Child Mental Health Research Research Articles

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

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

Overcoming challenges of embedding child and youth mental health research in community NHS services

PurposeThis paper aims to examine the barriers and facilitators of conducting and implementing research in frontline child and youth mental health settings in the UK.Design/methodology/approachResearchers, clinicians and commissioners who attended a workshop at the Big Emerging Minds Summit in October 2022 provided their expert views on the structural barriers and possible solutions to integrating research in clinical practice based on their experiences of child and young people mental health research.FindingsThe identified barriers encompass resource constraints, administrative burdens and misalignment of research priorities, necessitating concerted efforts to foster a research-supportive culture. This paper proposes the potential actionable solutions aimed at overcoming challenges, which are likely applicable across various other health-care systems and frontline NHS services. Solutions include ways to bridge the gap between research and practice, changing perceptions of research, inclusive engagement and collaboration, streamlining ethics processes, empowering observational research and tailored communication strategies. Case examples are outlined to substantiate the themes presented and highlight successful research initiatives within NHS Trusts.Originality/valueThis paper provides an insight into the views of stakeholders in child and youth mental health. The themes will hopefully support and influence clinicians and academics to come together to improve the integration of research into clinical practice with the hope of improving service provision and outcomes for our children and young people.

Trends in Child and Adolescent Mental Health Research and its Countermeasures

The mental health issues among children and adolescents have become a focal point of attention in today's society. This paper reviews and analyzes the current trends in research on the mental health of children and adolescents. The results indicate that future research will exhibit characteristics of interdisciplinary collaboration, technological applications, and innovative psychological intervention strategies. To promote overall improvement in the mental health of children and adolescents, it is necessary to enhance the qualifications of professionals, provide social support, and establish collaborative networks. By implementing these measures, we can create a better psychological environment for children and adolescents.

Operational Definitions and Structured Instruments for Childhood Emotional Abuse in Clinical Research: A Narrative Review

Childhood emotional abuse (CEA) is a highly prevalent but often overlooked area of child mental health research. One of the major hurdles in research in this area is the difficulty in defining emotional abuse (EA) across different cultures. This article aims to review the operational definitions and structured instruments used to assess CEA and to critically analyse the existing lacunae and challenges in this area. Original articles, systematic reviews, and meta-analyses with the objective of assessing emotional abuse in children and adolescent populations were chosen for the study. From the chosen articles, the data pertaining to the definition or structured instrument used to assess CEA was extracted and a narrative review was done. A total of 4 operational definitions and 9 structured instruments were included in the review of the 26 included articles. From this review, as per the author, some of the shortcomings of the available definitions and tools for assessing CEA include a paucity of instruments to assess EA in young children and special populations, the need for consensus on the terminologies used to denote EA, the need for longitudinal studies, the need for culturally appropriate standards for assessment, and also the need to understand the context of EA. A CEA assessment framework has been proposed that includes a longitudinal and qualitative assessment of the subjective experience of the child, which includes the context of EA, so as to plan individualized interventions.

Involving children, teachers and parents/carers in dialogues around child well-being in schools

Building dynamic partnerships between communities and academic institutions, via knowledge exchange, plays a vital role in generating research with mutual benefits for research partners and wider communities. Knowledge exchange between universities and schools has recently received particular interest in child and adolescent mental health research. This article outlines a knowledge exchange programme that involved children, primarily, and teachers and parents/carers in dialogues around school well-being. Using a series of co-created and multimodal creative activities, we: (1) worked closely with 25 students of an inclusive and multicultural primary school (aged 9 to 10 years old) to understand their school well-being experiences, and to co-create a school blog to communicate key messages with local communities; and (2) initiated a discussion around child and school well-being with a group of parents/carers and teachers through expanding on the children’s blog. In this article, we outline our methodology to facilitate children’s involvement with the project well-being activities. We explore key methodological strengths and challenges, and highlight lessons we learned and how these stress the significance of seeking young people’s points of view when designing school well-being initiatives.

Epigenetics applied to child and adolescent mental health: Progress, challenges and opportunities.

Epigenetic processes are fast emerging as a promising molecular system in the search for both biomarkers and mechanisms underlying human health and disease risk, including psychopathology. In this review, we discuss the application of epigenetics (specifically DNA methylation) to research in child and adolescent mental health, with a focus on the use of developmentally sensitive datasets, such as prospective, population-based cohorts. We look back at lessons learned to date, highlight current developments in the field and areas of priority for future research. We also reflect on why epigenetic research on child and adolescent mental health currently lags behind other areas of epigenetic research and what we can do to overcome existing barriers. To move the field forward, we advocate for the need of large-scale, harmonized, collaborative efforts that explicitly account for the time-varying nature of epigenetic and mental health data across development. We conclude with a perspective on what the future may hold in terms of translational applications as more robust signals emerge from epigenetic research on child and adolescent mental health.

Debate: Inequalities within understanding of Eco Distress.

Increased attention and youth action on Climate Change have increased global societal awareness of the climate crisis. However, this has not come without a cost, lack of international political action and increased media attention towards climate change has triggered a surge in young people experiencing Eco Distress. I discuss how increased levels of Eco Distress experienced by young people has uncovered vast inequalities within child and adolescent mental health provision and research across the globe, which follow geopolitical and Economic divides formed during the colonial period. I also discuss how psychiatrists can embrace different knowledge systems and collaborate across socio-political barriers, to support and enable equality in the access of mental health care for all young people, regardless of location in helping manage Eco Distress or climate-related worries. I conclude this piece by suggesting actions which psychiatrists can undertake to show themselves to be allies with young people, in not only tackling climate change, but systemic inequality harboured in child and adolescent mental health care.

Building a research agenda for mental health assessments in resolving legal dilemmas on adolescent sexual consent.

The dilemma of adolescent consent confounds dispensation of justice in child sexual abuse and juvenile justice contexts, with legal personnel struggling to discern between consent and coercion in cases of adolescents who are sexually abused and those who are accused of alleged sexual offences. Given that capacities for consent also determine personal safety and mental health, there is an imperative to build a child mental health research agenda for developing methodologies that incorporate psychological knowledge on abuse dynamics, adolescent mental health and development, vulnerability and risk, to assess adolescent sexual consent and sexual decision-making processes.

Academic-Policy Partnerships in Evidence-Based Practice Implementation and Policy Maker Use of Child Mental Health Research.

Strategies are needed to improve policy makers' evidence-informed decision making and the availability of evidence-based, state-supported services. This study examined whether academic-policy partnerships could promote these outcomes. Data from two national surveys of state mental health agency representatives were used to compare barriers to implementation of evidence-based practices (EBPs) and policy makers' use of child mental health research in states with strong academic-policy partnerships in workforce training or in program implementation/evaluation (IE) with barriers in states with no or limited partnerships in these areas. Strong IE partnerships were associated with more confidence in research use and fewer issues with provider readiness and capacity but with more issues with EBP fidelity. Strong training partnerships were associated with fewer endorsements of lack of time as a barrier to research use. Academic-policy partnerships had some benefit for states' research use and EBP implementation. Because these partnerships may reduce barriers, further research should explore characteristics of effective collaborations.

Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa.

Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.

Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review.

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

Morgan Stanley grants $1.3 million to Columbia University psychiatry department

Morgan Stanley has reported a grant of $1.3 million to the Columbia University Department of Psychiatry in the Vagelos College of Physicians and Surgeons to advance children's mental health research in an effort to raise awareness, drive innovation and inform intervention strategies and actions, Close‐up Media Inc. reported Nov. 28. Specific research areas include the impact of telehealth treatment, use of technology to assess adolescent depression, and the impact of COVID‐19 and digital technology use on Latinx youth's mental health, according to a news release. “The COVID‐19 pandemic will be accompanied by a wave of mental health consequences for children, adolescents, and families. Unfortunately, these mental health sequelae are super‐imposed upon the long‐standing and persistent problems of racial and social injustice,” said Jeremy Veenstra‐VanderWeele, M.D., director of the Division of Child & Adolescent Psychiatry in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons and the New York‐Presbyterian Morgan Stanley Children's Hospital.

Study on Aberrant Eating Behaviors, Food Intolerance, and Stereotyped Behaviors in Autism Spectrum Disorder.

Objective: To investigate the aberrant eating behaviors (EBs), gastrointestinal (GI) symptoms, and food intolerance in children with autism spectrum disorder (ASD) and their association with clinical core symptoms of ASD.Method: A total of 94 preschool children with ASD treated at the Child Mental Health Research Center of Nanjing Brain Hospital between October 2016 and April 2018 were enrolled. In addition, 90 children with typical development (TD) in the community during the same period were recruited. The conditions of aberrant EBs and GI symptoms in children were investigated using questionnaire surveys. Serum specific IgG antibodies against 14 kinds of food were detected using enzyme-linked immunosorbent assays (ELISAs).Results: The detection rate of aberrant EBs in the ASD group was significantly higher than that in the TD group (67.39 vs. 34.94%), and the rate of GI symptoms was also higher in the ASD group than that in the TD group (80.22 vs. 42.11%). Detection of food intolerance in children with ASD showed that the positive rate was 89.89% and that the majority of children had multiple food intolerances. The correlation analysis results showed that the severity of aberrant EBs positively correlated with stereotyped behavior of children with ASD (r = 0.21, P = 0.04) and that food-specific IgG antibodies concentrations positively correlated with high-level stereotyped behavior in children with ASD (r = 0.23, P = 0.03).Conclusion: ASD with aberrant EBs or high food-specific IgG antibodies concentrations had more severe stereotyped behavior, which may have implications for exploring the immune mechanism of ASD.Clinical Trial Registration: ChiCTR-RPC-16008139.

Children and young people\u2019s experiences of completing mental health and wellbeing measures for research: learning from two school-based pilot projects

BackgroundIn recent years there has been growing interest in child and adolescent mental health and wellbeing, alongside increasing emphasis on schools as a crucial site for research and intervention. This has coincided with an increased use of self-report mental health and wellbeing measures in research with this population, including in school-based research projects. We set out to explore the way that children and young people perceive and experience completing mental health and wellbeing measures, with a specific focus on completion in a school context, in order to inform future measure and research design.MethodsWe conducted semi-structured interviews and focus groups with 133 participants aged 8–16 years following their completion of mental health and wellbeing measures as part of school-based research programmes, using thematic analysis to identify patterns of experience.FindingsWe identified six themes: Reflecting on emotions during completion; the importance of anonymity; understanding what is going to happen; ease of responding to items; level of demand; and interacting with the measure format.ConclusionsOur findings offer greater insight into children and young people’s perceptions and experiences in reporting on their mental health and wellbeing. Such understanding can be used to support more ethical and robust data collection procedures in child and adolescent mental health research, both for data quality and ethical purposes. We offer several practical recommendations for researchers, including facilitating this in a school context.

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania, Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family‐inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family‐inclusive approach. Future research could focus on attaining a more in‐depth understanding of individual family member experiences with a view to improving SST delivery.

Challenges for Child and Adolescent Psychiatric Research in the Era of COVID-19.

Challenges for Child and Adolescent Psychiatric Research in the Era of COVID-19.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Same proof, different pudding: comparative views of New Zealand child psychiatrists, child psychologists and child psychotherapists regarding a proposed national child and adolescent research network.

This study was undertaken to evaluate the views of New Zealand clinicians regarding a proposed national child and adolescent mental health research network. Child psychiatrists, child psychologists and child psychotherapists were invited to participate in an electronic survey describing their previous experience of research, current interest in research, barriers to undertaking research and interest in a national research network. Responses were received from child psychiatrists (N = 33), child psychologists (N = 58) and child psychotherapists (N = 8), many of whom were clinicians and few of whom were researchers. Although most clinicians were interested in participating in future research, areas of interest differed between clinical groups. Clinician barriers to research included lack of time, lack of confidence and lack of research skills. Researcher barriers included lack of funding, time and administrative support. All groups were supportive of the development of a national research network. Despite some different areas of interest, there appears to be sufficient combined support from New Zealand child psychiatrists, child psychologists and child psychotherapists to pursue the establishment of a national child and adolescent mental health research network.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare.

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Child and Adolescent Mental Health Services in South Africa-Senior Stakeholder Perceptions of Strengths, Weaknesses, Opportunities, and Threats in the Western Cape Province.

Background: There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services. Methods: A qualitative study was conducted with 13 purposively sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis. Results: The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and pediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services. Conclusions: This analysis of strengths, weaknesses, opportunities, and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive "tipping points" for improvements and strengthening of child and adolescent mental health service delivery, training, and research.