Health Care For Young People Research Articles

Mind the gap: exploring stakeholder perspectives on police-led pathways to crisis mental health care for young people in Ireland

ABSTRACT Over the past few decades, the level of police involvement at a community level in matters of mental health has increased significantly. Police are often the only agency immediately available day or night to respond to such emergencies and are often left to deal with mental illness and associated social crises with very limited support. Whilst recent years have witnessed an upsurge in governmental policy intended to safeguard vulnerable groups, such as young people and people with mental illness, there is a dearth of research regarding the proficiency and operability of these directives in practice. Even less is known about how these policies are practically applied to young people in crisis. The study examines the police-led care pathways of Irish youth experiencing a crisis mental health event from the commencement of police involvement through to the initiation of psychiatric care. Qualitative interviews were conducted with police and a group of stakeholders comprised of medical professionals and a social worker. Results indicate a complex care pathway beset with ambiguous policy and legislation, deficits in specialist training, and chronic under-resourcing of services. In the face of these shortcomings, police innovate informal practices that sometimes help and at other times pose a risk to young people in crisis. Furthermore, uncertainties surrounding formal procedure was a source of significant psychological burden for police and potential disciplinary action. These findings are discussed in the context of existing theory and research, and recommendations for policy and practice are offered.

Cost-effectiveness of train-the-trainer versus expert consultation training models for implementing interpersonal psychotherapy in college mental health settings: evidence from a national cluster randomized trial

BackgroundThis study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared.MethodsTwenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions.ResultsMean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85–1.46; p < .001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008–0.14; p = .03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence.ConclusionsDespite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers.Trial registrationClinicalTrials.gov Identifier: NCT02079142.

Early intervention in psychosis for first episode psychotic mania: the experience of people diagnosed with bipolar disorder

Background Early intervention for people diagnosed with bipolar disorder has been identified as a priority, but little is known about how existing early intervention services are experienced by this group or could be tailored to their needs. Aims This study examined the experience of early intervention in psychosis (EIP) services for people diagnosed with bipolar disorder, following first episode psychotic mania. Method Semi-structured interviews were conducted with 11 adults in EIP services and analysed using Interpretative Phenomenological Analysis. Results One superordinate theme was formed, Rebuilding within EIP service, consisting of five subthemes: (i) Piecing together episode through talking to staff; (ii) Exploring other perspectives during CBT; (iii) Empowered through shared decision-making; (iv) Reconsidering future and purpose; (v) Service as safety-net. EIP provision was pivotal in helping participants understand their episode, adjust their perspective, build confidence and progress. Conclusions Aspects of the service that were valued, including person-centred relationships with staff, shared decision-making and the development of motivation and opportunities, reflect key principles of mental health care for young people following first episode psychosis. Furthermore, findings point to elements that may be particularly relevant to early intervention following first episode psychotic mania including managing mood escalation and individualised approaches to goals.

Soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users.

A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment. Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.

Primary care provision for young people with ADHD: a multi-perspective qualitative study.

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. UK guidance states that primary care has a vital role in effective ADHD management, including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many GPs feel unsupported to provide health care for young people with ADHD. Inadequate health care is associated with rising costs for patients and society. To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD and healthcare professionals (HCPs). A qualitative study. Interviews were conducted with HCPs (GPs, practice managers, and a wellbeing worker) and people with lived experience of ADHD (young people aged 16-25 years and their supporters) located in integrated care systems across England. Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by deprivation, ethnicity, and setting). Questions focused on experiences of accessing/providing health care for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework to understand how provision works in practice and to explore potential improvements. In total, 20 interviews were completed with 11 HCPs and nine people with lived experience. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change in ADHD primary care provision. Standardisation of ADHD management in primary care, providing better information and support for HCPs, and advising on reasonable adjustments for people with lived experience could help improve access to effective treatments for young people living with ADHD.

Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis.

Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people.

Medium secure mental health care for young people: decisions to detain

Medium secure units are one component of secure mental health care for young people across the UK. No research has previously examined the appropriateness of admissions. This is a retrospective cohort study of all patients admitted to one unit by examining clinical notes for demographic, mental health and criminological variables. Descriptive data was statistically analysed to then characterise the cohort, audit against admission criteria and examine changes over time. There were 149 admissions. All patients admitted were male, most were 17 years old and from racialized groups. Most were detained under forensic sections with a primary diagnosis of psychosis. Four of five admissions met all 4 admission criteria. There were notable changes in use of forensic sections and risk over time. Our cohort differs from previous historical and contemporaneous cohorts in terms of diagnosis, legislation determining admission and ethnic breakdown. Our analysis relies on an interpretation of existing admission criteria but it suggests that not all admissions were appropriate, raising important practical, ethical and cost benefit questions. We suggest greater transparency about admission decisions to ensure that patients are admitted to the least restrictive setting needed and that national service planning is responsive to changes in demand.

Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study.

Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being. This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being. A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period. Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention. The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people.

PA20 Assessing the value of transition readiness assessment clinics within a dermatology service

Abstract Successful transition of healthcare from paediatric to adult services is a key component of developmentally appropriate healthcare for young people with long-term conditions. Poor preparation for transfer and shifting social roles results in up to 25% of young individuals regularly missing follow-up visits and poor treatment adherence once transferred to adult services. Transition clinics were developed as an intervention to support young people in navigating the journey from paediatric to adult care. The Ready Steady Go (RSG) tool was implemented by Southampton Children’s hospital and endorsed by the Royal College of Paediatrics and Child Health and the National Institute for Health and Care Excellence for use in transition clinics. It considers the developmentally appropriate healthcare domains of self-management of long-term conditions, independence and self-advocacy, sexual health, mental health and emotional wellbeing, and activities of daily living (ADLs). The role and success of the RSG tool in many medical specialties has been documented. However, it has not yet been routinely implemented within dermatology departments. The aim of this project was to assess the additional value of the use of the RSG tool by a paediatrician with expertise in adolescent health, in a transition readiness assessment clinic piloted within a dermatology service. Notes of all patients attending the transition clinic between January and December 2022 were reviewed. Details of any interventions provided during the RSG-guided clinical appointment were compared with interventions previously received by the same patients in their routine dermatology appointments over the preceding 24 months. Intervention types included the assessment of independence, verbal advice, written leaflets, links to websites and direction to self-help services. Sixteen patients were seen in the transition clinic and included in the analysis. All patients were seen without their parents for at least part of the consultation. With the use of the RSG tool, 100% of patients received one or more intervention concerning self-management of their long-term condition, self-advocacy and ADLs vs. 44%, 81% and 75% in their previous clinic attendances for each of these domains, respectively. Eighty-seven per cent of patients received advice on sexual health/family planning, and 87% received information on mental health help with use of the RSG tool in the transition clinic, where 0% and 37% patients, respectively, had received information about these domains at previous dermatology appointments. All patients successfully achieved transition, with 44% having attended their first adult dermatology appointment, while the remaining 56% have their adult appointments still pending at time of writing. This study highlights the value and yield of a transition-readiness assessment for paediatric dermatology patients. During this presentation, we will discuss the RSG tool and the practicalities of implementing its use in dermatology services.

Mapping young people's journeys through mental health services: A prospective longitudinal qualitative study protocol.

Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. Understandings of mental health care for young people are impeded by a lack of longitudinal research. Without this research, it is difficult to understand how services do or do not support the recovery of young people over time. This project will analyse the healthcare journeys of young people aged 16-25 years experiencing their first episode of mental ill health for which they have sought GP support, over 12 months in the Australian Capital Territory. The study team will recruit up to 25 diverse young people and their general practitioners (GPs), and conduct four qualitative semi-structured interviews over 12 months with each participant. GP interviews will explore their role in the mental health care and care coordination for the young person. Interviews with young people will explore experiences and perceptions of navigating the health system, and the supports and resources they engaged with during the 12-month period. In between interviews, young people will be asked to keep a record of their mental health care experiences, through their choice of media. Participant-produced materials will also form the basis for interviews, providing stimuli to discuss the lived experience of care. Through analysing the narratives of both young people and their GPs, the study will establish how young people understand value in mental health care delivery. The study will use longitudinal qualitative mapping of healthcare journeys to identify key barriers and enablers to establishing effective, person-centred health care for young people with mental ill health.

Teen Clinic - An integrated primary healthcare model that improves access for young people in rural communities.

Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase access to health care for young people, particularly school-aged young people (12-18 years) living in small rural towns (<5000 people). To determine the extent the Teen Clinic model meets its accessibility objective and to determine the barriers and enablers to sustainable delivery of the Teen Clinic service. A multimethod case study approach was used to assess access (multidimensional framework for patient-centred access) and determine the barriers and enablers to sustainable delivery. Data collection included a survey of young people in the included rural communities and key stakeholder interviews. The survey of young people indicated Teen Clinic model was accessible across multiple dimensions. From a practice perspective, accessibility was achieved by varying from usual care to a nurse-led, young person-centred drop-in model. This required skilled nurses working at the top of their scope; however, unpredictable demand and patient complexity made accounting for the time and therefore funding somewhat complex. The Teen Clinic model meets its objective of increasing healthcare access for young rural people. Relational and cultural factors were more important facilitators of practice integration than organisational processes. A key challenge to the ongoing provision of Teen Clinic was dedicated sustainable funding. Teen Clinic is an integrated primary healthcare model that increases access for young people in small rural communities. Sustainable implementation would benefit from dedicated funding.

Mental health-related hospitalizations among adolescents and emerging adults with autism in the United States: A retrospective, cross-sectional analysis of national hospital discharge data.

Autistic young people are more likely to have mental health conditions, like depression and bipolar disorder, than people without autism. These mental health issues sometimes lead to hospitalizations, which can be expensive and traumatic. Because of this, we wanted to understand mental health-related hospitalizations among autistic young people aged 10-20. We found that the main mental health reasons for the hospitalization of autistic young people were neurodevelopmental, disruptive, depressive, and bipolar disorders. These hospitalizations cost an average of US$7401.23 per stay, for a total of US$106 million in service delivery costs in 2016. Mental health-related hospitalizations were compared between young people with autism, young people with complex and chronic conditions, and young people with no chronic conditions. Autistic young people were almost 11 times more likely to be hospitalized for mental health reasons than young people with complex and chronic conditions, and two times more likely than young people with no complex and chronic conditions. We believe the United States needs better community-based mental health care for young people with autism.

FORMATION OF SANITARY AND HYGIENIC COMPETENCE IN HOTEL AND RESTAURANT SPECIALTY STUDENTS

The article theoretically highlights the mechanism of sanitary-hygienic competence formation among students of higher education majoring in “Hotel and restaurant business”. It has been established that this problem has its relevance and the need for its fastest solution, namely by revising the conditions of the educational process of higher education institutions. This involves the formation of students at a high level of safe and responsible behavior regarding the care of their health. The factors that directly affect the process of forming sanitary and hygienic competence among student youth of higher education institutions are analyzed. Ways to create an optimal educational process for the formation of sanitary-hygienic competence in first-level higher education graduates of the “Hotel and restaurant business” specialty are proposed. This approach will allow the future specialist to create a health-saving environment for employees of service establishments.The state of health of young people plays an important role in the formation of an economically and socially sustainable state. After all, the health and well-being of society is the driving force behind the development of the state, especially in the matter of the reproduction of productive forces (human resources), as a universal reserve. Particular attention is paid to the health care of young people as a socio-medical and pedagogical-psychological problem of the state with the search, development and implementation of effective health-forming technologies.The approach is designed to provide information about the professional activities of a future specialist in the service sector, namely the formation of a health-saving environment in which employees can work effectively. The existing sanitary and hygienic competence implies being ready to preserve the health of both one’s own and nearby.&#x0D; Keywords: sanitation; hygiene; competence; health; healthy lifestyle; acquirer; educational process; educational institution; youth; education.

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Parents' views, experiences and expectations when the health care of adolescents with congenital heart disease is transferred from pediatric to adult care. results from a meta-synthesis

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction International guidelines and research endorse collaboration with parents. However, parents of young people with congenital heart disease (CHD) face several challenges when the healthcare of their child at the age of 16 or 18 years is transferred from pediatric to adult care. Parents are expected to "step aside" but they have an unclear view of what to expect and are uncertain about their role in this process. Although there has been attention to the needs of parents during young peoples’ transfer in current guidelines, it is still vaguely how health care professionals can involve parents in this process. Purpose A qualitative systematic meta-synthesis was undertaken in order to inform health care professionals on how they can involve the parents in the transfer process. This review covers parents’ experiences, expectations and needs when the health care of young people is transferred from pediatric to adult care. Methods This review was conducted in accordance with the JBI’s methodology for systematic reviews of qualitative evidence. A science librarian was involved in searches at following databases: MEDLINE, PubMed, CINAHL (EBSCO), Embase, PsychInfo, SweMed+, and Scopus. Qualitative studies in English, German, Swedish, Norwegian and Danish were considered for this review. The methodological quality of the included studies was assessed independently by three reviewers using a standardized data extraction tool. Findings were assembled according to their quality and categorized based on their similarity in meaning. The categories were subjected to meta-synthesis in order to produce a single comprehensive set of synthesized findings. Results Six qualitative studies were included covering experiences from parents of young people with CHD. 40 findings were extracted and aggregated into seven categories and from these three synthesis were derived: i) Information is a prerequisite for being able to support young people ii) The transition process should be prepared, individualized, and based on the young people’s maturity iii) The role shift causes ambivalent feelings requiring a scaffolded transition process. Conclusion Information about organization and future follow up in adult care is a prerequisite for parents to be able to support their childs’ transfer. The transfer to adult care is a logic step, but parents fear to be excluded from future clinical discussions. Young peoples’ transfer to adult care should be decided on the basis of their maturity rather than a predefined age. Parents worry that the healthcare professionals are unaware that the young people are beginners. It causes ambivalent feelings when parents experience a role shift from being a full caregiver to become a supportive person. Parents grief because they are not needed anymore, however, it is a relief to hand over responsibility for the disease to the young people. A scaffolded transition process can help parents to adapt to their new role.

Parenting roles for young people with attention-deficit/hyperactivity disorder transitioning to adult services.

To inform transitions from child to adult health services, we explored the work and roles parents take in the care of young people with attention-deficit/hyperactivity disorder (ADHD) aged 14 to 25 years old. Using framework thematic analysis, we analysed data collected from 28 semi-structured interviews with parents of young people with ADHD to generate a typology and triangulated it against findings from 64 interviews with young people with ADHD. The interviews were carried out as part of a three-strand, interactive mixed-method study. An entourage typology of three parent roles was identified. Parents moved between 'manager' and 'roadie' roles as their child gradually matured. A 'superfan' role was identified which supported young people's positive self-image but may impede withdrawal from the 'manager' role. Continued parental involvement into adulthood reflected a need to maintain the balance of resources required to maintain quality of life for the whole family. This is the first study to explore parental roles in the health care of young people with ADHD. Parents will vary in their capacity to fulfil the identified roles and step back their care as their children reach adulthood. The findings can inform intervention development to support families and transition between services. Parents move from a 'manager' to 'roadie' role as young people mature. A 'superfan' role supports positive self-image and directed health care work. Continued involvement reflects parental responsibility to juggle wider family needs and resources. Parents differ in capacity to fulfil and move between these roles.

Mental health care for young people using video games: a pilot RCT on the development of a new intervention method toward Hikikomori and Futōkō

Background: Young people in their teens and twenties don’t seek treatment immediately for mental health issues. This is due to the perceived stigma linked to mental health, pragmatic inconveniences to reach clinical settings, and the tediousness to seek help or engage with adults in traditional ways. Alternative approaches aside from drugs administration are needed. Method: We conducted an internet-delivered pilot randomized controlled trial directed to Hikikomori and Futōkō experienced subjects. This study aimed to understand the difference in efficacy for an intervention using a fictional story vs factual scientific information (self-aid texts), as well as the feasibility of an internet delivered program .. Evaluation of emotional transportation and mental health related measures were administered at base line before the program and at one week after the completion of the program. Results: 40 participants were enrolled. A post-intervention (T2) Independent T-student showed that Emotional Transportation was significantly lower for the intervention group than for the control group at T2. Relaxation was significantly higher for the intervention group than for the control group at T2. For the other outcome variables, the difference was not statistically significant. An ANCOVA showed that there was a significant effect of groups on emotional transportation (lower in the intervention group). There was a significant effect of groups on empathy (lower in the intervention group); for the other variables the effects of groups were not detected. Conclusions: The results showed a significant diminishment in emotional transportation and empathy for the interventional group contradicting the hypothesis that an enhancement of emotional transportation mediates the positive mental health effects. A marginal improvement in relaxation in the intervention group (T-test) was found. In the posthoc analysis, the positive effects on the relaxation of pre-intervention (habitual) high emotional status of participants were confirmed. This trial is registered with UMIN, ID UMIN000044204.

The role of primary care pharmacist in the management of chronic illnesses in young people: a qualitative study

Abstract Introduction Recent evidence has shown that the incidence of long-term illnesses in young people is increasing (1). Pharmacists, as medicine experts, are in a unique position to promote young people’s health by improving their knowledge regarding effective use of medication through the provision of pharmaceutical services. To date, there are few studies that have explored the potential roles of primary care pharmacists in providing health care for young people with long term illnesses (2). This study attempts to show the potential role of primary care pharmacists in caring of young people with chronic illnesses. Aim To explore the role of primary care pharmacists in the management of chronic illnesses in young people aged 18-24 years. Methods A qualitative study was undertaken. From June to November 2019, semi-structured interviews were conducted with 23 primary care pharmacists in the UK. A purposive sampling strategy was followed to form a population for this study. The targeted participants were UK primary care pharmacists i.e. General Practice (GP) and community based pharmacists. Through professional networks, the participants were identified, approached and recruited by email or in person. Interviews on average lasted 35 minutes, and were audio recorded, transcribed verbatim and analysed inductively using thematic analysis. Emergent themes were reviewed by all authors and any discrepancies were resolved through discussion. Results Four themes emerged from the data: pharmacists’ roles, prescribing issues, pharmaceutical services and young people medication-related experiences. Participants identified several roles for primary care pharmacists in caring of young people with chronic illness. These roles included encouraging young people to visit the pharmacy to collect their medicines and ensuring that they have enough medicines supply, counselling and educating young people about their medicines and answering their queries, building trusted relationships directly with them, provision of specialist services, following up with young people and checking on medication compliance, and signposting them for further support. The most discussed chronic illnesses in young people by participants were respiratory diseases such as asthma and mental health illnesses. However, many pharmacists perceive a fundamental communication barrier that hinders the provision of this support, i.e., lack of access to the patient. Participants identified a lack of support from other health care providers as one of the associated challenges for pharmacists in supporting young people with chronic illness. Conclusion Primary care pharmacists felt that they have an important role in supporting young people with chronic illness. This study identified many ways in which pharmacists provide services and support to young people. This study makes a major contribution to the limited literature on primary care pharmacists’ experience of dealing with young people with chronic illness by exploring the pharmaceutical care currently available and identifying other issues which may influence pharmaceutical care. Although the research was limited by a relatively small number of participants, the findings of this research could inform future research to provide more evidence of the benefit of primary care pharmacists in supporting young people with chronic illness in the optimal use of their medication. References (1) Shah R, Hagell A, Cheung R. International comparisons of health and wellbeing in adolescence and early adulthood. London (UK): Nuffield Trust; 2019. (2) Gray N, Shaw K, Smith F, et al. The Role of Pharmacists in Caring for Young People With Chronic Illness. Journal of Adolescent Health, 2017; 60 (2): 219–225.

Egyptian Students Open to Digital Mental Health Care: Cross-Sectional Survey.

BackgroundIn Egypt, the shortage of mental health services, particularly for adolescents and young adults, is apparent. Electronic mental health (EMH) has been proposed as a solution to bridge the gap and better address the needs of young people. However, EMH is new to Egypt and its acceptability among target populations is crucial to its implementation and success.ObjectiveThe objective of this study is to explore the interest of Egyptian youth in EMH, identify perceived barriers to EMH, and inform the design of EMH tools to best address the needs of youth.MethodsA web-based cross-sectional survey was distributed among medical students at Tanta University in Egypt. Chi-square and one-way analysis of variance tests were performed for inferential analyses using a significance level of .05.ResultsOf the 707 individuals who completed the survey (90.9% response rate), 60.5% (428) were female, 62% (438) lived in urban and suburban areas, and the mean age of the sample was 20.5 (SD 1.8) years. The vast majority of participants (522/707, 73.8%) had already used the internet to find information about mental health problems, but the information was unsatisfactory for about half of them (386/707, 54.6%). Almost all students reported that they would prefer web-based therapy if EMH were available through a trustworthy national web-based platform for youth mental health (601/707, 85%). Students believed that emotional difficulties, social support, and coping strategies were the main topics that EMH should help with. The most common perceived barriers for EMH use in Egypt were concerns about privacy (382/707, 54%) and a lack of technology literacy and unfamiliarity with EMH (352/707, 50%).ConclusionsEMH is a promising strategy for addressing gaps in the mental health care for young people. To construct and implement a digital system of care that addresses the unique needs and preferences of youth, adolescents and young adults should be involved in the co-development and design.

Integrated care to address child and adolescent health in the 21st century: A clinical review.

Increasing specialisation and technical sophistication of medical tools across the 21st century have contributed to dramatic improvements in the life-expectancy of children and adolescents with complex physical health problems. Concurrently, there is growing appreciation within the community of the extent that children and adolescents experience mental disorders, which are more prevalent in those with complex chronic, serious or life-limiting health conditions. In this context, there are compelling reasons for paediatric services to move to a model of care that promotes greater integration of child psychiatry within the medical, somatic teams that care for children and adolescents in children's hospitals. In this article, we discuss the range of medical disorders managed by contemporary paediatrics. We conducted a broad review of the literature and existing services, and use individual accounts to illustrate adolescents' healthcare preferences in the context of the challenges they experience around their mental health. Relevant disorders include life-limiting disorders, such as cancer; disorders involving the brain, such as epilepsy; common chronic disorders, such as asthma and diabetes; psychiatric emergencies, such as deliberate self-harm; and conditions that most commonly present to paediatric services, but where psychiatric input is required, such as severe eating disorders, somatic symptom disorders and gender dysphoria. The persisting legacy of the historical separation of physical and mental health services is described. Yet there are many models of service integration that can promote more collaborative care between psychiatrists and medical specialists, including some which have been taken to scale. In essence, clinical teams in children's hospitals require more collaborative approaches that facilitate early recognition and treatment of the psychological aspects of illness as an integral part of patient-centred, family-focussed paediatric care, rather than as something that is bolted on when things go wrong. Whilst trust and goodwill between services and providers will be required for novel models of care to be implemented, evaluation of these new models and incorporation of young people's healthcare preferences is needed.