Emergency child mental health services in Poland

This paper describes emergency child mental health services in Poland. The paper defines common emergencies for children and adolescents, describes who responds and how services are organized. The evaluation process, interventions and treatment follow-up are outlined. The lack of consistency across Poland is highlighted. Recommendations for further training of professionals, as well as improvements in the mental health and legal systems are made.     

Engaging families in child mental health services

To increase the involvement of urban youth and families who need mental health services, child mental health agencies and providers might consider the following: (1) examining intake procedures and developing interventions to target specific barriers to service use; (2) providing training and supervision to providers to increase a focus on engagement in the first face-to-face meetings with youth and families; (3) providing service delivery options with input from consumers regarding types of services offered. Involvement of youth and their families is a primary goal that must receive as much attention as any other part of the service delivery process. One might argue that without youth and family participation, effective services never will be provided to youth and families in need.     

Emergency child mental health services in Estonia

This paper describes emergency child mental health services in Estonia. The paper defines what is an emergency in Estonia, who provides services to children and adolescents, the process of evaluation, follow-up care and societal emergencies. Centers for care in Tartu and Tallin are described. The need for ongoing training and the expansion of services into the countryside is noted.     

Emergency child mental health services in Latvia

This paper describes emergency child mental health services in Latvia. The paper defines child mental health emergency and outlines which professionals are involved in evaluation and where evaluations occur. The described follow-up services are only now developing, with the majority of children still receiving minimal mental health services in shelters or detention centers. Recommendations for more training of professionals, specific protocols and an integrated system of care are made.     

Developing child mental health services in resource-poor countries

Despite significant gains in tackling the major causes of child mortality and evidence of an urgent need for child mental health services, resource-poor countries continue to lag behind in child and adolescent mental health service development. This paper analyses possible barriers to the development of child mental health services in resource-poor countries and attempts to proffer solutions. Obstacles identified are the magnitude of child mental health problems that remain invisible to policy makers, an absence of child mental policies to guide the process of service development, and overburdened child mental health professionals. The belief systems about mental illness also prompt help seeking in alternative health systems, thereby reducing the evidence for the burden associated with health seeking. Solutions that may support child mental health service development are the provision of adequate advocacy tools to reveal the burden, poverty alleviation, health awareness programmes, enforcing legislation, training centred within the region, and partnerships with professionals in developed countries. These solutions require simultaneous approaches to encourage service development and utilization. Reductions in child mortality in resource-poor countries will be even more dramatic in the years to come and preparations need to be made to take care of the mental health needs of the children who will survive.     

Evidence-based practice in child and adolescent mental health services

The authors review the status, strength, and quality of evidence-based practice in child and adolescent mental health services. The definitional criteria that have been applied to the evidence base differ considerably across treatments, and these definitions circumscribe the range, depth, and extensionality of the evidence. The authors describe major dimensions that differentiate evidence-based practices for children from those for adults and summarize the status of the scientific literature on a range of service practices. The readiness of the child and adolescent evidence base for large-scale dissemination should be viewed with healthy skepticism until studies of the fit between empirically based treatments and the context of service delivery have been undertaken. Acceleration of the pace at which evidence-based practices can be more readily disseminated will require new models of development of clinical services that consider the practice setting in which the service is ultimately to be delivered.     

Systems development of child mental health services in developing countries

This article reviews recent findings in the epidemiology of childhood psychiatric disorders in the developing world and the relationship of epidemiology to system development. Examples of systems developed in the Third World are discussed. The experience with attention-deficit/hyperactivity disorder and the development of a comprehensive system of care around it in Lebanon are described. Cultural factors that affect special populations in childhood mental health are examined. The article concludes with recommendations for systems development in Third World countries.     

Facilitating treatment attendance in child and adolescent mental health services: a community study

Failure of parents to attend and engage in treatment is a significant barrier to implementing effective interventions in child and adolescent mental health. Approaches to enhance treatment attendance and participation have targeted both structural operations of the clinic and aspects of the therapeutic process. Little research, however, has looked at clinicians' use of strategies to enhance treatment participation. Fifty-one mental health practitioners completed measures of strategies to increase treatment participation among families of conduct problem children. Client attendance was collected for each clinician over a 1-month period. As hypothesized, therapists were more aware of, and reported greater use of, therapy process compared to structural approaches to increase treatment participation. Clinician ratings of usefulness, competence and willingness to use therapy process strategies predicted client appointment attendance. The results are discussed in relation to the importance of training and supervision of professionals working with families in mental health services targeting a range of strategies to enhance treatment participation.     

User satisfaction with child and adolescent mental health services

BACKGROUND: Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. METHOD: The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. RESULTS: About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. CONCLUSION: The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.     

Measuring use of services for mental health problems in epidemiological surveys

The use of services for mental problems is generally reported as being relatively low. However, the methods used for data collection in surveys may have influenced the quality of self-reported service use. This study compares the information on recourse to physicians for mental problems reported in different sections of a survey conducted in six European countries. Thus, 5545 respondents were asked questions on contacts with physicians at least twice: (1) after the symptoms checklist in any completed diagnostic section, and (2) in a section devoted to use of care for mental problems. Of these 39.3% reported contacts with physicians about mental problems in the diagnostic sections, whereas 29.5% did so in the use-of-care section. Inconsistencies concerned 20.1% of participants, among whom those reporting consultations in diagnostic sections without reporting them in the use-of-care section represented the majority (74.4%). Multiple logistic regression analysis revealed that age, marital status, educational level and country were associated with under-reporting in the use-of-care section, as well as having mood or sleep problems. In conclusion, services used for mental health reasons when measured through a question referring to use of care due to the presence of a mental problem may underestimate the care people received for their problems.     

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.     

Living arrangements of individuals with schizophrenia in Japan: impact of community-based mental health services

AIMS: In Japan psychiatric hospitals and family play the predominant roles in caring for people with serious mental illness. This study explored how the introduction of community-based care has changed this situation by examining living arrangements of individuals with schizophrenia who were treated in one of the most progressive systems in Japan (Kawasaki) compared with national norms. METHODS: The proportion of clients with schizophrenia in the community versus hospital and living arrangements for those in the community were compared between the Kawasaki and national treated population, using data from the Kawasaki psychiatric service users survey in 1993 and two national surveys in 1993 and 1983. The variation in living arrangements was examined across five different age cohorts. RESULTS: The estimated national population was 36.7, which was similar to 32.7 clients per 10,000 population in Kawasaki. Some 71% of the Kawasaki clients were treated in the community compared with 55% nationally. The difference between the Kawasaki and national populations was the largest among clients aged 40 to 59. The Kawasaki community clients had a higher proportion of clients living alone. CONCLUSIONS: The community mental health services available in Kawasaki appeared to reduce hospitalisation and help clients to live alone in the community.     

Connecting science and practice in child and adolescent mental health services research

Collaboration between researchers and stakeholder groups is a potentially powerful mechanism for strengthening the quality of mental health research and for amplifying its public health impact. For stakeholders, collaboration offers opportunities to help shape research questions; participate in data collection and interpretation; and improve local capacity to access and use research findings. For researchers, collaboration can build understanding of what stakeholders want and need from research; enhance capacity to frame research questions and findings in language and metrics of value to stakeholders; and provide opportunities to contribute science-backed knowledge to decision-making processes in real world settings. Key stakeholder groups can include the recipients and providers of care, public and private care systems, health plans, schools, family service and faith-based organizations, correctional systems, and employers providing mental health benefits. This commentary reflects on the path that NIMH has taken in fostering researcher-stakeholder collaboration, particularly regarding child and adolescent mental health research. It describes the goals that NIMH set out to achieve, steps taken to realize those goals, lessons learned from those efforts, and possible next steps.