Service utilization by children with conduct disorders: findings from the 2004 Great Britain child mental health survey

Children with conduct disorders (CD) and their families are in contact with multiple agencies, but there is limited evidence on their patterns of service utilization. The aim of this study was to establish the patterns, barriers and correlates of service use by analysing the cohort of the 2004 Great Britain child mental health survey (N = 7,977). Use of social services was significantly higher by children with CD than emotional disorders (ED) in the absence of co-morbidity, while use of specialist child mental health and paediatric was significantly higher by children with hyperkinetic disorders (HD) than CD. Children who had comorbid physical disorders used more primary healthcare services compared to those without physical disorders. Utilization of specialist child mental heath and social services was significantly higher among children with unsocialized CD than socialized CD and oppositional defiant disorders. Services utilization and its correlates varied with the type of service. Overall, specialist services use was associated with co-morbidity with learning disabilities, physical and psychiatric disorders. Several correlates of services use in CD appeared non-specific, i.e. associated with use of different services indicating the possibility of indiscriminate use of different types of services. The findings led to the conclusion that there is the need for effective organization and co-ordination of services, and clear care pathways. Involvement of specialist child mental health services should be requested in the presence of mental health co-morbidity.     

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.     

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.     

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.     

Children's Voices: A Review of the Literature Pertinent to Looked-After Children's Views of Mental Health Services

Service-user involvement is an essential component of mental health service provision. This review aims to synthesise literature that has attempted to elicit children's experiences of mental health services with particular reference to looked-after children. The review is limited to qualitative research with study inclusion based on a synthesis of good quality criteria. Identification of gaps in the literature, directions for further research and implications for service developments are discussed.
Key Practitioner Message:  Relating to looked-after children and service user involvement:

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  Vulnerable children should be given equal choice and involvement in their treatment decisions and not miss out on the wider NHS drive for service user involvement.
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  Incorporating children's views will by definition require a comprehensive service creating financial and training challenges.
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  While realistic, asking looked-after children about their views requires that a number of complex issues be addressed: methodologically, reflexively and ethically.

     

Evidence‐Based Child and Adolescent Mental Health Services: Oxymoron or Brave New Dawn?

Professionals working in child and adolescent mental health services are increasingly encouraged to examine the evidence underlying their clinical practice. Embracing evidence-based practice can present difficulties, as barriers to changing practice exist. These difficulties are examined, along with the meaning of evidence-based practice in a multidisciplinary speciality, and the potential benefits that develop from it.     

Capacity of Tier 2/3 CAMHS and Service Specification: A Model to Enable Evidence Based Service Development

This paper proposes a model to analyse the 'needs' of any given CAMHS tier 2/3 service catchment area and establish the service capacity/workforce required to deliver 'evidence based practice' that is in keeping with good clinical governance. The key point is that in order to provide 'evidence based' practice and keep within good guidance, we need 'Evidence Based Service Development'. This includes appropriate corporate governance linked to evidence based data to ensure effective commissioning of services based on the evidence of 'what works for whom'.