorder that caused life-long disability. However, since the late 1990s autistic disorder was found to have a high prevalence rate and to affect children on a spectrum from mild to severe dysfunction. The purpose of this retrospective, descriptive study was to examine changes in the characteristics of patients with autistic disorder in Taiwan from 1987 to 1995. To that end, we examined the characteristics, age at diagnosis, symptoms, and developmental condition of affected children and the educational background of their parents who visited an autism clinic at the children's mental health center of a medical center in Taipei. This clinic was the first, largest, and for many years the only autistic disorder clinic in Taiwan. Across the 9-year study period, we observed trends in decreasing age at first visit, increasing age at assessment, rising maternal educational level, lessening autistic disorder symptomatology, and increasing developmental quotients. These changes may have been due to improved diagnostic criteria, government policy, and healthcare professionals’ and parents’ increased awareness of autistic disorder. Clinical implications and related policy making toward these changes are proposed.

ROLE OF MATERNAL CHILDHOOD TRAUMA ON PARENTING AMONG DEPRESSED MOTHERS OF PSYCHIATRICALLY ILL CHILDREN

Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting. Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting.

An Exploratory Study of Parents' Perceived Educational Needs for Parenting a Child with Learning Disabilities

This exploratory, qualitative study was conducted to explore Chinese couples' perceived educational needs for parenting a child with specific learning difficulties (SLD). We recruited a purposive sample of 25 couples who were caring for a child with SLD at home from one regional child mental health center in Hong Kong. Data were collected from individual couples via audio-taped, semi-structured interviews between April and June 2011. Each interview lasted for about an hour. We analyzed the interview data using qualitative content analysis, as suggested by Graneheim and Lundman (2004). Four identified categories of parents' perceived educational needs were information needs for caregiving, a variety of health concerns with themselves and their child, inadequate psychosocial support, and perceived stigma attached to help-seeking. These results reveal challenges and information for mental health professionals in providing effective educational and psychosocial support and culture-specific health care for these families and their children with learning disabilities. Our findings indicate a few important educational needs of parents in caring for a child with SLD that might be underestimated by mental health professionals and teachers, such as psychological support and information needs. To facilitate effective parenting, holistic and individualized needs assessment and education should be provided to address each parent's biopsychosocial and cultural needs in relation to caregiving.

The critical role for psychology in the children's mental health system: Being a catalyst to implement and build better interventions.

Abstract The increasing demands for accountability, effectiveness, and use of research in the children's mental health system places psychology in a unique and important position. Psychology practitioners are highly trained in scientific and clinical methods and possess the skills needed to implement evidence-based practices in community organisations. Moreover, psychology's central role in the increasing demand to evaluate services can help to foster the development of reflective learning organisations. The current article describes current directions in evidence-based practice in the children's mental health system and the critical role psychology can play in building more effective services. Key priorities and directions for psychology's role in children's mental health are provided. Keywords: children, implementation, evidence-based, treatment, organizations The children's mental health field, like most sectors of our society, is in the midst of dramatic transformation. There are increasing demands for accountability, effectiveness, and integration of available empirical research into everyday service delivery. While this represents a positive shift in clinical it also leaves many frontline clinicians, organisations, and policymakers in a state of uncertainty about how to achieve such ideals. What does it mean to be evidence-based? Am I using the research information possible? What constitutes a sound or adequate program evaluation? These questions, and many others like them, receive a wide range of answers by current psychology practitioners. This variability, in part, represents the nascent status of the field and the paucity of research in children's mental health. Notwithstanding these challenges, it is an exciting and important time of transition where practitioners, organisations, and policymakers are all striving toward the realisation of improved child and adolescent mental health interventions. However, much is to be learned as frontline practitioners face the challenge of incorporating new knowledge into daily clinical practice. This journey is a process which will require collaboration across multiple sectors and disciplines, and will inevitably result in some failures and mistakes along the way. Like Dr. Seuss, who was rejected by publishers 27 times before his first book, And to Think That I Saw it on Mulberry Street, was published, persistence in our efforts to implement and build more effective interventions is critical to the success of our work. The current article will attempt to describe my perspective and thoughts as a frontline practitioner on how psychology's unique skill set can be used to build more effective interventions in the children's mental health system. This will include psychology's ability to use the various approaches to evidence-based practice that currently exist in the children's mental health field. In addition to promoting the use of effective approaches, psychology can and should play an increasingly critical role in facilitating the careful implementation of evidence-based practices. Finally, in light of the current state of the field, recommendations for moving forward are provided both from the perspective of a frontline practitioner and from the personal lessons learned through implementing evidencebased programs in a community-based children's mental health centre (Schmidt & Taylor, 2002). Effectiveness of Usual Children's Mental Health Treatment Kutcher (2011) argues that the children's mental health field must move toward best evidence, not best practice, and must use interventions which are right rather than using what feels right. These strong statements by Kutcher arise from the disappointing results found in past reviews of Treatment as Usual (TAU) in the children's mental healm system. As described in past studies, TAU refers to the usual provision of eclectic treatment services, by community-based clinicians, under the confines of existing available resources. …

Challenges working with infants and their families: Symptoms and meanings-two approaches of infant-parent psychotherapy.

In this article, the authors describe the rationale for the way they work with troubled infant-parent relationships. They focus on two approaches developed at the Hincks-Dellcrest Children's Mental Health Centre (Toronto, Canada), a publically funded agency where they work and teach. One approach is Watch, Wait and Wonder, and the other is Infant-Parent Psychotherapy. The authors share a common philosophy that directs the way they think about the way they work. Two clinical case studies are presented to illustrate the treatment process of each approach. The presenting symptoms in both cases are similar (sleep difficulties), but the meaning, ages, and family compositions are different. The interventions unlocked the difficulties that each relationship was experiencing in a brief period of time.

Opening remarks.

Infant Mental Health JournalVolume 32, Issue 6 p. 582-582 Introduction Opening remarks Elizabeth Tuters, Corresponding Author Elizabeth Tuters [email protected] The Hincks-Dellcrest Children's Mental Health Centre and Institute, Toronto Elizabeth Tuters, Hincks-Dellcrest Children's Centre, 114 Maitland Street, Toronto, ON. M4Y 1E1, CAN Yvon Gauthier, Department of Psychiatry, Hôpital Sainte-Justine, 3175 Côte Ste Catherine, Montreal, Quebec H3T 1C5, CanadaSearch for more papers by this authorYvon Gauthier, Corresponding Author Yvon Gauthier [email protected] University of Montreal Elizabeth Tuters, Hincks-Dellcrest Children's Centre, 114 Maitland Street, Toronto, ON. M4Y 1E1, CAN Yvon Gauthier, Department of Psychiatry, Hôpital Sainte-Justine, 3175 Côte Ste Catherine, Montreal, Quebec H3T 1C5, CanadaSearch for more papers by this author Elizabeth Tuters, Corresponding Author Elizabeth Tuters [email protected] The Hincks-Dellcrest Children's Mental Health Centre and Institute, Toronto Elizabeth Tuters, Hincks-Dellcrest Children's Centre, 114 Maitland Street, Toronto, ON. M4Y 1E1, CAN Yvon Gauthier, Department of Psychiatry, Hôpital Sainte-Justine, 3175 Côte Ste Catherine, Montreal, Quebec H3T 1C5, CanadaSearch for more papers by this authorYvon Gauthier, Corresponding Author Yvon Gauthier [email protected] University of Montreal Elizabeth Tuters, Hincks-Dellcrest Children's Centre, 114 Maitland Street, Toronto, ON. M4Y 1E1, CAN Yvon Gauthier, Department of Psychiatry, Hôpital Sainte-Justine, 3175 Côte Ste Catherine, Montreal, Quebec H3T 1C5, CanadaSearch for more papers by this author First published: 18 October 2011 https://doi.org/10.1002/imhj.20316Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume32, Issue6Special Issue: The Practice of Clinical Infant Mental HealthNovember/December 2011Pages 582-582 RelatedInformation

The Use of Pro Re Nata or Statim Medications for Behavioral Control: A Summary of Experience at a Tertiary Care Children's Mental Health Center

The present study aims to identify patterns for use of medication given pro re nata (PRN or "on an as needed [preordered] basis") or statim (STAT [a new order] or "at once, immediately") and their efficacy in controlling aggressive behavior in the mental health (MH) services environment. PRN and STAT medication data were combined and referred to as PRN throughout this article, as the data were not collected in a manner required to differentiate between PRN and STAT medication administration. Analyzed data were extracted from the clinical records of a sample of children and youth admitted for the first time to a tertiary MH center. MH Program patients (characterized by at least one Axis I psychiatric diagnosis [Axis I group]) were compared to Dual Diagnosis Program patients (characterized by an Axis I diagnosis in addition to an Axis II diagnosis of mental retardation [Axis II group]). Age, gender, Program (Axis I or II group), and the length of stay for treatment produced significant differences in the use of PRNs between the two groups. Further, the study investigated the precipitating factors leading to use of PRNs, in conjunction with the level of supervision and the de-escalation techniques used to avoid the use of PRNs. Axis I patients were more likely to endanger others, whereas Axis II patients were more likely to endanger themselves. Both groups of patients demonstrated a need for an increased level of supervision prior to the crisis. Olanzapine, chlorpromazine, and lorazepam were effective in calming patients and preventing further aggressive outbursts.

The Role of Patient Activation in Psychiatric Visits

The Role of Patient Activation in Psychiatric Visits

EEG connectivity differences at different ages in autism spectrum disorder

Autistic disorder was originally viewed as a distinct, rare, and severe childhood mental disorder that caused life-long disability. However, since the late 1990s autistic disorder was found to have a high prevalence rate and to affect children on a spectrum from mild to severe dysfunction. The purpose of this retrospective, descriptive study was to examine changes in the characteristics of patients with autistic disorder in Taiwan from 1987 to 1995. To that end, we examined the characteristics, age at diagnosis, symptoms, and developmental condition of affected children and the educational background of their parents who visited an autism clinic at the children's mental health center of a medical center in Taipei. This clinic was the first, largest, and for many years the only autistic disorder clinic in Taiwan. Across the 9-year study period, we observed trends in decreasing age at first visit, increasing age at assessment, rising maternal educational level, lessening autistic disorder symptomatology, and increasing developmental quotients. These changes may have been due to improved diagnostic criteria, government policy, and healthcare professionals’ and parents’ increased awareness of autistic disorder. Clinical implications and related policy making toward these changes are proposed.

Administrative Issues in Child Psychiatry

Administrative issues related to operating child and adolescent psychiatry programs or child mental health centers are substantially different than their adult counterpart programs. The increasing demands from managed care and other regulatory agencies make these programs difficult to operate. The smaller scale of these programs and the fewer existing programs make managing access to care more complicated. The administrators and clinicians in these programs have to be vigilant of legal responsibilities and reporting mandates that child practitioners and agencies that treat children need to abide by. In order to continue thriving, programs need to be efficient and fiscally viable. Issues such as building the continuum of care and finding the qualified personnel to staff these services are discussed in this article.

How Parents Seek Help for Children with Mental Health Problems

Parents seeking help for their child's mental health problem face a complicated system of services. We examined how parents navigate the various services available. Sixty parents contacting a children's mental health center were interviewed regarding their efforts and rationale in seeking help for their child. On average, in the year prior to the interview parents sought help for two different child problems, contacted five different agencies or professionals for help, and parents and/or children received two different treatments. One fifth of the time parents said they accepted treatments that they did not want. Almost all parents (87%) were simultaneously in contact with more than one agency at some point within the previous year. Future help-seeking models need to capture the iterative referral process that many parents experience.

Social Cognition and Externalizing Psychopathology: An Investigation of the Mediating Role of Language

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to 14 years) recruited from a children's mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology.

Evaluation of a Children's Temper-Taming Program

To examine the effectiveness of a group cognitive-behavioural therapy program in reducing anger and aggressive behaviour in children. Study participants were 68 children aged 7 to 13 years and their parents. A total of 12 groups were run at an outpatient children's mental health centre. The children were referred to the groups by their clinician for assistance in reducing their aggressive behaviour. We obtained quantitative information on the effectiveness of the group from the children and their parents, who completed questionnaires before the first session and after the last session. The children completed the Children's Inventory of Anger (CIA), and the parents completed the Children's Hostility Inventory (CHI). We used t tests and analyses of covariance to test for posttreatment differences. Results were available for 56 children. At posttreatment, children reported that the intensity of their anger had decreased (CIA, t41 = 4.39, P < 0.0001), and parents indicated a reduction in the frequency of aggression (CHI-Aggression, t44 = 2.82, P < 0.01) and hostility (CHI-Hostility, t44 = 4.93, P < 0.0001) in their children. The group program appeared to reduce children's anger and aggression. However, the results are preliminary, and further controlled evaluation is required.

The Use of Emotionally Focused Family Therapy in a Children's Mental Health Center

Emotionally focused family therapy (EFFT) is a model derived from emotionally focused therapy. It has a primary focus on utilizing emotion within sessions to address and change negative interaction patterns which result from attachment injuries. This paper discusses the use of EFFT with clients in a Children's Mental Health Center in London, Ontario, Canada. Three case examples are provided.

Putting empirically supported treatments into practice: Lessons learned in a children's mental health center.

With the increasing focus on service accountability, there is an urgent need to identify empirically supported treatments (ESTs) and disseminate their use in the daily practice of mental health organizations. This articledescribes the authors' experiences of implementing an EST at a children's mental health center by involving the collaboration of clinicians, administrators, and innovator(s). Initially, a small group of clinicians voluntarily commit to pilot test the EST, with the intention of evaluating the adoption and integration of the treatment model into the organization's full-service delivery system. Using E. M. Rogers's (1995) work on the diffusion of innovations, the current case study example suggests that ESTs can be flexibly and successfully implemented with integrity.