Evaluation of a CAMHS in Primary Care Service for General Practice

Background:  Many CAMH Services have Tier 2 provision in primary care, but there has been little published evaluation. In a service aimed at general practice, this study examined: 1) the clinical activities of the primary mental health workers; 2) the effect of the service on referrals to specialist CAMHS; and 3) the utilisation and perceived usefulness of the service.
Method:  clinical activity data collection, evaluation of referral patterns, and a postal questionnaire.
Results:  Informal (unstructured) consultation-liaison was used more than formal consultation. Referrals to specialist CAMHS increased from practices using the service. The service was perceived as helpful and accessible.
Conclusions:  The service supported primary care staff in their work with child and adolescent mental health issues. Referrals to Tier 3 may increase as a result of the service.     

The Global Absence of Child and Adolescent Mental Health Policy

Background:  Few policies designed specifically to support child and adolescent mental health exist worldwide. The absence of policy is a barrier to the development of coherent systems of mental healthcare for children and adolescents.
Method:  This study collected data on existing policies from international databases, WHO headquarters in Geneva, Switzerland, and in consultation with experts in child and adolescent psychiatry from around the world. A set of criteria for ranking the adequacy of these policies was developed.
Results:  Though no single country was found to have a mental health policy strictly pertaining to children and adolescents alone, 35 countries (corresponding to 18% of countries worldwide) were found to have identifiable mental health policies, which may have some beneficial impact on children and adolescents. Though little has been achieved worldwide in this area, there has been a significant degree of movement towards policy development in the past 10 years. The policies identified vary greatly in terms of their provisions for delivering services, initiating research, training professionals, and educating the public.
Conclusions:  The development of mental health policies is feasible and would substantially aid in the expansion of service systems, the institutionalisation of culturally relevant data gathering, and the facilitation of funding.     

What Makes a Good CAMHS Primary Mental Health Worker?

Background:  The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role.
Method:  Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed.
Results:  In addition to clinical skills and mental health knowledge all respondents consistently emphasised the importance of inter-personal attributes such as general accessibility, flexibility, and self-motivation.
Conclusions:  Both professional competencies and inter-personal skills are perceived as important characteristics for PMHWs. It therefore seems appropriate for these to be made more explicit in competency frameworks.     

The Impact of Primary Mental Health Workers on Referrals to CAMHS

Background:  This paper describes the impact of a new primary mental health team within the existing child and adolescent health service on referrals and attendance rates.
Method:  100 referrals to CAMHS from prior to the PMHT and 100 referrals prior to the evaluation were examined and classified as appropriate or inappropriate for CAMHS. Information was also gathered as to whether the child and/or family attended for their appointment with CAMHS.
Results and Conclusions:  a large increase in attendance and decrease in non-attendance rates to CAMHS was seen. The referrals to CAMHS have become more appropriate for a psychiatry service. However, the service provoked a mixed response from Tier 1 professionals. Recommendations are made for the skills needed by primary mental health workers and further evaluative techniques.     

Developing the Primary Mental Health Worker Role in England

Background:  The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role.
Method:  415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction.
Results:  PMHWs perceive their role to involve successful collaboration with primary care staff, offering improved access to mental health services, and being supported by a generally good infrastructure; although training opportunities remain an area of need.
Conclusions:  The workforce development policy appears, from the PMHWs' perspective, to be successful although training opportunities need consideration.     

Ethnic variation in service utilisation among children with intellectual disability

Background   This study examined whether service utilisation among children with intellectual disability (ID) varied by ethnic cultural group.
Method   Survey carried out in four special schools in London. Information was provided by school teachers using case files, and 242 children aged 7 to 17 years with mild and moderate ID were identified. Ethnic categories were derived from self-reported main categories. Service utilisation categorised as use of: child and adolescent mental health services (CAMHS), social services, physical health and education services.
Results   Child and adolescent mental health services uptake was lower for South Asians than for White British ( P  = 0.0487). There were statistically significant differences among ethnic groups for community-based social services uptake (being the highest for the Black groups and the lowest for South Asians, P  = 0.015) and respite care uptake (being the highest for the Black and White European groups and the lowest for South Asians, P  = 0.009). In regression analysis family structure predicted CAMHS service utilisation and social service community support. Ethnicity predicted use of respite care.
Conclusions   Significant ethnic differences in service utilisation among children with ID were found for both CAMHS and social service contact. There was particularly low service use for the South Asian group. These differences might arise because of differences in family organisation, as more South Asian children lived in two-parent families, which may have been better able to provide care than single-parent families. Other factors such as variation in parental belief systems and variation in psychopathology may be relevant. Implications are discussed.     

Experiences in the United States--a difference in the status in the United States and that in Japan]

Child and adolescent psychiatry has been established as a subspecialty in the United States. The systematic education, training and research opportunities are currently available and child and adolescent psychiatry is a major part of psychiatric practice in the US. However, there are many burdens to overcome to provide adequate child mental health care. Several important focus on child mental health care in US are to 1) improve the assessment of and recognition of mental health needs in children, 2) promote scientifically-proven and evidence based interventions and 3) increase access to and coordination of quality mental health care services. To understand the current status and problems in child and adolescent psychiatry in US may help the Japanese psychiatrists to develop and establish child and adolescent psychiatry in Japan.     

Developing primary mental healthcare for children and adolescents

PURPOSE OF REVIEW: Governmental initiatives to enhance child and adolescent mental healthcare are giving renewed impetus to work in primary care. This review identifies and discusses critically new findings in this area. RECENT FINDINGS: Research reviews and new studies continue to highlight the burden of unidentified and hence untreated psychopathology among children attending primary care. Expression of parental concern appears to provide important help in improving recognition. Shared protocols have been developed for primary care use for clinical conditions such as attention deficit hyperactivity disorder, but adherence to protocols is still limited. Randomized controlled trials have shown the feasibility and efficacy of suitably adapted therapeutic interventions for adolescent depression in primary healthcare and in educational settings. Surveys indicate a significant amount of child and adolescent mental health work by social services in countries such as the UK, and attest to the usefulness of protocols to attend to children in foster care. The new role of primary mental health worker has the potential to help support the interface between primary and specialist child and adolescent mental health services. SUMMARY: There is increased interest in further clarifying and enhancing the role of primary care child and adolescent mental health services.     

Child and adolescent psychiatry in general practice.

OBJECTIVE: This review discusses the role of general practitioners and primary care health staff in the assessment, treatment and prevention of child and adolescent psychiatric disorders and to consider implications for service delivery. METHOD: Literature review. Papers were selected as having an empirical evidence base or as describing and documenting new initiatives in general practice. RESULTS: A small proportion of about 3% of children present to general practice with behavioural or emotional problems, but psychiatric disorders in the context of somatic presentations are considerably more common. They are probably higher than in the general population reflecting an increased tendency by children with disorders to consult. Recognition by general practitioners is limited and few children with disorders are referred to specialist clinics. However, referrals are mostly appropriate: the more severely affected children in difficult psychosocial circumstances. A number of pilot studies have shown the feasibility and potential usefulness of setting up shifted specialist clinics in primary care and of training primary care doctors and other staff in the recognition or management of child mental heath problems. CONCLUSION: Primary care is an appropriate resource to help increase attention to child and adolescent mental health problems. Its potential requires further development and rigorous evaluation. Areas lending themselves to development include: improved medical undergraduate teaching and postgraduate training; suitable information and advice-giving on child mental health problems by the primary care team; the development of specific child and adolescent psychiatric interventions for use in the primary care setting; careful and discriminating development of shifted outpatient clinics for selected child psychiatric disorders; the development of focused protocols for referral to specialist services; further development of mental health promotion clinics in primary care.     

Broad Outcome Measures May Underestimate Effectiveness: An Instrument Comparison Study

Background:  Outcome measures are routinely used in child and adolescent mental health services to demonstrate the effectiveness or otherwise of interventions.
Methods:  We followed up a consecutive sample from a large teaching hospital's Obsessive Compulsive Disorder (OCD) service for young people, comparing improvements using instruments of differing broadness.
Results:  The effect size of improvement decreased as the breadth of the questionnaire increased.
Conclusion:  Specialist clinics are recommended to use two questionnaires: a broad one to facilitate comparability with other clinics, and a narrow one to maximise power to detect significant changes.     

The Development,Evaluation and Dissemination of a Training Programme for General Practitioners in Evidence-Based Parent Consultation Skills

General practitioners (GPs) and family doctors are usually the first point of professional contact for parents concerned about their children's behaviour and they are often asked for advice on the management of behavioural and emotional problems. The training of GPs to provide effective early intervention is an important issue in the prevention of child and adolescent mental health problems. This paper describes the development, evaluation and subsequent wide-scale implementation of a tailored training programme to prepare GPs to provide consultative advice and support to parents of children from birth to mid-adolescence. Primary care training in the Triple P-Positive Parenting Program was provided to 331 GPs in Queensland, Australia. Participation in a brief focused training course was associated with significant improvement in practitioners' consultation skills, greater satisfaction with their consultations and high levels of participant satisfaction with the training provided. The implications of this experience for population - level approaches to prevention of child and adolescent behaviour problems are discussed.     

An Evaluation of a Primary Care-Based Child Clinical Psychology Service

Background: This paper describes a primary care-based clinical psychology service operating in an inner London borough that provides psychological intervention for children with emotional or behavioural difficulties and their families, and consultation and support to the primary health care teams.
Method: A comparison is made with a local secondary level child mental health service in terms of characteristics of referrals and clinical outcome. Referrers' perceptions of the primary care-based service are described.
Results and Conclusions: The findings demonstrate a useful child and adolescent mental health service for children and adolescents with a broad range of childhood difficulties within a primary care setting, which appears to overcome some of the problems often associated with referral to secondary level services.     

Need for Child Mental Health Consultation and Paediatricians' Perception of these Services: A Survey in the West Midlands

Background:  High rates of psychopathology have been noted in children presenting to GP surgeries and paediatricians. However, paediatricians do not always recognise this and when they do the Child and Adolescent Mental Health Service (CAMHS) is often unable to meet their consultation needs.
Method:  This postal survey looked at paediatricians' perception of the need for child psychiatry consultation in the West Midlands.
Results:  The survey confirmed that paediatricians see a significant proportion of children with mental health problems and the findings showed that their need for child psychiatry consultation was not being adequately met. Lack of access to CAMHS was a significant issue.
Conclusions:  This has implications not only for further development of consultation services within CAMHS but also for improving training in child psychiatry for paediatricians in a more formalised way.     

Mental Health of Children in Palestinian Kindergartens: Resilience and Vulnerability

Background:  Exposure to adversity does not necessarily lead to the development of psychopathology in all affected children. This study examined the factors associated with resilience and vulnerability in mental health in the Gaza Strip in 2007.
Methods:  Children selected from a random sample of kindergartens (3-6 years old, N  =   350) were assessed for growth and their mothers administered an interview including a psychometric test battery.
Results:  Factors associated with resilience were maternal rated good health, higher maternal level of education, and less child exposure to traumatic events. Factors associated with vulnerability were poor maternal mental health, and male gender.
Conclusions:  Our findings highlight the importance of maternal health and education in affecting children's mental health.     

Unmet Mental Health Service Needs Among Norwegian Children and Adolescents

Background:  The Norwegian 10 year mental health plan identifies important roles for public health nurses in the early identification, care and referral of children and adolescents with mental health problems. This study aims to identify the extent to which public health nurses are meeting these needs.
Method:  Over a 4 week period the mental health needs of 3065 children who were seen by publich health nurses were identified.
Results:  Achieving the ongoing Norwegian mental health plan may require better access to trained professionals in the public health sector, further expansion of specialised mental health services, and efforts to improve inter-agency collaboration.     

Parental Perceptions of the Assessment of Autistic Spectrum Disorders in a Tier Three Service

Background:  Little is known about the satisfaction of the parents of children receiving child and adolescent mental health services in general, and autistic spectrum services in particular.
Method:  This audit examined parent and carer perceptions of the Autistic Spectrum Disorder assessments undertaken by the multi-agency team in a Tier Three CAMHS in Manchester. Forty families completed a brief questionnaire.
Results:  The majority of parents and carers reported satisfaction with the service (95%), although responses highlighted areas in both the assessment process and the service facilities that needed improvement.
Conclusions:  Useful information with both local and national applications can be gathered quickly in an easily replicated manner.     

What Can the FOCUS E‐mail Discussion Group Tell Us About the Issues Facing CAMH Professionals?

Background:  The FOCUS e-mail discussion group was established in 1998 with the aim of facilitating information-sharing between professionals working in child and adolescent mental health services (CAMHS).
Method:  A content analysis was carried out on messages sent to the FOCUS e-mail discussion group between September 2004 and August 2005.
Results:  Discussion topics were widely distributed across twelve main themes, reflecting the breadth of issues discussed by CAMH professionals. The five most frequently discussed were: clinical cases; workforce issues; interventions; service policy; and service organisation.
Conclusion:  The findings demonstrate the usefulness of the FOCUS e-mail discussion group as a means of identifying the key issues facing CAMH professionals and consequently its potential to inform healthcare practice and policy.     

Burden and coping strategies in mothers of patients with schizophrenia in Japan

Aim:  The present study was conducted to identify factors contributing to burden of care in 57 mothers caring for patients with schizophrenia.
Methods:  Members of the Federation of Families of People with Mental Illness in Nagasaki Prefecture were evaluated using well-validated scales to evaluate burden of care (eight-item short version of the Japanese version of the Zarit Caregiver Burden Interview), general health status (General Health Questionnaire 12-item version), difficulty in life, coping strategies, emotional support, and understanding of mental illness and disorders.
Results:  Burden of care was significantly associated with general health status and difficulty in life.
Conclusion:  On multiple regression it was found that 'social interests' and 'resignation', both of which are the subscales of coping strategies, exerted significant and independent effects with respect to burden of care.