Community Child Health Services Research Articles

Mental Health Aftercare Availability for Juvenile Justice-Involved Youth in New York City.

The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.

'There was nothing, just absolute darkness': Understanding the needs of those caring for children and young people with complex neurodisability in a diverse UK context: A qualitative exploration in the ENCOMPASS study.

Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges, which require complex packages of multidisciplinary care. Part of the holistic care required includes supporting the families and parents/caregivers. The aim of the wider study was to introduce a new programme ('Ubuntu') to parents/caregivers and healthcare professionals (HCPs) in order to test the feasibility and acceptability of the concept and content, with the goal of potential adaptation for the UK in mind. Data collection and analysis uncovered rich data on caregiving journeys, navigation of health services, and perceived service gaps. This paper focuses solely on these topics. Further papers will report on the feasibility and adaptation data. Two rounds of semi-structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six HCPs from a variety of disciplines, recruited from a community child health service in London Borough of Newham, UK in 2020. The interviews included open-ended questions to explore caregiving journeys, experiences of navigating health services and perceived service gaps. Transcripts were analysed using a data-driven inductive thematic analysis. Three themes were identified that related to the aim of understanding caregivers' experiences and unmet needs relating to current service provision. These were (1) Caregiver Mental Health, (2) The Information Gap and (3) The Need for Holistic Support. Mental health difficulties were reported, particularly around the period of diagnosis. Priority needs included the provision of clear information about the diagnosis and services offered, opportunities to forge peer support networks and for services across the community to collaborate. The delivery of health services for CYP with neurodisability should encompass the broad needs of the family as well as meeting the clinical needs of the CYP.

Strength-Based approaches to providing an Aboriginal Community Child Health Service

Strength-Based approaches to providing an Aboriginal Community Child Health Service

Quantitative and qualitative assessment of maternal and child health services among hard-to-reach communities in Adamawa State, Nigeria

Background: Recent global reports highlighted the significance of improving the quality of healthcare delivery in all settings, including rural and hard-to-reach communities, as a central strategy for attaining sustainable development goals in universal health coverage. Objectives: This study aimed to assess and document relevant data associated with delivering qualitative Maternal and Child health services in the HTR communities using carefully selected indicators. Methods: The study used a mixed-design approach of quantitative and qualitative methods. Results: This study report high performance on the first antenatal visit (ANC 1), use of modern contraceptives (CPR), Penta 3, measles vaccination coverage, and, Low dropout rate also noticed in Penta 3, thus signifying a generally good performance in all the Local Government areas. Furthermore, Yola South, Fufore, Toungo, Ganye and Michika LGA were found to be the best performing LGAs on the selected maternal and Child indicators, namely: (ANC1), ANC4, ANC8, Institutional delivery rate, and Contraceptive Prevalence Rate (CPR), while Gombi, Guyuk and Madagali LGAs were the poorest performing LGAs. The poor performance of the fore mentioned LGAs was associated with human and environmental interferences: ongoing security challenges, high HTR communities due to mountains and riverine, low level of education, inadequate outreach services during the period under review, poverty, lack of adequate emergency transport system, inadequate HRH, inadequate and poor infrastructure, many communities lack a comprehensive PHC. Conclusion: The assessment highlights LGAs with low utilization of MCH services in HTR communities in Adamawa State, the reasons for the low coverage, and the possible strategies for increased utilization of these services.

Disordered eating prevention: Co-designing a brief intervention for use in Community Child Health Services

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting “how” to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses.

The impact of the COVID-19 pandemic on physical activity and anxiety levels of young mental health patients and their parents

Abstract: Introduction: One restriction measure during the COVID-19 pandemic period was the closure of sport-related facilities, generating substantial anxiety. This study analyzed longitudinal changes in anxiety and physical activity (PA) levels in young people (YP) attending a community child and adolescent mental health service, and their parents/caregivers from 2020 to 2022. Method: This quantitatively driven convergent mixed-methods cohort study utilized validated scoring tools (GAD-7/GLTEQ) as the core quantitative component, and open-ended questions as the supplementary qualitative component. The quantitative and qualitative data were statistically analyzed, and both results were integrated. Questionnaires were distributed in August–October 2020 (Phase 1: At the peak of restriction period), August–October 2021 (Phase 2: During gradual removal of restrictions) and August–October 2022 (Phase 3: When all restrictions were removed). Results: Parent/caregiver’s anxiety levels significantly reduced from Phase 1 to Phase 3. Results revealed non-significant improvements in YP’s PA levels from Phase 1 to Phase 3. PA levels in YP were significantly higher than those of parents/caregivers throughout all Phases. A significant negative correlation was revealed between PA and anxiety levels in parents/caregivers throughout all Phases. The fear of getting infected, lifting of restrictive measures, vaccination benefits, and pandemic-induced social/financial struggles were common themes generated from the qualitative comments. Conclusion: The authors recommend PA promotional campaigns and incentives during such restrictive periods, helping the population’s mental well-being. The high attrition rates in this study may decrease its generalizability. However, the results generated from this innovative study may serve as a platform for future research carried out during traumatic periods.

The impact of COVID-19 on children and adolescents attending Child and Youth Mental Health Services in Queensland, Australia.

This explorative study aims to provide insight into impacts of the COVID-19 pandemic and associated restrictions, on mental health of children and adolescents treated at Child and Youth Mental Health Services, and their parents. The COVID-19 Mental Health Survey was disseminated to parents of children and adolescents under treatment at community Child and Youth Mental Health Services (Brisbane, Australia) between July-November 2020 throughout different stages of COVID-19 related restrictions. Parents of 110 children participated. Most reported child's symptoms were sadness (46%), anxiety (60%), lack of focus (61%), lack of joy in their usual activities (38%) and reduction in sleep (42%). Parental emotions were significantly correlated with their child's emotions. Parent's lack of enjoyment of usual activities had the overall strongest average correlation (0.27) but this was no longer significant once other variables were controlled for. Children who attended school remotely for some of the days had a significantly (p < .05) higher risk of having more reported symptoms. Interestingly, in later stages of the lockdown with further easing of restrictions, symptoms also tended to be more severe. Cross-sectional data on children and adolescents in Queensland, Australia with pre-existing mental health issues suggests mental health continued to deteriorate through the pandemic even as restrictions eased. Changes in schooling seem to be an especially important risk factor.

Pemberdayaan Kader Posyandu dalam Sosialisasi Kesehatan Reproduksi dan Mental pada Kalangan Remaja di Kelurahan Tongauna

Empowerment of Posyandu Cadres through the socialization of reproductive and mental health among adolescents aims to increase the capacity and skills of Posyandu Cadres in immunization services, community nutrition education, maternal and child health services, sex education for adolescents, and reproductive health counseling. To achieve this goal, the method used is training by focusing on the extension approach and FGD. The results show that the Empowerment of Posyandu Cadres through the socialization of reproductive and mental health among adolescents has the following functions: 1) increasing cadre capacity in the form of knowledge, experience, and technical skills in maternal and child health services, as well as knowledge of reproductive and mental health for adolescents; 2) Counseling on reproductive and mental health among adolescents will bring closer the understanding of Posyandu Cadres, parents, and government officials about the importance of instilling ethical and moral values ​​for youth; 3) The implementation of the discussion becomes a vehicle for exchanging information and experiences from the community service team, Posyandu cadres, midwives, and village officials; so that there is a shared commitment to socialize the movement for basic health services, to create cheap, healthy, fair and sustainable services.

Assessing recovery in treatment as usual provided by community child and adolescent mental health services.

Despite the importance of routinely assessing the outcomes of everyday practice, few studies have reported outcome metrics for child and adolescent mental health services (CAMHS). Our aim is to investigate reliable change and recovery rates for treatment as usual, provided by one community CAMHS over two time periods. We prospectively audited accepted consecutive referrals from November 2017 to January 2018, and April to September 2019. Cases with paired outcomes were identified, and reliable change and recovery rates were calculated. Baseline outcome data were obtained for 672 (78.2%) and 744 (77.5%) young people in 2018 and 2019, respectively. Of eligible participants, 174 (59.2%) and 155 (45.7%) completed at least one follow-up outcome measure in 2018 and 2019, respectively. Pre- and post-test scores on the Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ) showed a reduction in symptoms. Total RCADS scores showed 21-25% of participants reliably improved, with 44-49% showing reliable improvement on one or more subscale. On the SDQ, 11 (15.5%) and 19 (25.3%) participants reported reliable improvement on at least one subscale in 2018 and 2019, respectively. Reliable recovery rates ranged from 48 to 51% for youth-completed and 40 to 42% for parent-completed RCADS. Half of young people receiving treatment as usual from CAMHS reliably improved on at least one routine outcome measure subscale, improvement rates comparable with adult psychological therapies services. Our findings indicate that reliable change and recovery on subscale rather than total scores may be a better indication of outcomes.

Promoting Confident Body, Confident Child in community child health: A mixed-methods implementation study.

To evaluate population-level implementation of Confident Body, Confident Child (CBCC); an evidence-based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2-6years; with community child health nurses (CHNs). This study utilised an implementation-effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre- and post-intervention delivery to CHNs, respectively. Twenty-six CHNs (all female; mean age 52.7±9.5years) participated in the study by attending a 1-day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non-significant improvements in CHN knowledge (P=.077) and attitudes towards overweight (using Anti-Fat Attitudes scale; significant improvements on willpower sub-scale only (P<.05)). This is the first study to evaluate population-wide CBCC implementation in a real-world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation-focused methodologies to translate preventive eating disorder programs into community child health services.

Health status and health service use of urban Aboriginal children attending an Aboriginal community child health service in Sydney.

There is limited information on the health status of urban Australian Aboriginal children and young people attending community-based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. Cross-sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0-18 years who visited the service between January 2013 and December 2017. A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty-six percent of occasions of service noted >3 diagnoses; 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty-five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear-nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.

Involvement of community paediatricians in the care of children and young people with mental health difficulties in the UK: implications for case ascertainment by child and adolescent psychiatric, and paediatric surveillance systems

ObjectiveTo ascertain the extent to which community paediatricians are involved in the care of children with mental health conditions in order to determine which difficulties are appropriate for single or...

10 minutes with Kelly Garside, Team Manager, Community Child and Adolescent Mental Health Service, Oxford Health Foundation Trust

![Graphic][1]</img> ### Biography Kelly Garside is a registered mental health nurse who graduated with Distinction in a Higher Diploma in Mental Health Nursing in 1997 and obtained her BSc (Hons)...

“Improving Access to Early Childhood Developmental Surveillance for Children from Culturally and Linguistically Diverse (CALD) Background”

Introduction:Developmental vulnerabilities in pre-school aged children from culturally and linguistically diverse (CALD) backgrounds with low English proficiency are less likely to be identified through universal developmental surveillance. Barriers include low parental health literacy and low rates of attendance to mainstream child and family health services. Late detection of developmental vulnerabilities can have lifelong impacts on life trajectory.Method:Integrated outreach early childhood developmental surveillance was trialled in South East Sydney by local health services with non-government organisations (NGO) delivering early childhood education and support. NGO staff were trained in Parents Evaluation of Developmental Status (PEDS), a validated developmental screening tool to explore parental/carer and provider concerns [1]. Families with children identified with developmental concerns by NGO staff were referred to co-located or visiting Child and Family Health Nurses (CFHN), community child health, speech pathology or developmental services for developmental screening, assessment and/or care planning.Results:Integrated health and NGO services improved access to developmental surveillance for CALD families in a non-threatening environment enabled by co-locating CFHN, or through visits by paediatric medical/speech pathology staff to participating playgroups.Conclusions and discussion:Integration supported vulnerable families from CALD backgrounds to access developmental surveillance through child and family health services but required flexibility and adjustments by all involved.

Brief Report: An Evaluation of the Social Communication Questionnaire as a Screening Tool for Autism Spectrum Disorder in Young People Referred to Child & Adolescent Mental Health Services.

The SCQ is a widely used screening measure for the assessment of autism spectrum disorder (ASD). However, its sensitivity and specificity when used with older children in the context of community Child & Adolescent Mental Health services is unclear. Seventy-seven (Mean age = 12.8years) young people with suspected ASD were screened using parent- and teacher-reported SCQ's before completing a comprehensive diagnostic assessment. Of the 77 young people included, 44 (57%) met criteria for an ASD diagnosis. Our results indicated that regardless of informant, SCQ scores did not significantly predict the outcome of the diagnostic assessment. Based on the published cut-off score for the SCQ, Receiver Operating Characteristic curve analyses revealed a lower than expected sensitivity and specificity. This suggests that the SCQ is not an effective screening tool when used in the context of community Child & Adolescent Mental Health services.

Learning from 35 Years of Community Child Health Services in the United Kingdom: Reflections for Community Geriatricians

This article reviews the development of community child health services in the UK over the last 35 years and the role of the community paediatrician and reflects on the issues that had to be addressed to enable the specialty to evolve to the service that it is today. The article considers three areas-clinical practice, local service delivery and the national issues of leadership and policy, all of which may be relevant when developing community geriatric services.

A Profile of Common Neurodevelopmental Disorders Presenting in a Scottish Community Child Health Service –a One Year Audit (2016/2017)

A Profile of Common Neurodevelopmental Disorders Presenting in a Scottish Community Child Health Service –a One Year Audit (2016/2017)

Asking the difficult questions: Building the capacity of community paediatricians to routinely enquire and respond to family violence.

To enhance the confidence and capacity of community paediatricians and paediatric trainees to identify and respond to family violence, through a series of education sessions and evidence-based recommendations. The action research methodology included a literature search to review the data on family violence education programmes and evidence-based family violence screening tools. Six education sessions were then developed and held for physicians at the Community Paediatric and Child Health Service (CPCHS). An audit was performed on the charts of all new referrals to the CPCHS for a period of 18 months prior to the education sessions and 5 months following the education sessions. A questionnaire was distributed at the first and final education sessions to gauge physician comfort with enquiry into family violence. The documented rate of enquiry into family violence at CPCHS was 24% in the retrospective chart audit. Following the series of education sessions, the documented rate of enquiry increased to 60% (P < 0.05, odds ratio 4.7, confidence interval 2.7-8.4). The documented rate of disclosure of family violence also increased from 13% of all new patients in the retrospective chart audit to 24% in the prospective arm of the study (P < 0.05, odds ratio 2.1, confidence interval 1.0-4.0). Following the education sessions, all participants agreed that they routinely enquired about family violence and were comfortable enquiring about family violence. This study demonstrates that clinician education about family violence supports routine enquiry about family violence in community paediatric consultations.

Childhood unusual experiences in community Child and Adolescent Mental Health Services in South East London: Prevalence and impact

BackgroundDistressing ‘psychotic-like’ or unusual experiences (UEDs) signify increased mental health risk in the general population, including greater likelihood and severity of co-occurring non-psychotic mental health problems, and, from fourteen years of age, increased risk of a future psychotic illness. Healthcare guidelines for under eighteens recommend psychological intervention for UEDs, to reduce current distress and adverse functional impact, and, potentially, future mental health risk. Children tend not to report UEDs unless directly asked, indicating a need for routine screening. We report on the feasibility of a routine screening methodology, and screening outcomes, in Child and Adolescent Mental Health Services (CAMHS) in South East London, United Kingdom. MethodFour general community CAMHS teams were invited to screen, by adding a nine-item self-report UED measure to their routine assessment battery. Screening data were collected over 18months from 02/2015 to 07/2016. ResultsAll but one team agreed to screen. Each team saw around 300 accepted referrals during the audit period (total: 900); 768 of these (85%) were successfully screened; of those screened, 68% (n=524) self-reported UEs, 60% (n=461) with associated distress/adverse functional impact. Screening was acceptable to clinicians, children and families. ConclusionsAssessing UEDs routinely in CAMHS is feasible, and suggests that around two thirds of assessed referrals could potentially benefit from interventions targeting UEDs. Additional training may be required for the CAMHS workforce to address this need.

Access to integrated community case management of childhood illnesses services in rural Ethiopia: a qualitative study of the perspectives and experiences of caregivers.

Background: In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services.Methods: A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers.Results: In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands.Conclusion: Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes.