Paediatricians' attitudes to and management of functional seizures in children

Objective

To explore paediatricians' attitudes to and treatment practice for children with functional seizures (FS).

Child and Adolescent Mental Health Services in the UK: Nurse Consultants

TOPIC: Children's mental health services in the UK are transforming. Innovations in health, social welfare, education, and youth justice agencies have all got emotional literacy at their core. The changing face of children's services has called for partnerships and new ways of planning and delivering services in statutory and voluntary sectors. Alongside this, nursing is evolving and developing new ways to meet the challenges that modernization brings. Nurse consultants are children's champions who have a leading role in helping lead children's services into the 21st century. PURPOSE: The following article explores the role of nurse consultants in child and adolescent mental health services (CAMHS).     

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.     

A Home and School Support Project for Children Excluded from Primary and First Year Secondary School

Background:  In the last 10 years the problem of exclusion has reached a crisis point. Research suggests that exclusion is a complex phenomenon that needs involvement from all the involved services such as Health, Education and Social Services.
Method:  One hundred and twenty-four pupils, aged 4–12 years who, through school and social exclusion, were at risk of developing more serious mental health difficulties, were randomly allocated to standard care ( n  = 62) or standard care plus the new intervention ( n  = 62).
Results:  There were no significant differences in the primary outcomes between the two groups at either of the outcome assessments. However, the intervention group with non-compliance cases removed from the analysis did significantly better ( p  < . 014, 95%CI −12.8 to −1.4).
Conclusions:  The Home and School Support project managed to reduce the number of excluded days and the appearance of mental health symptoms for pupils who engaged fully with the intervention. The project also highlights the importance of multi-agency involvement at a very early stage.     

Parents' and Clinicians' Perception of Severity of Referral Problems

Background:  Referral meetings are commonly used in CAMH Services to allocate a priority rating that reflects urgency, and thus severity, of the referral. Whilst it is recognised that a system is needed to manage the current level of demand, the literature suggests that decisions about severity are often inaccurate.
Method:  The current study aimed to evaluate a CAMHS referral system by looking at whether the priority ratings allocated by the Multi-Disciplinary Team (MDT) accorded with the parents' and the individual clinician's perception of the severity of the child's difficulties. Data were taken from the Service's outcome database.
Results:  The results showed that priority ratings did not reflect the parents' and the individual clinician's perception of the problem. It is therefore suggested that the current system for prioritising referrals requires some reform.
Conclusion:  There is discussion of procedures that might improve the accuracy of the priority rating process, such as using scores on standardised measures as part of the decision-making process.     

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.     

CORC's Survey of Routine Outcome Monitoring and National CAMHS Dataset Developments: A Response to Johnston and Gower

Background:  The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice.
Methods:  Members were surveyed in 2004, in order to establish a baseline against which we could measure progress.
Results:  Like Johnston and Gowers, we discovered a wide range of measures were being used, while a third of CORC members were sharing information with clinicians and commissioners, and were using it to develop clinical practice or services.
Discussion:  We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.     

Eliciting Children's and Young People's Views of Child and Adolescent Mental Health Services: A Systematic Review of Best Practice

Background:  A systematic review of children's and young people's views of Child and Adolescent Mental Health Services (CAMHS) was undertaken to identify the methods used, the 'best practice' methods, and the methods most effective in leading to service changes.
Method:  Electronic databases and grey literature were systematically searched. Both authors independently quality-appraised studies using a standard framework. Of 381 studies identified, only 13 were both relevant and of sufficient quality to be included in the review. Interviews, focus groups, brainstorming exercises, and questionnaires were the methods used.
Results:  No study reported a change of practice as a result of hearing children's and young people's views.
Key Practitioner Message:  So few studies have been adequately reported in the literature that it is difficult to make recommendations about good practice for undertaking views studies in CAMHS. Practitioners should use age-appropriate and rigorous methods, report findings clearly, and check beforehand that their organisation is willing and able to implement changes suggested by the young people.     

The mental health of looked after children: matching response to need

Previous research has established high rates of mental health need in looked after children. The study described in this paper aimed to explore in more depth the mental health problems of looked after children and to examine the service response to those needs in two English local authorities. The study utilised a purposive sample of 80 looked after children which was biased towards those with high needs but which reflected the characteristics of looked after children in the two areas with regard to age, gender and type of placement. Key data on children and young people were collected from social services' case files and a set of indicators of mental health need was designed by the research team in order to distinguish different types and levels of mental health problems. High levels of mental health need in the study group were associated with placement disruption. Educational difficulties were also apparent in the group with the highest levels of mental health need. Longer-term input from child and adolescent mental health services (CAMHS) professionals did not appear to be targeted on the group with the highest level of mental health needs. The researchers conclude that longer-term CAMHS interventions could be usefully focused on looked after children who have experienced high levels of placement disruption. As the professional group most likely to be providing substantial intervention to looked after children and their carers, social workers require relevant training in identifying and responding to mental health needs. CAMHS professionals could develop and strengthen their consultative roles with front-line carers, social workers and schools.     

Training Health Professionals for Child and Adolescent Mental Health Care in Nigeria: A Qualitative Analysis

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration.