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.     

Parental Problem Recognition and Child Mental Health Service Use

This study estimates the prevalence and correlates of two components of problem recognition among parents and assesses their relative effects on child mental health service use in several settings. Analyses were based on data from a population-based sample of 1,420 youth-parent pairs. Child psychopathology and impairment were assessed using the Child and Adolescent Psychiatric Assessment. Problem perception was defined as reporting one or more problems or needs; family impact as reporting one or more impacts. Recent use of 30+ types of mental health services was examined. The frequency of problem perception was 13.3% and family impacts 11.2% across all observations. Among parents of children with 1+ DSM-IV psychiatric diagnosis, 39.0% perceived problems and 31.7% perceived impacts. The strongest predictor of problem perception was impact and vice versa. Problem perception (and not impact) was predictive of specialty services after controlling for child illness. Neither problem recognition component predicted general medical or school use. Findings suggest the need for parent education to help them identify serious problems and for universal screening to ensure that access to specialty services is not dependent solely on parents. Problem recognition should be expanded to include perceptions of other adults in models of access mental health care.     

Perceived Need and Use of Child Mental Health Services in Korea

This study examined the degree of perceived need and use of child mental health services in Korea, as well as the factors associated therewith. The sample consisted of 3,477 children aged 8–13 years. Overall, 10.4% of the parents demonstrated a perceived need for mental health services regarding their children’s emotional or behavioral problems, while 1.9% used mental health services. Although the perceived need for mental health services is high, only a small proportion of children receive them. Whether a child receives mental health care is influenced by the child’s psychopathology, especially when social and/or thought problems exist.     

Selecting Measures for Use in Child Mental Health Services: A Scorecard Approach

The implementation of evidence-based treatments in mental health services requires reliable and valid measurements to guide treatment. This study evaluated the efficiency of three caretaker-report measures of child psychiatric disorders. Data from 211 caregivers were used to assess the CBCL, the OHIO, and the SDQ. A scorecard methodology was implemented to determine the efficiency of each scale as compared to the DISC-IV. Across measures, the OHIO was optimal for assessing services need while the CBCL and SDQ provided better disorder-specific assessment. Results may improve clinical practice by providing an empirical approach to the selection of assessment tools.     

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.     

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.     

Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

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.     

Child Characteristics Influencing Referral to Mental Health Services

This study explored whether certain child characteristics (age, type of problem presented, and gender) influenced the referral decisions of parents, general practitioners, and child psychologists. These three groups were taken as key gatekeepers in controlling access to mental health services. Results suggested that age of child and type of problem significantly affected the subject's responses whilst sex of child did not. Psychologically disturbed 10-year olds may be more likely to reach mental health services than psychologically disturbed 3-year olds, and children who showed their disturbance in terms of conduct disorder may be more likely to arouse concern than those who present with emotional disturbance.     

Service Contacts Among the Children Participating in the British Child and Adolescent Mental Health Surveys

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups.
Results:  Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services.
Conclusions:  British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.     

Child Mental Health Services in the United Arab Emirates

This paper is an account of child mental health services in a country that has undergone very rapid socioeconomic growth and change. Despite the economic wealth and the availability of funding, there are problems with human resources. Patterns of morbidity are similar to Western cultures, but attitudes to child mental health in the community are different. Such difficulties necessitate taking different approaches in service delivery. Child psychiatrists have to assume a variety of roles and working through the family seems to be surprisingly feasible and acceptable.     

Mental Health and Substance Abuse Services Preferences among American Indian People of the Northern Midwest

This study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.Melissa L. Walls, Kurt D. Johnson, Les B. Whitbeck, Dan R. Hoyt are affiliated with the Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE 68588-0324, USA; e-mail: mwalls@unlserve.unl.edu.This research was funded by the National Institute on Drug Abuse (DA13580) and the National Institute of Mental Health (MH67281), Les B. Whitbeck, Principal Investigator.     

Methodological Challenges in Assessing Children's Mental Health Services Utilization

This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4–17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11–17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.     

Assessing the Strengths of Children Referred for Community-Based Mental Health Services

This study investigated the relationship between child strengths and functional impairment, specifically whether youth with greater levels of functional impairment also exhibit strengths. The relationship was investigated for children (N = 1,838) of different genders, ages, race, and ethnic backgrounds and whose families were living at different income levels. A moderate relationship was found between child strengths and functional impairment. Those children with even the most severe functional impairment were rated as having average or near average strengths. With the exception of gender, the relationship between impairment and strengths did not differ as a function of demographic characteristics. These findings provide additional support for the construct validity of the Behavioral and Emotional Strengths Rating Scale (M. Epstein & J. Sharma, 1998) and they highlight the need for strength-based assessment and screening for youth entering mental health services. Child strengths as the foundation for service planning and implementation, and other implications are discussed.     

Public Mental Health Care Utilization by Older Adults

The present study examined the extent to which older adults began public mental health treatment throughout Texas in 1999, the types of services they used, and how they compared on demographic and clinical variables to younger consumers. Notwithstanding recent policy and related developments, older adults were found to use public mental health services at substantially low rates, as in past decades. Significantly, older consumers tended to be relatively healthy and independent. Among younger and, even more so, older consumers, there were relatively high proportions of rural residents and minorities, groups previously found to be unlikely to utilize private mental health services. Overall, the findings urge that greater attention be devoted to public mental health outreach and service delivery with the elderly, and raise the question of what role the public mental health system should have in nursing homes and other long-term care settings.     

Ethnicity and Use of a Child and Adolescent Mental Health Service

This study investigated possible associations between ethnic background of referred children and non-attendance, referrer type, problem type, age and gender. The sample consisted of 769 children offered outpatient appointments. Ethnic background influenced referrer type. Over-referrals against expectations were: White children more by GPs than expected, Black and South Asian children by specialist doctors, Black children by education services and Mixed Race children by social services. There was neither a significant difference in ethnic background between attendees and non-attendees nor were gender, age or problem types related to ethnic group. Clinicians should be aware that referral routes may appropriately, or inappropriately, be different for different ethnic groups. Differences found may be due to genuine variations in morbidity, thus leading to presentation to different referrers.     

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.