Dose Response in Child and Adolescent Mental Health Services

This study examines the dose–response relationship, the correlation between the amount of mental health treatment a child receives (dose) and the outcome (response) in a community setting. Participants were 125 children treated in the Stark County Child and Adolescent Mental Health System. Study methods include multiple outcomes, multiple-dose definitions, longitudinal hierarchical analysis of repeated measures, and instrumental variable estimation to control for possible confounding between outcome and treatment dose. Results show no statistically significant dose response. The results do not support the existence of a dose response for children and adolescents consistent enough to guide clinicians, administrators, or policymakers.     

A Characterisation of Tier 2 Services in Child and Adolescent Mental Health

UK government initiatives have proposed changes in the provision of child and adolescent mental health services (CAMHS) within the NHS. In response to this, tier 2 services have been created to provide early assessment and intervention and improved access. This study investigated whether these services met the aims compared to traditional generic tier 3 services, using data from a national mapping exercise. The results were consistent with the tier 2 services providing early assessment and intervention and enhanced accessibility of the services compared to tier 3. The implications of these results in relation to service development are discussed.     

The Staffing of Inpatient Child and Adolescent Mental Health Services

Background:  There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services.
Method:  Postal surveys were sent to all units in England and Wales.
Results:  Seventy-three percent ( n  = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day).
Conclusions:  Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.     

Paediatric Liaison Work by Child and Adolescent Mental Health Services

Background:  Although psychiatric morbidity is common amongst paediatric patients, little is known about the availability of CAMH paediatric liaison services.
Method:  We surveyed all Trusts with specialist CAMH services and paediatric units in Greater London, enquiring about the nature of liaison that CAMHS provide.
Results:  We found that although liaison paediatric work was common, dedicated paediatric liaison services were provided by only a minority of specialist multidisciplinary CAMHS. Their work involved most aspects of child psychopathology, and included emergencies and children with joint physical and psychiatric problems. About 2/3 of paediatricians were satisfied with CAMHS liaison services, but virtually all desired to see them developed further. There were few indications of co-ordination between specialist multidisciplinary CAMHS and other paediatric psychosocial support services.     

Routine Outcome Measurement: A Survey of UK Child and Adolescent Mental Health Services

Background:  Research suggests that the routine measurement of treatment outcomes is a neglected area of clinical practice within mental health care settings. Still it is not clear to what extent such findings apply to child and adolescent mental health services (CAMHS). A cross-sectional survey of UK CAMHS revealed that although quantitative clinical measures are commonly used within these services, there is little uniformity in the instruments utilised, and they rarely inform a system of routine outcome measurement. However, in general, respondents did not have a philosophical or scientific objection to the practice of routinely measuring outcomes, but rather felt that they lacked the necessary resources to facilitate such initiatives.     

Cross-National Reliability of Clinician-Rated Outcome Measures in Child and Adolescent Mental Health Services

Clinician-rated measures are in extensive use as routine outcome measures in child and adolescent mental health services. We investigated cross-national differences and inter-rater reliability of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), the Children’s Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD). Thirty clinicians from 5 nations independently rated 20 written vignettes. The national groups afterwards established national consensus ratings. There were no cross-national differences in independent scores, but there were differences in national consensus scores, which were also more severe than independent scores. The ICC for the HoNOSCA total score was 0.84, for the CGAS 0.61 and for the GAPD 0.54. These measures may usefully contribute to cross-national comparison studies.     

A Triage Clinic in a Child and Adolescent Mental Health Service

Aims: To determine whether non-urgent referrals can be adequately assessed in a triage clinic, to determine the service outcome of these referrals, and whether triage was acceptable to families, referrers and CAMHS clinicians.
Method: Families, CAMHS clinicians and GPs were surveyed to ascertain the acceptability of triage. Non-attendance and outcome of triage were recorded.
Results: Ninety-two cases were included and the DNA rate fell by one-third.
Conclusions: Overall, clinicians and families reported high rates of satisfaction with triage (93.7% and 95.2%) and multidisciplinary working improved.     

Inter-rater Reliability of Clinician-rated Outcome Measures in Child and Adolescent Mental Health Services

This study investigated the inter-rater reliability when 169 out of 171 clinicians working in 10 Norwegian child and adolescent mental health services rated 20 written vignettes using the following outcome measures: Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), Children's Global Assessment Scale (CGAS) and Global Assessment of Psychosocial Disability (GAPD). Three clinicians rated both patients and vignettes. On vignettes the intraclass correlation coefficient (ICC) for the HoNOSCA total score was 0.81 (single scales 0.47-0.96), for the CGAS 0.61 and for the GAPD 0.60. The reliability was not lower on patients. The rater's profession, experience or clinic did not have effect on the scores.     

False-Negative Reporting and Mental Health Services Utilization: Parents' Reports About Child and Adolescent Services

Parents' ability to make reliable and valid reports about health service utilization is a key research design consideration for studies about the unmet needs of children and adolescents with emotional or behavioral problems. This research report addresses the validity of parents' reports, in particular, parents' rates of false-negative reporting about their children's mental health service use. Our findings show that only a few parents of known service users fail to report that their child or adolescent has received services for an emotional or behavioral problem. However, when parents are asked to report about their child's service use with specific providers or in specific service settings, the rate of false-negative reporting tends to increase, and in some circumstances this increase is dramatic. Logistic regression results indicate that false-negative reporting is more likely to occur among parents whose children are male, less frequent service users, or service users whose use is less recent. After controlling for these factors, we did not find a significant difference in the rate of false-negative reporting for parents of Anglo and Latino children. Implications for research designs and survey instruments are discussed.     

User and Carer Involvement in Child and Adolescent Mental Health Services: A Norwegian Staff Perspective

It has been suggested that user involvement in heath care leads to improved services. The aim of the study was to explore attitudes towards user involvement of staff employed in Norwegian Child and Adolescent Mental Health Services (CAMHS). Most of the investigated mental health service staff expressed the opinion that users should be involved in the planning of their own treatment and generally have a positive attitude towards user involvement. Skepticism was related to some aspects of involvement and does not contradict their generally positive attitude towards user involvement.     

The Demand Side: Uses of Research in Child and Adolescent Mental Health Services

This special issue on child and adolescent mental health contains a thoughtful set of papers that address many of the challenges in bridging research and practice. These articles, however, focus predominantly on the supply side of producing research for use by a range of audiences, including practitioners, administrators and policy makers. This commentary emphasizes the importance of attending to, and better understanding, the demand side with regard to how research evidence is evaluated, understood, and utilized. Drawing from work underway at the William T. Grant Foundation, the authors argue for the need to understand three broad topics: user settings and perspectives, political, economic and social contexts, and the various uses of research. Furthermore, understanding the use of research evidence, or the demand side, is itself a topic for empirical investigation. The authors conclude that, when it comes to supplying evidence, don’t forget the demand side.     

Collaboration Between the NHS and Social Services in the Provision of Child and Adolescent Mental Health Services: A Personal View

The quality of collaborative links between the NHS and Social Services in the field of child mental health is dependent on the culture of co-operation set at the highest level of government. There needs to be an understanding of the different theoretical models that underpin working practices. The importance of personality factors, power struggles and misperceptions is highlighted. Constructive suggestions are made on how to ensure that collaboration works effectively.