Child Mental Health Services Research Articles

A Study on Effect of Sleep Training Program in Children with ADHD: A Comparative Prospective Study

Objective: To study complementary effect of sleep training program in children with attention deficit hyperactivity disorder (ADHD) receiving tablet methylphenidate with respect to sleep, quality of life (social, behavioral, emotional, and executive functioning of children), and their parent’s emotional state. Methods and Materials: It was a comparative and prospective study, and it was conducted in child mental health services of a tertiary care municipal hospital. The children (age 8−12 years) were diagnosed with ADHD using DSM 5 criteria. The children’s sleep habit questionnaire (CSHQ) and Kiddie-SADS-PL questionnaire (K-SADS-PL) were used to select 100 consecutive participants (parent–child dyad). They were randomly equally divided into two groups: A and B. Semi-structured proforma was filled and different scales were applied for children; these scales include Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory (PQLI), Stroop test (ST) and Verbal fluency test (VFT), and to parent-Depression Anxiety Stress Scale-21 (DASS-21). The participants in group A received a validated sleep intervention and the scales were reapplied after 12 weeks. We used Chi-square test, paired t-test, unpaired t-test, Wilcoxon signed-rank test, Mann-Whitney U test, Spearman’s correlation test, and logistic regression analysis for data analysis. p-Value <.05 was taken as significant. SPSS version 20 software was used for data analysis. Results: We found significant post-intervention improvement in sleep, quality of life, social, emotional, behavioral, and executive functioning in children and emotional factors in parents. Conclusion: The combination of sleep intervention and tablet methylphenidate were more effective in improving these factors.

Functional Outcomes Among Young People With Trajectories of Persistent Childhood Psychopathology

Understanding which children in the general population are at greatest risk of poor functional outcomes could improve early screening and intervention strategies. To investigate the odds of poor outcomes in emerging adulthood (ages 17 to 20 years) for children with different mental health trajectories at ages 9 to 13 years. Growing Up in Ireland is a longitudinal, nationally representative population-based cohort study. Data collection began in August 2007 and was repeated most recently in September 2018. All results were weighted to account for sampling bias and attrition and were adjusted for socioeconomic factors. Data analysis took place from October 2022 to April 2023. Four latent classes captured variation in mental health in children aged 9 and 13 years, based on the parent-completed Strengths and Difficulties Questionnaire. Classes included no psychopathology, internalizing, externalizing, and high (comorbid) psychopathology. Those who remained in the same class from ages 9 to 13 years were included. Poor functional outcomes in emerging adulthood were measured at approximate ages 17 years (range, 16 to 18 years) and 20 years (range, 19 to 21 years). Outcomes included poor mental health, poor physical health, social isolation, heavy substance use, frequent health service use, poor subjective well-being, and adverse educational/economic outcomes. Of 5141 included participants, 2618 (50.9%) were male. A total of 3726 (72.5%) were classed as having no childhood psychopathology, 1025 (19.9%) as having persistent externalizing psychopathology, 243 (4.7%) as having persistent internalizing psychopathology, and 147 (2.9%) as having persistent high psychopathology. Having any childhood psychopathology was associated with poorer functional outcomes in emerging adulthood. The internalizing group had elevated odds of most outcomes except for heavy substance use (range of odds ratios [ORs]: 1.38 [95% CI, 1.05-1.81] for frequent health service use to 3.08 [95% CI, 2.33-4.08] for poor mental health). The externalizing group had significantly elevated odds of all outcomes, albeit with relatively small effect sizes (range of ORs: 1.38 [95% CI, 1.19-1.60] for frequent health service use to 1.98 [95% CI, 1.67-2.35] for adverse educational/economic outcomes). The high psychopathology group had elevated odds of all outcomes (nonsignificantly for frequent health service use), though with wide confidence intervals (range of ORs: 1.53 [95% CI, 1.06-2.21] for poor physical health to 2.91 [95% CI, 2.05-4.12] for poor mental health). Female participants with any psychopathology had significantly higher odds of poor physical health and frequent health service use compared with male participants with any psychopathology. In this longitudinal cohort study, childhood psychopathology was associated with a widespread pattern of functional impairment in emerging adulthood. Findings point to the need for a wider range of preventive interventions in child and adolescent mental health services.

Association of Food Insecurity Status with Resolution of Mental Health Conditions in Children and Adolescents.

Adverse consequences related to unresolved mental health issues underscore the importance of identifying factors that impede resolution of mental health conditions. Although studies have identified food insecurity as a risk factor for the diagnosis of mental health conditions, its impact on unresolved mental health issues is not understood. The objective of this study is to investigate the association of food insecurity status with resolution of depression, anxiety, and behavioral/conduct problems in children and adolescents. Using National Survey of Children's Health 2016 to 2019, logistic regression analyses examined the relationship of food insecurity status with the diagnosis and resolution of depression, anxiety, and behavioral/conduct problems in children (aged 5-11 years) and adolescents (aged 12-17 years). Mild, moderate, and severe food insecurity were significantly associated with higher odds of being diagnosed with depression, anxiety, and behavioral/conduct problems. Severe food insecurity was significantly associated with higher odds of unresolved behavioral/conduct problems in children (adjusted odds ratio [aOR], 10.09; 95% confidence interval [CI], 2.99-34.04), after adjustment for demographic covariates. In adolescents, severe food insecurity was significantly related to greater odds of unresolved depression (aOR, 6.64; 95% CI, 2.13-20.70), anxiety (aOR, 3.27; 95% CI, 1.31-8.14), and behavioral/conduct problems (aOR, 5.57; 95% CI, 2.09-14.85). These associations of severe food insecurity with unresolved mental health conditions were significant even after adjustment for the receipt of mental health care. Mild and moderate food insecurity were not significantly associated with unresolved mental health conditions. The findings suggest that severe food insecurity is associated with increased odds of unresolved mental health conditions in children and adolescents. This study highlights the importance of tailoring interventions to provide appropriate mental health services for children and adolescents from severely food insecure households.

How clinical psychologists respond to child safeguarding dilemmas: A qualitative study

AbstractThis research aimed to explore how clinical psychologists respond to child safeguarding dilemmas, with special attention to the role of psychology in child welfare. Transcripts from 20 semi‐structured interviews with clinical psychologists working in Child and Adolescent Mental Health Services in England were analysed using a qualitative framework approach. In these interviews, two family case vignettes were used to examine how psychologists respond to child safeguarding dilemmas. We identified three overarching themes: operating within a system of stretched resources; characterising who is considered ‘supportable’ by psychological services; and challenges around conceptualising and responding to risk. Clinical psychologists viewed social services as responsible for family cases with safeguarding concerns and were reluctant to engage in high‐risk cases where stability in the home was not yet established. They saw their role in child welfare primarily as sense‐makers for families, by offering a contextualised explanation/formulation for the presenting difficulties.

Debate: Child and adolescent mental health services: time to take the lead in prevention of psychosis in youth.

Children and adolescents are at risk of developing mental disorders that have lifelong consequences. This debate piece argues that youth meeting the criteria for clinical high risk for psychosis cannot be assessed and treated with the same tools as adults, given that they often present with different patterns and timecourse of symptoms, age-specific comorbidities and follow different pathways to care. It looks at the key role that Child and Adolescent Mental Health Services and other professionals can play by using an age-specific approach to detecting and preventing psychosis.

A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial.

Youth in the child welfare system (child welfare-involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50%) to FCFN and 40 (50%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437. DERR1-10.2196/49999.

Expanding the early intervention offer: A new care pathway for children's wellbeing practitioners in a south London child and adolescent mental health service.

Child and Adolescent Mental Health Services (CAMHS) have been under recent increased demand, with increasingly limited resources, contributing to longer waiting lists, and a growing proportion of rejected referrals due to limited capacity and increasing thresholds. Child and Wellbeing Practitioners (CWPs) provide an opportunity to meet the needs of rejected referrals. We aimed to determine the feasibility of a new and direct referral route within a South London CAMHS. All referrals rejected to the local CAMHS in one year were assessed for inclusion to an embedded child and youth wellbeing in schools team (CYWS), and data collected on reasons for rejection, demographics and eligibility for the CYWS team. Of the 1,322 referrals made to CAMHS in this period, 317 were rejected. The most common reason for referral rejection was not meeting the severity threshold. One third of rejected referrals were judged to be eligible for inclusion to the CYWS team. Therefore, a significant number of children and young people (CYP) being rejected by CAMHS would be eligible for assessment and possible treatment under the CYWS team, making a new referral route potentially feasible, allowing more CYP to access mental health support and have a positive impact on waiting times.

Analyzing Chinese parents' and teachers' perception of play, children's emotional needs and therapy: implications for seeking help.

Before going through play therapy with children, parents' consent is usually needed. Thus, Parents' perception of play therapy can be a very important variable that influences the extent to which children are exposed to play therapy. Previous research has demonstrated the significant influence of social-cultural factors on people's perceptions of play therapy. This may in turn influence parents' decision about whether their children will participate in play therapy. This study explores the factors that influence Chinese parents' decisions on their children's engagement in play therapy from a social-cultural perspective. This small-scale research includes the following: a questionnaire with 16 parents; three one-to-one semi-structured interviews with three parents; and one focus group with 3 teachers. The results showed that Chinese parents' perceptions of therapy are mostly negative, which may reduce the desire of parents to let their children become involved with play therapy. The children's academic stress and the parents' economic pressures indicate a barrier for families to commit time and money to play therapy. Parents' confidence in their ability to recognize children's emotions, their lack of knowledge about play therapy, and the process of obtaining help from mental health services for children could be another barriers preventing engagement with play therapy. Even though the research is conducted with a very limited sample size and the results cannot represent the wider population, this research provides some insights into this issue that can be explored in detail in future research, to re-evaluate the results and form a more concrete theory within a wider population in China.

User satisfaction in child and adolescent mental health service: Comparison of background, clinical and service predictors for adolescent and parent satisfaction.

To improve quality, child and adolescent mental health services (CAMHS) are expected to quantify families' views on healthcare with user satisfaction measures. As little is known about what influences satisfaction in CAMHS, this study aimed to examine predictors of adolescents' and parents' user satisfaction. Data from 231 adolescents and 495 parents in treatment at an outpatient clinic who returned a user satisfaction measure, the Experience of Service Questionnaire (ESQ), was analyzed. Registry data on background, clinical and service characteristics were predictors for the ESQ factors general satisfaction, satisfaction with care and satisfaction with environment. In regression models, satisfaction with care for adolescents (r2 = .12) was significant and was predicted by low parent-self-reported mental health burden and low clinician-rated overall symptom burden at intake. For parents, regression models for general satisfaction (r2 = .07), satisfaction with care (r2 = .06) and satisfaction with environment (r2 = .08) were significant. Parents general satisfaction was predicted by higher levels of hyperactivity, less family stress and longer travelling distances to the service. Satisfaction with care for parents was predicted by higher levels of hyperactivity at intake and longer travelling distances. Satisfaction with environment for parents was more likely if the adolescents was a boy, with low levels of family stress and longer travelling distances. Predictors for adolescentand parent user satisfaction in CAMHS differ. Hence, to improve quality CAMHS should enhance focus on collaborative practice with parents, and person-centred care for adolescents with moderate to severe mental health illness. Representatives from the hospitals' youth panel and the non-governmental organization called The Change Factory have been consulted regarding study design and results.

Leaving child and adolescent mental health services (CAMHS): the impact of diagnosis and medication management on optimal discharge or transition

PurposeThis study aims to explore how young people in child and adolescent mental health services (CAMHS) in the UK, Ireland, The Netherlands and Croatia, experienced leaving CAMHS and identified a range of factors impeding optimal discharge or transition to adult mental health services (AMHS).Design/methodology/approachInterviews about discharge or transition planning, including what information was provided about their ongoing mental health needs, undertaken with 34 young people aged 17–24, all previous or current attendees of CAMHS. Some interviews included accounts by parents or carers. Data were thematically analysed.FindingsA number of previously well-documented barriers to a well-delivered discharge or transition were noted. Two issues less frequently reported on were identified and further discussed; they are the provision of an adequately explained, timely and appropriately used diagnosis and post-CAMHS medication management. Overall, planning processes for discharging or transitioning young people from CAMHS are often sub-optimal. Practice with regard to how and when young people are given a diagnosis and arrangements for the continuation of prescribed medication appear to be areas requiring improvement.Originality/valueStudy participants came from a large cohort involving a wide range of different services and health systems in the first pan-European study exploring the CAMHS to adult service interface. Two novel and infrequently discussed issues in the literature about young people’s mental health transitions, diagnosis and medication management were identified in this cohort and worthy of further study.

Dynamic modelling of the impact of community-based acute mental health services for children and adolescents.

To evaluate the potential impact of the recently announced 'Safeguards' initiative on mental health-related emergency department presentation rates for children and adolescents (0-17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. We estimated the effects of the 'Safeguards' initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022-2031 by 15.0% (95% interval, 12.0-18.2%) and 31.7% (26.2-37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the 'Safeguards' initiative significantly. Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the 'Safeguards' initiative on demand for hospital-based emergency mental health care is to be realised.

Parent-Child Inpatient Treatment in Child and Adolescent Mental Healthcare: Predictors of Child Outcomes.

Family inpatient units in child and adolescent mental health (CAMH) services engage all admitted family members in the treatment of children's symptoms. Studies demonstrated improvements in child and family functioning following family inpatient treatment, but evidence regarding predictors of treatment outcome is lacking. We analyzed data of families (n = 66) who received a four-week inpatient treatment for families with severe parent-child interaction problems. Hierarchical linear regression analyses revealed that parents who recalled harsher parenting practices of their own fathers reported greater improvements in their children's externalizing and internalizing problems. Greater improvements in externalizing problems were further predicted by lower parental educational level, less adverse impacts of stressful life events, and less internalizing child problems prior to admission. We therefore conclude that family inpatient treatment was particularly effective for children in families with lower parental education and a history of harsh parenting.

Using electronic health record data to predict future self-harm or suicidal ideation in young people treated by child and youth mental health services.

Identifying young people who are at risk of self-harm or suicidal ideation (SHoSI) is a priority for mental health clinicians. We explore the utility of routinely collected data in developing a tool to aid early identification of those at risk. We used electronic health records of 4610 young people aged 5-19 years who were treated by Child and Youth Mental Health Services (CYMHS) in greater Brisbane, Australia. Two Lasso models were trained to predict the risk of future SHoSI in young people currently rated SHoSI; and those who were not. For currently non-SHoSI children, an Area Under the Receiver Operating Characteristics (AUC) of 0.78 was achieved. Those with the highest risk were 4.97 (CI 4.35-5.66) times more likely to be categorized as SHoSI in the future. For current SHoSI children, the AUC was 0.62. A prediction model with fair overall predictive power for currently non-SHoSI children was generated. Predicting persistence for SHoSI was more difficult. The electronic health records alone were not sufficient to discriminate at acceptable levels and may require adding unstructured data such as clinical notes. To optimally predict SHoSI models need to be tested and validated separately for those young people with varying degrees of risk.

The experiences of young people, parents and professionals of using the attend anywhere video consultation system in a child and adolescent mental health service: a mixed-methods approach

BackgroundIn 2020, Attend Anywhere video consultation service was introduced across the Irish public health service to facilitate the provision of health interventions remotely in light of COVID-19-related restrictions. This study aims to explore the experiences of young people, their parents and their clinicians, of using the newly introduced Attend Anywhere video consultation as part of their Child and Adolescent Mental Health Service (CAMHS).MethodA cross-section of twenty-nine young people, their parents and clinicians working in CAMHS Clare completed a survey pertaining to their experiences of using Attend Anywhere as part of their service. A cross-disciplinary research steering group of CAMHS clinicians adapted the NHS Scotland evaluation of Attend Anywhere / Near Me survey to better capture experiences in a CAMHS setting. The survey included both quantitative and qualitative items. Descriptive statistics were used to examine quantitative data. Qualitative data was analysed using Thematic Analysis.Results/FindingsResults demonstrated a decrease in the number of barriers reported by clients and professionals in accessing the CAMH service following the introduction of Attend Anywhere video consultation. Overall, the majority of professionals reported that they would use Attend Anywhere again, whereas almost a quarter of clients reported that they did not wish to use it again. Clients indicated a preference for receiving face-to-face services over other service provision options and this finding was associated with not having to rely on technology or manage connectivity issues and finding it easier to build the therapeutic relationship in-person.ConclusionFindings suggest that both professionals and clients value face-to-face service provision while also acknowledging the benefits of Video Enabled Care in overcoming access barriers. We conclude that VEC be offered as an option in a blended service model, in conjunction with rather than as a replacement of face-to-face service provision.

Author's Reply. RE: Psychosis prediction 2.0: why child and adolescent mental health services should be a key focus for schizophrenia and bipolar disorder prevention research.

Author's Reply. RE: Psychosis prediction 2.0: why child and adolescent mental health services should be a key focus for schizophrenia and bipolar disorder prevention research.

The impact of adolescent suicide on clinicians: a mixed-methods study.

Clinician reactions to client suicide may include shock, grief, guilt, self-doubt, shame, anger, and fears of blame and medico-legal consequences. Clinicians will often differ in their reactions to the suicide and the type of supports required. Adolescent suicide-specific literature is limited. We sought to explore clinician reactions and perceptions of support following child and adolescent suicide. One hundred and fifteen staff working for a Child and Adolescent Mental Health Service were invited to complete an online survey with quantitative and qualitative components, and an in-depth semi-structured interview. Results were presented to teams for reflection and further feedback. Eight clinicians participated in the semi-structured interview, and 33 in the online survey. Thirteen were the primary clinician, and 21 were part of a multi-disciplinary team when a client suicided. Respondents were predominantly female, from a range of disciplines. Fifty per cent of primary clinicians found the support good to very good. The rest were neutral. However, 26% of team members found support poor to very poor. Clinicians reported questioning their clinical effectiveness and chosen vocation. Some reported a need to disconnect or withdraw to preserve motivation and empathy for the work. They received significant support from their team, and teams were very anxious for the well-being of primary clinicians. Health services must find ways of helping staff feel that their sense of vocation is valued and nurtured. These strategies will likely include fostering team cohesiveness and mutual support and allowing opportunities to temporarily step back and recover after challenging experiences.

Understanding the Perspective of Youths on Undergoing Metabolic Monitoring While on Second-Generation Antipsychotics: Challenges, Insight, and Implications.

Introduction: Prescription of second-generation antipsychotics (SGAs) in youths is rapidly increasing globally, despite the potential for significant adverse effects and long-term health consequences. A known adverse reaction resulting from SGAs is metabolic syndrome (MS). Youths exposed to antipsychotics are at higher risk than adults for adverse drug reactions, including adverse events such as MS (with weight gain as the most significant adverse outcome) and other long-term endocrinological abnormalities. This study aimed to explore the experiences of young patients on factors impacting barriers to metabolic monitoring of SGAs and the strategies to address those barriers thereby providing further guidance on policy and service delivery. Methods: Semi-structured interviews were conducted with patients (youths who were prescribed SGAs) who attended Child and Youth Mental Health Services. The interviews focused on barriers to monitoring and strategies to enhance rates of monitoring that could be customized across study sites. Results: Young patients revealed that none of them had any concerns or objections to receiving anthropometric metabolic measurements. However, they seemed concerned to undergo blood tests as part of the metabolic monitoring process. Specifically, youths cited their fear of the needles as barrier to undergo the required blood tests. Youths have also reported that their dislike to healthy foods and exercise being the most common challenge they face while trying to engage in a healthy lifestyle to manage the SGAs resulted weight gain. Conclusion: Prescribers are recommended to actively engage young patients about the expected SGAs-induced adverse effects, the importance of conducting metabolic monitoring, and how to prevent and minimize the expected adverse effects from the start of initiating SGAs. This could be a vital step toward a successful treatment as the insight of youths into the details of the chosen treatment can play a significant role into treatment adherence and recovery.

Validation of the post-traumatic stress disorder subscale of the child behaviour checklist (PTSD-CBCL): screening for post-traumatic stress disorder or attention deficit/hyperactivity disorder?

Almost 20% of children and adolescents who attend in mental health centres are witnesses of domestic violence (WDVs). It would therefore be clinically useful to have an appropriate screening instrument for this population, such as the PTSD-CBCL. Our aim here was thus to assess the psychometric properties of relevant tools by determining their internal consistency, sensitivity/specificity, and positive/negative predictive values in our centre's population. We recruited 194 parents of children aged 4-16 at the Child and Adolescent Mental Health Service of the Hospital Sant Joan de Déu and Els Pins primary school. This sample was divided into: (1) a WDV group (n = 104); (2) an ADHD diagnosis group (n = 28); and (3) a general population (GP) primary school group (n = 62). The PTSD-CBCL total reliability score was high (Cronbach's alpha = 0.87). We found significant mean difference for WDV vs. GP (MD = 8.57; p < 0.001) with significantly higher mean scores in WDV than in GP. We also found significant differences for ADHD vs. GP (MD = 6.91; p < 0.001) with higher mean scores in ADHD than in GP. We observed good discriminatory power indices in the following group comparisons: WDV vs. GP, ADHD vs. GP, WDV vs. ADHD + GP, and GP vs. WDV + ADHD. Nevertheless, the PTSD-CBCL did not discriminate WDV vs. ADHD. Thus, we conclude that the PTSD-CBCL instrument has good discriminatory power in general and clinical populations, and could be implemented in the context of prevention and early intervention after trauma.

Integrating professional identities: an ethnographic study of psychoanalytic child psychotherapy in a children’s social care setting

ABSTRACT The importance of child and adolescent mental health services (CAMHS) collaborating with other agencies is of paramount concern for children with complex difficulties, including children in care. However, there is a lack of research exploring the role of child and adolescent psychoanalytic psychotherapists in multi-disciplinary and multi-agency work surrounding these children. Aims: to develop a theory of how child and adolescent psychoanalytic psychotherapists function within a social care setting, including how they position themselves in a multi-disciplinary and multi-agency environment. Methods: an ethnographic case study design, consisting of participant observation supplemented by interviews. Findings: grounded theory analysis identified that the child psychotherapists balanced three elements of their professional identity: discipline-specific identity; CAMHS team member identity; child’s care network member professional identity. To be effective in their role, the child psychotherapists needed to integrate the elements of their professional identity. The findings have implications for understanding the contribution of child psychotherapists in this field, particularly how to integrate into multi-disciplinary and multi-agency settings, whilst retaining their distinctive professional identity.

Child and adolescent mental health and social psychiatry

This article stages a discussion on the role of social psychiatry in present-day child and adolescent mental health care. Taking a broad perspective, it considers the growing demand for mental health services for children and young people and how social psychiatry can be situated in the current framework of psychiatry as a medical specialty as well as within child and adolescent mental health care provision more widely. Avenues available to expand social psychiatry’s reach and impact in the field of child and adolescent mental health are also addressed.