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Team formulation refers to the 'process of facilitating a group of professionals to construct a shared understanding of a service user's difficulties' (Johnstone & Dallos, 2013, p. 5). This project was conducted at a specialist inpatient CAMHS service for young people under the age of 13 to understand staff views on the usefulness of team formulation and how it could be further developed. The project also assessed the service's involvement of young people and their parents/carers in formulations following NHS England's service specification for tier four CAMHS. The study used a sequential mixed methods design. Quantitative data was collected with a questionnaire and analysed, and then qualitative data was collected through focus groups and analysed using reflective thematic analysis. The results were then integrated through triangulation. A high proportion of the staff team took part in the project. Team formulation was reported as generally helpful by staff, especially in developing a shared team understanding and gathering all the information about a young person in one place. Further, staff reported feeling passionate about team formulation, and that it positively impacted their practice. Staff reported difficulties regarding the meeting dynamics and feeling that it is important to involve young people and families in formulations in a different way. The results of this project have inspired discussions about how team formulation is used in the service. [ABSTRACT FROM AUTHOR]

Purpose: Emotional and behavioral problems in children and young people (CYP) have increased over the pandemic. Those with pre-existing mental disorders are more vulnerable but have been understudied. We investigated emotional and behavioral outcomes in this population; differences across diagnostic groups; and social, educational, and clinical determinants. Methods: We invited 5386 caregivers and CYP (aged 5–17) under child mental health services pre-pandemic to complete an online survey on CYP's emotional/behavioral symptoms and pandemic-related circumstances, and integrated responses with clinicodemographic information extracted from electronic health records. We compared four parent-rated outcomes (total emotional/behavioral scores and emotional/behavioral changes as compared to before the pandemic) across the three most common diagnostic groups in our population (Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and emotional disorders (EmD)). We then estimated the association of clinicodemographic and pandemic-related characteristics with emotional/behavioral outcomes. Results: A total of 1741 parents (32.3%) completed the survey. Parents of CYP with ADHD or ASD reported more behavioral difficulties (t(591) = 5.618 (0.001); t(663) = 6.527 (0.001)); greater emotional deterioration (t(591) = 2.592 (0.009); t(664) = 4.670 (< 0.001); and greater behavioral deterioration (t(594) = 4.529 (< 0.001); t(664) = 5.082 (< 0.001)) as compared to the EmD group. Those with ASD and EmD showed more emotional difficulties than ADHD (t(891) = − 4.431 (< 0.001); t(590) = − 3.254 (0.001)). Across diagnoses, poor parental mental health and challenges with education were most strongly associated with worse outcomes. Conclusions: Within our clinical population, CYP with ADHD/ASD were the most adversely affected during lockdown. Enhancing clinical service provision that tackles parental stress and supports education may help mitigate the impact of future restrictions. [ABSTRACT FROM AUTHOR]

Background: Social prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve mental health and wellbeing in adult populations. In the last few years, it has been used in child and youth settings with promising results. Currently, pathways are being developed for social prescribing in Child and Adolescent Mental Health Services (CAMHS) to support children and young people on treatment waiting lists. The Wellbeing While Waiting study will evaluate whether social prescribing benefits the mental health and wellbeing of children and young people. Methods: This study utilises an observational, hybrid type II implementation-effectiveness design. Up to ten CAMHS who are developing social prescribing pathways as part of a programme run across England with support from the Social Prescribing Youth Network will participate. Outcomes for children and young people receiving social prescribing whilst on CAMHS waiting lists will be compared to a control group recruited prior to the pathway roll-out. Questionnaire data will be collected at baseline, 3 months and 6 months. Primary outcomes for children and young people are mental health symptoms (including anxiety, depression, stress, emotional and behavioural difficulties). Secondary outcomes include: loneliness, resilience, happiness, whether life is worthwhile, life satisfaction, and service use. An implementation strand using questionnaires and interviews will explore the acceptability, feasibility, and suitability of the pathway, potential mechanisms of action and their moderating effects on the outcomes of interest, as well as the perceived impact of social prescribing. Questionnaire data will be analysed mainly using difference-in-differences or controlled interrupted time series analysis. Interview data will be analysed using reflexive thematic analysis. Discussion: The Wellbeing While Waiting study will provide the first rigorous evidence of the impact of social prescribing for children and young people on waiting lists for mental health treatment. Findings will help inform the prioritisation, commissioning, and running of social prescribing in other CAMHS. To maximise impact, findings will be available on the study website (https://sbbresearch.org) and disseminated via national and international networks. Trial Registration: N/A. [ABSTRACT FROM AUTHOR]

The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the 'THRIVE' needs-based principles of care. The implementation protocol in which this model, 'i-THRIVE' (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young people's mental health, a cohort study design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 'comparator sites' that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young people's mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive. [ABSTRACT FROM AUTHOR]

Parent/carer involvement in their child's support for mental health difficulties is a critical component of effective care. 13 Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) across England were developed to provide specialist support to young people at high risk of harm to self and in particular others, and their families. The aim of this study is to explore parent/carer experiences of Community F:CAMHS. Thematic analysis of interviews (N = 18, from 5 sites) was conducted. Superordinate themes generated focused on 1) facilitators; and 2) barriers to support. Subthemes generated relate primarily to facilitators, particularly empowering parents/carers through the co-production of strategies to help, "holding" cases (taking ownership), and acting on behalf of and supporting parents/carers. Managing clear, joined-up communication across multi-agencies is also of key importance. Barriers to effective support are a lack of joined-up communication at the beginning of the implementation of the services, awareness of Community F:CAMHS, and limited contact. Implications, including the need to further embed the Community F:CAMHS offering in the overall provision of support for this population are discussed. Areas for future research are identified, including the exploration of how young people's characteristics and outcomes may impact parents/carers' experiences of interacting with services. [ABSTRACT FROM AUTHOR]

Background: Eating disorders are among the most serious mental health problems affecting children and young people and without appropriate treatment often have a protracted course with high levels of morbidity and mortality. While considerable progress has been made in recent years in developing effective evidence-based outpatient treatments, these are not always readily available. In England, until recently, the usual care pathway for young people with an eating disorder was referral from primary care to local generic Child and Adolescent Mental Health Services with varying levels of expertise in eating disorders and a mix of outpatient treatments available. Poor treatment progress or physical deterioration would usually result in inpatient admission. Admission rates were high, with children and young people with an eating disorder accounting for nearly a quarter of all child and adolescent psychiatric hospital admissions. Inpatient treatment is costly and has high relapse rates with some evidence that it may contribute to poorer long-term outcomes in eating disorders. Accumulating clinical and research evidence that early expert outpatient treatment can significantly reduce the need for inpatient care indicates,+ that investing in dedicated community-based eating disorders services is likely to be both clinically and economically beneficial. Overview of paper: This paper describes a large-scale transformation programme following a major government investment (initially £30 million/year, since then increased to over £50 million/year) aimed at service level change in the provision of eating disorder services for children and adolescents in England. We describe the history, background, political context, and clinical and research evidence that contributed to the government's decision to invest in eating disorders. We also provide a brief account of the implementation of an England-wide whole team training to support the creation of a network of over 70 dedicated community-based eating disorders services for children and young people. Plain English summary: Eating disorders are among the most serious mental health problems affecting children and young people. There has been accumulating clinical and research evidence that early expert outpatient treatment is effective and can also significantly reduce the need for costly inpatient care, indicating that investing in community-based eating disorder services is likely to be both clinically and economically beneficial. This paper describes a large-scale service transformation programme following a major government investment (initially £30 million/year, since then increased to over £50 million/year) aimed at service level change in the provision of eating disorder services for children and adolescents in England. We describe the history, background, political context, and clinical and research evidence that contributed to the government's decision to invest in new services for eating disorders. We also provide a brief account of the implementation of an England-wide whole team training to support the creation of a network of over 70 dedicated community eating disorders services for children and young people. [ABSTRACT FROM AUTHOR]

Background: Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic. Aims: To examine the utilization and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the pandemic. Method: Cross-sectional survey (OxWell) of 10,560 secondary school students aged 12-18 years in the south of England. Information on self-harm, support(s) accessed after self-harm, and satisfaction with support received were obtained via a structured, self-report questionnaire. No tests for significance were conducted. Results: 1,457 (12.5%) students reported having ever self-harmed and 789 (6.7%) reported self-harming during the first national lockdown. Informal sources of support were accessed by the greatest proportion of respondents (friends: 35.9%; parents: 25.0%). Formal sources of support were accessed by considerably fewer respondents (Child and Adolescent Mental Health Services: 12.1%; psychologist/psychiatrist: 10.2%; general practitioner: 7.4%). Online support was accessed by 8.6% of respondents, and 38.3% reported accessing no support at all. Informal sources of support were rated as most helpful, followed by formal sources, and online support. Of the respondents who sought no support, 11.3% reported this as being helpful. Conclusions: More than a third of secondary school students in this sample did not seek any help following self-harm. The majority of those not seeking help did not find this to be a helpful way of coping. Further work needs to determine effective ways of overcoming barriers to help-seeking among adolescents who self-harm and improving perceived helpfulness of the supports accessed. [ABSTRACT FROM AUTHOR]

Background and Objective: Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties. Methods: Secondary analysis was conducted on administrative data collected from CAMHS between 2011 and 2015. The sample was composed of 3,175 cases across 58 sites in England. Frequencies were recorded and associations were explored between clinician-reported measures and parent/carer-reported experiences of SDM using a two-level mixed-effect logistic regression analytic approach. Results: Almost 70% of parents/carers reported experiencing higher levels of SDM. Individual-level variables in model one revealed statistically significant (p <0.05) associations suggesting Asian parents/carers (OR = 1.95, 95% CI [1.4, 2.73]) and parents/carers having children with learning difficulties (OR = 1.45, 95% CI [1.06, 1.97]) were more likely to report higher levels of SDM. However, having two parents/carers involved in the child's care and treatment decisions (OR = 0.3, 95% CI [0.21, 0.44]) and being a parent/carer of a child or young person experiencing conduct problems (OR = 0.78, 95% CI [0.63, 0.98]) were associated with lower levels of SDM. When adjusting for service level data (model two) the presence of conduct problems was the only variable found to be significant and predicted lower levels of SDM (OR = 0.29, 95% CI [0.52, 0.58]). Conclusion: Multilevel modelling of CAMHS administrative data may help identify potential influencing factors to SDM. The current findings may inform useful models to better predict and support SDM. [ABSTRACT FROM AUTHOR]

Background: Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This 'transformation' variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations. Methods: A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised. Outcomes: Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20). Interpretation: Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation. [ABSTRACT FROM AUTHOR]

Anxiety and depression affect a significant number of children and young people (CYP) and can have a far reaching and long-lasting impact. Cognitive behavioural (CB) interventions can be effective for treating anxiety and depression in CYP but are difficult to access. Recent government policy in England seeks to train a non-traditional graduate workforce to deliver a range of CB interventions for mild to moderate anxiety and depression to CYP, in community settings. This practice-based evaluation aimed to estimate the effectiveness of CB interventions delivered by postgraduate trainees undertaking training in a range of CB interventions for mild to moderate anxiety and depression whilst on placement in schools or community Child and Adolescent Mental Health Services (CAMHS). Self- and parent-reported routine outcome measures (ROMS) were completed pre- and post-intervention, including measures of symptom severity, symptom impact and goal achievement. Significant improvements were demonstrated across all self and parent-reported measures post-intervention, with mean scores falling firmly in the non-clinical range, a significant reduction in the proportion of CYP in the clinical range on measures, and predominantly medium to large effect sizes. Results are promising in terms of the capacity to train a graduate workforce to deliver a range of low-intensity CB interventions to CYP experiencing mild to moderate depression or anxiety-based difficulties in either CAMHS or school settings, increasing capacity across the system. The current practice-based evaluation also supports the potential effectiveness of current training models/programmes. Further research is needed in terms of long-term outcomes and to compare outcomes between settings, interventions, and demographic groups. Key learning aims: (1) To understand the potential prevalence rates of mental health difficulties in children and young people in England, and their wider impact. (2) Critical awareness of the evidence base for cognitive and behavioural interventions for depression and anxiety in children and young people. (3) Awareness of gaps in access to evidence-based psychological interventions for children and young people in England. (4) Knowledge of emerging graduate-level low-intensity psychological practitioner roles in England. (5) Awareness of the emerging evidence base for the estimated effectiveness of low-intensity cognitive and behavioural interventions delivered to children and young people by graduate-level practitioners in schools and community mental health settings. [ABSTRACT FROM AUTHOR]

Background: In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England.Methods: We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week's users was collected.Results: A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas.Conclusions: The introduction of a SPA has the potential to improve young people's access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations. [ABSTRACT FROM AUTHOR]

The impact of compassion fatigue (CF) on frontline professionals has been widely researched. However, interpreters often work alongside frontline professionals and are exposed to similar traumatic experiences. Despite this, there is a dearth of research exploring the impact of CF on interpreters. Mental health sign language interpreters (SLIs) are believed to be at a higher risk of developing CF compared to other professionals due to high engagement with therapeutic content, demands of their role, and low perception of control over those demands. Research demonstrates that working with children increases one's risk of developing CF further. Nevertheless, there has been no known research investigating the impact of CF on mental health SLIs working with children. This qualitative study aimed to explore this impact and the factors that may prevent CF from developing. In-depth semi-structured interviews were conducted with seven mental health SLIs working with children in mental health services in England between March and May 2018. An inductive thematic analysis highlighted five themes: 1) emotional challenges of the job, 2) ruminating on patient's emotions and experiences, 3) consequences of interpreting dilemmas, 4) becoming used to interpreting emotional sessions, and 5) benefits of obtaining support. Findings urge organizations involved in the development of interpreting guidelines, interpreter training, and those that require interpreting services, to consider the implications of CF and measures that can be taken to prevent it. [ABSTRACT FROM AUTHOR]

Background: Prior to commencing a randomised controlled trial, we conducted a focused ethnography to ensure that the trial was well suited to the proposed setting.Methods: A six-month observation of a Child and Adolescent Mental Health Service site in the North-East of England was undertaken to observe the site procedures, staff culture and patient care pathways. During this period, documentary data were collected and interviews were conducted with key informants to provide insight into staff perceptions of the proposed trial. The data were coded using thematic analysis and the resulting themes were verified by a second coder.Results: Seventeen documents were collected, 158 h of observation and six formal staff interviews were undertaken. Four themes emerged from the data; non-clinically orientated variation in practice, diagnosis, capacity and staff economy. Non-clinically orientated variation in practice occurred when staff decisions were based upon resource availability rather than on clinical judgement. Diagnosis demonstrated differing staff confidence in making diagnoses and in the treatment of patients who had received a diagnosis. Capacity consisted of the time to attend training and the psychological capacity to consider or incorporate learning into practice. Staff economy was characterised by staff changes and shortages. There was significant interaction between the themes, with staff economy emerging as a central barrier to research. The results directly informed adaptations to the trial protocol.Conclusions: An ethnographic approach has provided important insights into the individual, practical and organisational boundaries into which a trial would need to be implemented. [ABSTRACT FROM AUTHOR]

Objectives There is a need to develop a payment system for services for children with mental health problems that allows more targeted commissioning based on fairness and need. This is currently constrained by lack of clinical consensus on the best way forward, wide variation in practice, and lack of data about activity and outcomes. In the context of a national initiative in England our aim was to develop a basis for an improved payment system. Methods Three inter-related studies: a qualitative consultation with child and adolescent mental health services (CAMHS) stakeholders on what the key principles for establishing a payment system should be, via online survey (n = 180) and two participatory workshops (n = 91); review of relevant national clinical guidelines (n = 15); and a quantitative study of the relationship between disorders and resource use (n = 1774 children from 23 teams). Results CAMHS stakeholders stressed the need for a broader definition of need than only diagnosis, including the measurement of indirect service activities and appropriate outcome measurement. National clinical guidance suggested key aspects of best practice for care packages but did not include consideration of contextual factors such as complexity. Modelling data on cases found that problem type and degree of impairment independently predicted resource use, alongside evidence for substantial service variation in the allocation of resources for similar problems. Conclusions A framework for an episode-based payment system for CAMHS should include consideration of: complexity and indirect service activities; evidence-based care packages; different needs in terms of impairment and symptoms; and outcome measurement as a core component. [ABSTRACT FROM AUTHOR]

Purpose - The aim of this paper is to report the process, findings and implications of a three-year evaluation of integrated health centres (IHCs) established in three secondary schools in Cornwall by the School-Based Integrated Health Centres (SBIHC) partnership. Design/methodology/approach - When the partners had completed the capital works, an evaluation strategy was designed for 2009-2012 to identify the extent to which each of the IHCs was meeting the aims set for the IHCs, and each IHC and school was contributing to the aims of the SBIHC project. Formative and summative evaluation used annual case studies to apply data progressively regarding: the use, users and operations of each IHC; students' perceptions of the user-friendliness of the IHCs; indicators of the general health and well-being of students and their sexual and mental health; students' exposure to crime, substance abuse and poverty; and students' academic achievement, attendances and exclusions. This process culminated in this paper which reports and discusses findings, suggests implications for practice, theory and research and proposes future directions for the partnership. Findings - All three schools engaged students closely in the design and decoration of their IHCs. Student ownership was extended into the selection of Coordinators and into centre management and governance. Budehaven Community School appointed a National Health Service (NHS)-trained Coordinator for their IHC, The Haven, a mental health worker funded for one year by the NHS. After 2009-2010, his responsibilities were shared by the NHS-trained Receptionist and the Manager, an Assistant Headteacher. During Year 3, Budehaven added a "colocation" building, Kevren. About 37 professionals are now located in or visit The Haven and Kevren. Student footfall doubled to about 4,000 in the second year and increased by another 25 per cent in the third year. The wide range of general, mental and sexual health services were highly valued by the students. The Crayon, the IHC in Hayle Community School, achieved a similar footfall over three years. It started with a Receptionist and the Pupil Welfare Officer. The Manager, a Deputy Headteacher, and the Headteacher moving most student support services into the IHC at the end of Year 1. From then on the Crayon had three full-time professionals. By the end of Year 3, the Crayon had reached the limits of its facilities. A solely positive association was found between IHC usage and measured improvements to mental health and academic progress. The IHC in Penair School, Bywva, developed a wide range of general, sexual and mental health services, attracted a similarly strong footfall, and also reached capacity in Year 3. Penair refined their IHC's line management by an Assistant Headteacher and coordination by a Lead. Originality/value - This paper offers a new conceptual model of the SBIHC model of health care centred on the reciprocity and integrity of relationships between students and professionals. [ABSTRACT FROM AUTHOR]

The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers’ awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working. [ABSTRACT FROM PUBLISHER]

For health policies to be effective in practice, they need to be communicated and translated at strategic and operational levels and to be integrated into clinical practice. There is little empirical evidence to understand whether this happens and, if it does, whether it does so effectively. In the present study the views of professional healthcare staff from one service field (child mental health) are explored in order to ascertain their views on the translation of policy into practice through thematic analysis. Key themes of limited awareness, lack of strategic policies and problems in linking evidence carry implications for the development and strategies of policies. The interviews demonstrate that there is limited evidence that policies are being communicated as effectively as they could be, and we make recommendations on how these could be translated and implemented more effectively in the future. [ABSTRACT FROM AUTHOR]

Objective: This qualitative study explores the experiences of stakeholders in implementing the guidance for early-intervention services (EIS) for firstepisode psychosis in England. One important challenge in implementing early-intervention policy is to develop workable, integrated partnership across a number of diverse organizational boundaries, particularly with child and adolescent mental health services (CAMHS). Methods: A series of 142 semistructured interviews and six focus groups involving 31 people were undertaken between February 2004 and September 2007. A broad range of individuals were interviewed from different strategic, managerial, and operational levels of the health service. Results: A main finding was the challenge experienced by a majority of EIS agencies in developing partnerships with CAMHS. Elements that led to more successful partnership development included joint learning and training, senior-level "champions" of the partnership, joint operational policy or protocol development, and use of specffic CAMHS-EIS link workers. The most successful approach was to develop a separate youth-focused service that placed multiple teams and organizations responsive to younger people's needs (including education, employment guidance, social activities, pregnancy services, and peer support) under one roof. Conclusions: This study highlights that traditional hierarchical models of policy implementation may be less successful in achieving the goal of collaborative partnerships at the interface between CAMHS and ElS. The most successful model of working between CAMHS and EIS required an innovative approach to commissioning, policy implementation, and service development. The findings from this study may help determine the best model of partnership development for EIS and CAMHS in England. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This audit aimed to open and improve communication between health visitors in Kirklees and the primary mental health workers in the child and adolescent mental health services at Calderdale and Huddersfield NHS Foundation Trust. This was deemed to be important for the establishment of best working practices and the need for multidisciplinary, multi-agency collaboration in the interests and wellbeing of the children, young people and families who use this service. It was hoped the audit would establish health visitors' knowledge of the local primary mental health worker service so that its effectiveness and relevance could be determined. In essence, the audit was intended to find out if the service provided what the service users needed and wanted. The audit demonstrated that about half of the health visitors were satisfied with the service provided and believed that their concerns or queries were dealt with appropriately. Two thirds of respondents, however, believed that they had insufficient knowledge about the role of the primary mental health worker. [ABSTRACT FROM AUTHOR]

Infancy is a crucial time for interventions to reduce later developmental difficulties. In England, recent policy has required children's service delivery to be redesigned to attend to infant mental health across all four tiers of NHS provision through interagency networks of child-care professionals. The policy identifies child-care social workers as primary care professionals, able to recognize early infant mental health problems, promote mental health and prevent deterioration. Our paper explores whether, as a profession, English child-care social workers are well prepared in terms of their knowledge, ideological beliefs and professional acculturation to implement such changes to their practice. Empirical information is provided from a funded, independent evaluation of the implementation of the NSF policy at a local level. Data from professional focus group interviews describe and compare the differing professional ideologies and professional practice preferences within the infant mental health network of an English NHS Primary Care Trust in an urban local authority. The findings identified obstacles that were personal-ideological, cultural and structural in nature. Progress towards achieving the NSF policy standards appeared slight. [ABSTRACT FROM AUTHOR]

The article examines the interwar child psychiatry at Maudsley Hospital in London, England. In this paper, the expansion of the hospital's children's department is explored, in relation to novel behaviourist hypotheses and forging of formal links with local government and charitable bodies. It is noted that this development would structure the theoretical origins of child psychiatry.

Panos Vostanis, Guv Bassi, Howard Meltzer, Tamsin Ford and Robert Goodman examine data from the England survey on the use of services by looked after children with behavioural problems (or conduct disorders -- CD). Of the total 1,039 looked after children who participated, 384 (37%) fulfilled criteria for CD, of whom 57 (or 17% of children with CD) had an additional hyperkinetic and 46 (or 12% of the CD group) an additional emotional disorder. Children had high rates of multiple and overlapping contacts with social care, health, education and youth justice services. Children with additional emotional and hyperkinetic disorders had particularly high rates of contact with primary care, specialist child and adolescent mental health services (CAMHS), child health and special educational services. In conclusion, looked after children and young people with behavioural problems are likely to require access to a range of services, but these should be clearly defined and co-ordinated, with local care pathways and referral criteria, in order to maximise the use of resources. Although CAMHS involvement should not automatically be requested for all behavioural problems, looked after children with underlying mental health or developmental disorders would particularly benefit from specialist CAMHS input. [ABSTRACT FROM AUTHOR]

This paper describes and discusses the evaluation of an innovative child and adolescent mental health project located in a large county in eastern England. The project was one of eight located in the voluntary sector and supported by the Mental Health Foundation as part of a national initiative aimed at responding in new, accessible ways to young people requiring help for emotional and mental health problems. Traditional specialist CAMH services are overwhelmed by demand while also failing to engage many young people. This study provides evidence of how new services can develop to meet the needs of troubled young people in appropriate and acceptable ways. [ABSTRACT FROM AUTHOR]

This article will provide an overview of the national child and adolescent mental health service (CAMHS) workforce planning programme 2006-7, which used early implementer sites in each of the eight English regions to produce a specialist CAMHS workforce plan and explores the potential transferable learning from the CAMHS experience to workforce planning across a range of other settings. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the national child and adolescent mental health service (CAMHS) mapping exercise, the workforce data reported in the mapping between 2003 and 2006, and how this data relates to current policy. The paper will first outline key issues within current CAMHS workforce policy and provide an introduction to the mapping process itself in order to establish the context in which the findings from the mapping exercises are being presented. The mapping is carried out by Durham University on behalf of the Department of Health. Core trend data is provided on the growth and development of the specialist CAMHS. [ABSTRACT FROM AUTHOR]

We are now more aware of the mental health needs of children and young people with learning disabilities, but are we really aware of the range of services and support needed for this group? Until very recently, most child and adolescent mental health services (CAMHS) were not meeting these needs, yet by the end of 2006 CAMHS were required to be fully comprehensive and to include care pathways for children and young people with learning disabilities and mental health problems under the Public Service Agreement Targets (PSA). The Foundation for People with Learning Disabilities has undertaken a great deal of work in this area, including a year-long inquiry and a research programme, and now we are working with three regions in England to make CAMHS more accessible for this group of children and young people. In this article we describe how services have traditionally served this group, explore the policy context for change and discuss some of the projects currently under way that aim to address the PSA target for later this year. [ABSTRACT FROM AUTHOR]

Background: Atypical antipsychotics could be replacing traditional antipsychotics in the treatment of childhood disorders. Method: A postal survey was conducted of Child Psychiatrists in a region of the United Kingdom to evaluate their use of atypical antipsychotics for psychotic and non-psychotic conditions. Results: 97% of respondents reported prescribing atypical antipsychotics and at least 65% did so for non-psychotic indications although several concerns were raised. Differences in prescribing and monitoring practices between Community and Specialist services were noted. Conclusions: Atypical antipsychotics appear to play a significant role in current child psychiatry practice. Further discussions and research needs to occur about their use and guidelines produced. [ABSTRACT FROM AUTHOR]

In England, the demand for, and access to Child and Adolescent Mental Health Services (CAMHS) have led to endemic and intractable problems: long waiting lists, non-attendance and complaints of inaccessibility from both users and referrers. The dilemma facing CAMHS is how best to respond to rising demand without compromising the quality of specialist secondary care services. As a pilot, we developed an alternative model of service delivery that provided a brief (2+1) consultation. We also created a manual as a guide to this process. This was evaluated with 50 families, who were seen within four weeks of their returned questionnaire. Strengths and Difficulties Questionnaire (SDQ) scores showed that 72% of families improved and 95% of parents were satisfied with the service they received. This approach is brief and empowering, and is sufficient to produce change. Implications for services using this approach would include: (i) informing referrers of the alternative model, (ii) training requirements, (iii) increasing the number of mental health workers so that secondary care services are able to function effectively, and (iv) allowing more specialist services to deal with the more severely disturbed cases. [ABSTRACT FROM AUTHOR]

In this classic study, Bowlby reports on 88 children seen in the London Child Guidance Clinic during the 1930s. Half of them were referred for stealing, and half for other problems. Bowiby distinguishes several factors which may lead to maladjustment, but was particularly concerned with the hypothesis that prolonged separation of the child from the mother in the early years was a causative factor in delinquent character formation. Such separation, thought Bowlby, was especially instrumental in the development of an 'Affectionless Character' often seen in the persistent offender. Development of this indifferent, or dismissive pattern of attachment protected these children from forming close, personal relationships, hence eliminating 'any risk of allowing our hearts to be broken again.' His first empirical study, Bowlby's comprehensive and detailed analysis of the 44 thieves ushered in his revolutionary human attachment theory and foretells the enormous contribution of his subsequent career. [ABSTRACT FROM AUTHOR]

Discusses early studies on the short-term outcome of psychoanalytic treatment for children conducted at the Anna Freud Centre in London, England. Outcomes of child psychoanalytic therapy; Study exploring the relationship between metabolic control and the process of psychoanalysis in a single case of a diabetic adolescent girl; Comparison of two equivalent groups of diabetic children with grossly abnormal blood glucose profiles.

This article describes a school-based mental health service established to help psychologically distressed refugee pupils. The primary school involved was situated in an inner London borough and had a high proportion of refugee and immigrant children. Teachers identified refugee pupils with psychological difficulties and referred them to an outreach mental health worker who provided treatment on the school site. In addition to clinical interview the strengths and difficulties questionnaire was used as an assessment and outcome measure. In total 14 children (12 boys) were referred to the project. The children had been exposed to high levels of past violence and losses, and experienced ongoing socio-economic adversity. The children mostly had disorders related to these adversities, but a small number also appeared to have specific learning or scholastic difficulties. The difficulties mostly presented in the class as inattention and over-activity. A range of psychological and family interventions were offered, which included seeing the teachers initially, the children alone and relatives. Overall children were helped by the intervention with a reduction in SDQ scores (21.3 to 15.7) and some children showed dramatic benefit. This model seemed acceptable to the children, families and school. The implications of the project are discussed. [ABSTRACT FROM AUTHOR]

Presents information on a study which investigated the psychopathology, social impairment, adversities and service utilization of refugee families and their children seeking help at a child and adolescent psychiatry clinic in London, England. Sources of stress; Information on refugee utilization of psychiatric services; Methodology; Results and discussion.

This paper describes the development of a new assessment service in Southampton for children with autism and related disorders. The evolution of the service is described and the multidisciplinary assessment process is outlined. The response of families to the service is evaluated and the current status of the service is examined critically. The importance of forging good working links with other local services for children is emphasised. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of the first 81 cases seen in the recently established assessment service for children with autism and related disorders in Southampton. The children presenting for assessment are described in terms of a number of biographical, educational, behavioural, and medical features and the characteristics of our sample are compared with published findings. The future development of the service is considered in the light of current developments and common features and concerns of the families seen. [ABSTRACT FROM AUTHOR]

Asian and non-Asian referrals to the department of child psychiatry at the London Hospital in 1987 were analysed. Asian referrals were under-represented with respect to the local population but, contrary to our expectations, there were no significant differences between the groups with regard to demographic data, the nature of the presenting problem, and attrition rates. [ABSTRACT FROM AUTHOR]

The development of services in child and adolescent psychiatry in England and Wales, from their early beginnings in the 1920s to the 1970s, have been described in this article. These services, which have included local authority based Child Guidance Clinics, hospital out-patient and in-patient units and other settings for the practice of child and adolescent psychiatry, have become increasingly complex. The continuing shortage of psychiatrists adequately to man these expanding services has been pointed out, in spite of the increase in numbers that have taken place.

The article focuses on occupation and industry centers which aim to train high grade ineducable children to suitable employment. The centers train and prepare children to the routine of a small factory. In Leeds, England, all children attending occupational centers are placed under the supervision of a Mental Health Worker.

Background: There is consensus that health services commissioning and clinical practice should be driven by scientific evidence. However, workload pressures, accessibility of peer reviewed publications and skills to find, appraise, and synthesise relevant evidence are often cited as barriers to uptake of research evidence by practitioners and commissioners alike. In recent years a growing requirement for rapid evidence synthesis to inform commissioning decisions about healthcare service delivery and provision of care contributed to an increasing popularity of scoping literature reviews (SLRs). Yet, comprehensive guidelines for conducting and reporting SLRs are still relatively scarce.Methods: The exemplar review used as a worked example aimed to provide a readily available, comprehensive, and user-friendly repository of research evidence for local commissioners to help them make evidence-informed decisions about redesigning East of England Children and Adolescent Mental Health Services. In conducting the review, we were broadly guided by Arksey and O'Malley's framework, however some modifications were made at different stages to better reflect the largely pragmatic objective of this review. This paper compares the methodology used with existing methodological frameworks for scoping studies, to add to the existing knowledge base.Results: We proposed the following advancements to the existing SLR frameworks: (i) Assemble a research team with complementary skills and expertise; (ii); Draw on expertise of external partners, particularly practitioners, decision-makers and commissioners who will be translating findings into practice; (iii) Pre-register the review protocol. Keep a detailed record of all steps and decisions and consider how they would impact on generalisability and utility of review findings; (iv) Use systematic procedures for literature searchers, selection of studies, data extraction and analysis; (v) If feasible, appraise the quality of included evidence; (vi) Be transparent about limitations of findings.Conclusions: Despite some methodological limitations, scoping literature reviews are a useful method of rapidly synthesising a large body of evidence to inform commissioning and transformation of CAMHS. SLRs allow researchers to start with a broader questions, to explore the issue from different perspectives and perhaps find more comprehensive solutions that are not only effective, but also accounted for their feasibility and acceptability to key stakeholders. [ABSTRACT FROM AUTHOR]

The article tackles the speech of England's Care Services Minister Paul Burstow on children's mental health problem. It notes that Burstow encouraged the reforms of Great Britain's National Health Service (NHS) as he sets out the government's plans to complete the nationwide roll-out of the Improving Access to Psychological Therapies (IAPT) programme. It also mentions his suggestion on the funding availability of the mental health services for children.